VIII. Treatment of chronic lymphocytic leukaemia, where are we heading?

The past year has seen enormous changes in the treatment of chronic lymphocytic leukaemia (CLL), partly based on the approval of several new molecules. In fact, the American Society of Clinical Oncology (ASCO) named CLL therapies the ‘the Cancer advance of the year’ in its annual report of January 2015. This was the first time that ASCO singled out a particular advance in cancer treatment in its annual report. There were four new therapies approved for the treatment of CLL in 2014 (Figure 1). The four new therapies include two immunotherapies, ofatumumab and obinutuzumab, as well as two targeted agents, idelalisib and ibrutinib. Both immunotherapies are anti-CD20 monoclonal antibodies, and both have been approved in combination with chlorambucil for previously untreated patients with advanced CLL requiring therapy. The other drugs are oral agents and are both B-cell receptor inhibitors. Idelalisib is a PI3K delta inhibitor approved in combination with rituximab for patients with relapsed/refractory CLL. Ibrutinib is a Bruton’s tyrosine kinase (BTK) inhibitor approved for relapsed patients with CLL as well as for frontline therapy of patients with CLL and a 17p deletion. All four of these drugs have been approved in both the USA and Europe.