CLL Treatment: Newer Drug More Effective | News | Loyola Medicine
Monday, January 14, 2019

Leukemia Study Represents "Paradigm Change" in Treatment of Chronic Lymphocytic Leukemia

Patient taking pills

MAYWOOD, IL – A landmark study co-authored by a Loyola Medicine oncologist has found that a newer targeted drug is significantly more effective than standard therapy for treating elderly patients with chronic lymphocytic leukemia (CLL).

The drug, ibrutinib, also has fewer side effects and is more convenient than the standard treatment, the study found. Loyola oncologist Scott Smith, MD, PhD is among the senior authors of the study, published in the New England Journal of Medicine.

"This represents a paradigm change in how we will treat elderly patients with CLL," Dr. Smith said. "Ibrutinib should become the new standard of care."

Dr. Smith is a professor in the division of hematology/oncology, department of medicine of Loyola Medicine and Loyola University Chicago Stritch School of Medicine. He was executive officer of the Alliance for Clinical Trials in Oncology, which coordinated the study, and was responsible for the execution of the study.

CLL, a disease of the immune system, is the most common form of leukemia in adults. It affects mainly older adults, with the average age of diagnosis around 70. The risk is higher in men.

Until now, the standard treatment has been a combination of a chemotherapy drug (bendamustine) that kills cancer cells and an immunotherapy drug (rituximab) that suppresses the immune system. The regimen requires a patient to come in three times a month for infusions and an injection.

A newer treatment involves ibrutinib. The targeted drug attacks cancer cells without damaging normal cells, thus causing fewer side effects. Ibrutinib works by blocking signals that stimulate cancer cells to grow uncontrollably. The regimen requires a patient to simply take a pill once a day.

The study enrolled 547 CLL patients (67 percent male) at 219 centers in the United States and Canada. All were older than 65, with a median age of 71. Researchers randomly assigned patients to receive one of three regimens: the standard treatment of bendamustine plus rituximab; ibrutinib alone; or ibrutinib plus rituximab. After two years, 87 percent of patients receiving ibrutinib alone were alive without any disease progression, compared with 74 percent of patients who received bendamustine plus rituximab. There was no significant difference between patients receiving ibrutinib alone and those receiving ibrutinib plus rituximab.

About 17 percent of patients who received ibrutinib alone experienced an irregular heartbeat called atrial fibrillation. But overall, the drug caused fewer side effects than the standard treatment, Dr. Smith said.
Additional studies of ibrutinib are underway in CLL patients younger than 65, Dr. Smith said.

The study is titled "Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL." First author is Jennifer Woyach, MD, of Ohio State University.

As an academic medical center, Loyola is able to offer hundreds of cancer clinical trials, giving patients access to many new cancer drugs and therapies that are not available at most hospitals. Therapies under study at Loyola include targeted therapy, immunotherapy and new forms of surgery, chemotherapy and radiation.

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 94 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 133,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.