Revolutionizing Adult Leukemia Treatment With Targeted Therapies
Treatment Options New treatments provide CLL patients with more manageable options.
For Lewis Backler, a positive attitude has always been the key to success. The retired clothing manufacturer from Montreal credits this outlook for much of his good fortune in life, but it received a true test when he was diagnosed with chronic lymphocytic leukemia (CLL) at the age of 66.
“Back in late 2008, I noticed some lumps in my neck while shaving,” says Backler. “My brother being a doctor, I stopped by his office one day to check it out. Within minutes, by touching my neck, he said to me: ‘I think you have CLL and I will refer you to an oncologist.’ You hear the word oncologist and you immediately think cancer. Your life changes in a moment.”
Leukemia is often thought of as a disease that primarily affects children, but the median age of those diagnosed with CLL is 72. It’s the most common type of leukemia in adults, and its behaviour is very different from acute leukemias. “It really has more in common with indolent lymphoma (a cancer of the lymph nodes),” explains Dr. John Kuruvilla, a hematology and lymphoma specialist at the Princess Margaret Cancer Centre in Toronto. “All the biologic characteristics are very different from other leukemias, and the treatment populations can be very different.”
Watch and wait
Patients with CLL are often put on a “watch and wait” program, wherein the cancer is simply monitored, and some will never need treatment. For those whose cancers develop more aggressively, the standard front line treatment is chemotherapy, which can often put the disease into remission. This was exactly what happened in Backler’s case. But then, in 2014, the cancer came back, and his oncologist decided that the best option was a clinical trial for one of several new targeted therapies that were shaking up the world of CLL treatment.
“When I first started out in medicine, there were no treatments that had been demonstrated to improve survival for people with CLL, and now we have treatments that are both effective and easy to tolerate,” says Dr. Kuruvilla. “These newer, novel therapies are still early on in their development. Studies have been done in the relapse setting and there are some early results in the front line setting. The targeted therapies look so promising right now in the relapse setting that we imagine they might rewrite the standard of care when they get to the front line setting.”
Normal as normal could be
Backler’s therapy consisted of an oral agent that selectively binds to and inhibits the BCL-2 protein that normally prevents cancer cells from dying. “By preventing BCL-2 from doing its job, the drug causes cell death in cancer cells while leaving healthy cells untouched,” says Dr. Kuruvilla. “This unique mechanism of action provokes a deep response in difficult-to-treat CLL patients and offers a new tool for fighting this chronic cancer.”
For Backler, this treatment was profoundly successful, and now he is back to living life to the fullest. “We are now two years and nine months into the trial, and life is normal as normal could be,” he says. “I do what I want to do, spend time with my grandchildren, and enjoy all the same leisure and physical activities that I always did. I golfed 80 times last year and I walked the course most of the time.”
And Backler’s positive attitude is as intact as ever. He is adamant that it played a big role in his recovery. His primary piece of advice for other patients with CLL is simple and sunny: “Accept what is... Let go of what was... Have faith in what will be!”