Magic pills: new oral drugs to treat chronic lymphocytic leukemia

Abstract

Introduction: A deeper understanding of chronic lymphocytic leukemia (CLL) biology has led to the identification of new promising therapeutic targets. Different classes of molecules are currently under investigation and novel oral drugs have recently been approved or are in a late stage of clinical development. Areas covered: We present biological data illustrating the heterogeneous mechanisms of action of new oral drugs in CLL. Moreover, we provide clinical data from phase I to III studies, and discuss efficacy and side effects profile of these new therapies. Data are derived from peer-reviewed articles indexed in PubMed and from abstracts presented at major international meetings. Expert opinion: Novel oral drugs represent a valuable alternative to chemo-immunotherapy for patients with CLL, especially when high-risk disease features are present and when age or comorbidities preclude the use of standard treatments. Based on data from ongoing clinical trials, the indications of already approved agents will most likely be expanded and new options will soon be available. Moreover, treatment combinations will broaden the therapeutic armamentarium of physicians treating CLL. The availability of multiple choices is of benefit for patients with CLL, but also represents a challenge for the need of choosing the right drug for each patient. ARTICLE HISTORY

Ibrutinib-Associated Nail Plate Abnormalities: Case Reports and Review

“…Chronic lymphocytic leukemia is hematologic malignancy of B-lymphocytes. It is one of the most common leukemias diagnosed in adults [ 1 , 5 – 7 ]. It primarily presents in older individuals; 70% of patients are aged > 65 years at the time of diagnosis [ 1 , 5 – 7 ].…”

“…A diagnosis of chronic lymphocytic leukemia should be considered in the presence of unexplained absolute or relative lymphocytosis [ 1 , 5 – 7 ]. The clinical course of chronic lymphocytic leukemia is variable.…”

“…The first-line treatment for patients with chronic lymphocytic leukemia often includes a combination of chemotherapy agents and immunotherapy (anti-CD20 monoclonal antibody) [ 1 – 3 , 5 – 7 , 9 , 10 ]. However, the age and comorbidities of the individuals being treated often limit the applicability of these standard treatments.…”

“…However, the age and comorbidities of the individuals being treated often limit the applicability of these standard treatments. [ 1 , 2 , 5 – 7 , 11 ]. Ibrutinib is a new drug for the treatment of patients with chronic lymphocytic leukemia.…”

“…Ibrutinib, a tyrosine kinase inhibitor, is a novel therapy for chronic lymphocytic leukemia; it is typically dosed at 420 mg orally once daily. Tyrosine kinase is a cytoplasmic enzyme that is essential for B-lymphocyte survival; it is involved in the regulation of trafficking, homing and adhesion of chronic lymphocytic leukemia cells [ 1 – 4 ]. We describe two patients with chronic lymphocytic leukemia who developed nail plate abnormalities after initiating therapy with ibrutinib.…”