First-line therapy for chronic lymphocytic leukemia

The most common treatments used as first-line therapy for chronic lymphocytic leukemia (CLL) are targeted therapy and chemoimmunotherapy.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. Chemoimmunotherapy combines chemotherapy with monoclonal antibodies, which are a type of targeted therapy. Chemotherapy uses drugs to destroy cancer cells.

Your healthcare team will suggest treatments based on the molecular characteristics of the CLL cells. Your age and your overall health may also matter. What you want will also be important when planning your treatment.

First-line therapy if you have CLL that has a 17p chromosome deletion (the short arm "p" of chromosome 17 is missing) or a TP53 gene mutation (the TP53 gene has mutated, or changed) is usually targeted therapy.

The most common targeted therapy drugs that are offered are:

• acalabrutinib (Calquence)
• ibrutinib (Imbruvica)
• VO – venetoclax (Venclexta) and obinutuzumab (Gazyva)

First-line therapy if you have CLL that doesn't have a 17p chromosome deletion or a mutation to the TP53 gene is targeted therapy or chemoimmunotherapy. Your healthcare team's recommendation will depend on whether the IGHV gene is unmutated or mutated, your age and overall health.

If the IGHV gene is unmutated (the IGHV gene has not changed) and you are younger than 65 years old and in good overall health, you will be offered targeted therapy for first-line therapy. The targeted therapy drug or drug combinations include:

• acalabrutinib (Calquence)
• ibrutinib (Imbruvica)
• VO – venetoclax (Venclexta) and obinutuzumab (Gazyva)

These targeted therapy drugs may not be covered by all provincial or territorial health plans.

If the IGHV gene is unmutated and you are older than 65 or your overall health is poor, you will be offered targeted therapy for first-line therapy. The targeted therapy drug or drug combinations are:

• acalabrutinib (Calquence)
• VO – venetoclax (Venclexta) and obinutuzumab (Gazyva)

These targeted therapy drugs may not be covered by all provincial or territorial health plans.

Find out more about targeted therapy for CLL.

If the IGHV gene is mutated and you are younger than 65 years old and in good overall health, the most common first-line therapy is FCR, which is a type of chemoimmunotherapy. This combines fludarabine (Fludara), cyclophosphamide (Procytox) and rituximab (Rituxan and biosimilars).

Another treatment option that you may be offered is VO, which is a combination of 2 targeted therapy drugs called venetoclax (Venclexta) and obinutuzumab (Gazyva).

If the IGHV gene is mutated and you are older than 65 or your overall health is poor, the first-line therapy is either targeted therapy or chemoimmunotherapy.

The most common targeted therapy drugs are:

• VO – venetoclax and obinutuzumab
• acalabrutinib (Calquence) (may not be covered by all provincial or territorial health plans)

The most common chemoimmunotherapy drug combinations are:

• BR – bendamustine (Treanda, Benvyon, Esamuze) and rituximab (Rituxan and biosimilars)
• obinutuzumab and chlorambucil (Leukeran)

You may be asked if you want to join a clinical trial for CLL. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don't work anymore, they're not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can't have or don't want cancer treatment.

Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.