Mayo Clinic researchers say they have moved closer to their goal of providing personalized care for a common blood cell cancer.
They have found that the use of predictive biomarkers along with two targeted treatments significantly delays the need for conventional chemotherapy in patients with early-stage, but high-risk, chronic lymphoid leukemia (CLL).
Their study, published Oct. 15 in the journal Cancer, found that in a small group of patients the use of the new tools delayed the need for standard chemotherapy treatment to about four years after cancer diagnosis. Typically, people with this kind of high-risk CLL require chemotherapy at about two years after diagnosis.
Because this was a small phase II study, the researchers cannot yet say that this strategy will improve the quality or duration of life for patients. However, they say that because of these promising findings, all CLL patients at Mayo Clinic now undergo the predictive tests, whose results can be used to risk-stratify therapy, including enrollment in ongoing experimental treatments if appropriate.
The two targeted therapies studied, alemtuzumab and rituximab, are widely used in advanced-stage CLL. Both are monoclonal antibodies that produce an immune response against the cancer cells.
"This is the first publication of a study on CLL in which patients were selected for early treatment of their disease based on molecular prognostic markers, and it is also the first one to test a combination of targeted therapies in a group of patients who would not ordinarily be treated yet," says the study's lead investigator, Mayo hematologist Clive Zent, M.D.
"The standard of care for these patients is to watch and wait until patients develop more advanced disease and then to treat them with chemotherapy and monoclonal antibodies," he says. "We believe this new approach is better for patients because it identifies those who will develop aggressive CLL sooner than later and helps delay need for more toxic treatments.
"While this is a novel concept in the field of CLL treatment, we think it moves us toward the day when we can treat all patients uniquely, based on the characteristics of their individual cancer."
CLL is the most common malignancy of lymphocytes. Annually, in the United States, it is diagnosed in more than 15,000 people and results in almost 5,000 deaths. CLL is a cancer of B-lymphocytes, infection-fighting white blood cells that originate in the bone marrow. The disease progresses as the number of lymphocytes increases in bone marrow and lymph nodes and can cause patients to become ill. The rate of progression varies among patients, according to Dr. Zent. "We know that roughly one-third of patients will need treatment within two years of diagnosis, one-third will need treatment at some point in the future, and the remaining one-third of patients will never need treatment and will not die of their disease," he says.