title: Targeted therapies for CLL: Practical issues with the changing treatment paradigm.
abstract: Chemoimmunotherapy (CIT) such as FCR (fludarabine, cyclophosphamide, rituximab) has been the standard first-line therapy for younger patients with CLL. In the last few years, several novel targeted therapies have been developed for patients with CLL. These include B-cell receptor (BCR) inhibitors such as Bruton tyrosine kinase (BTK) inhibitors, PI3 kinase inhibitors, and Syk inhibitors, novel anti-CD20 monoclonal antibodies such as ofatumumab and obinutuzumab, and Bcl-2 antagonists such as venetoclax (ABT-199). Strategies targeting the immune system such as lenalidomide, chimeric antigen receptor (CAR) T cells, and more recently, checkpoint inhibitors, are in clinical development. Ibrutinib and idelalisib are already approved for patients with relapsed and refractory CLL. Ibrutinib is also approved for first-line treatment of CLL patients with del(17p). Several ongoing phase III clinical trials with novel therapies will further define the role of targeted agents in CLL.
authors.affiliation: Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Nitin
authors.initials: N
authors.lastname: Jain
authors.affiliation: Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, Orange, CA, USA. Electronic address: obrien@uci.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D003131:Combined Modality Therapy; D019468:Disease Management; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D058990:Molecular Targeted Therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor
keywords: Chronic lymphocytic leukemia; Ibrutinib; Idelalisib; Obinutuzumab; Targeted therapy