Tumor: therapies without chemo: the last frontier that gives hope

New laboratory techniques have made many forms of cancer more treatable: this is the case of chronic lymphocytic leukemia

Tumor: Advances in research have made many forms of cancer increasingly treatable. Those of the blood, in particular, have made epochal progress in recent years, with the so-called target therapies, which often sent chemotherapy to the attic. A paradigmatic example is given by chronic lymphatic leukemia (CLL), also called in the elderly, because it is usually diagnosed around the age of 70.

In Italy, there are 2,500-3,000 new cases per year, especially among men, twice as many as among women. CLL affects mature B lymphocytes, which is why it is a chronic form (acute ones affect immature lymphocytes). 

To shed light on this condition and other onco-hematological pathologies, Janssen Oncology organized the awareness campaign Giving voice to the future, sponsored by AIL, the Italian association against leukemia-lymphomas and myeloma. “We accepted Janssen’s invitation to sponsor this campaign, says Luisa Clausi Schettini, director of Ail Roma Adv for a future that puts scientific research ever more in the foreground”

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Tumor: In half of the cases, explains Professor Luca Laurenti, head of the Simple Operative Unit Chronic Lymphatic Leukemia, Hematology Division of the Gemelli Polyclinic Foundation, the LLC is discovered by chance during routine blood tests.

The alarm bell is an increase in lymphocytes in the blood count. The good news is that once diagnosed this form of leukemia does not always need treatment, because it evolves indolently.

Tumor: In a third of cases, the patient will never have to undergo therapy, in another third of cases he will do the therapy later in life and in the remaining cases he will start it immediately after the diagnosis “.

Tumor: When the disease gives symptoms

these are typical of lymphoproliferative diseases, such as lymphoma. The patient may present with weight loss, profuse sweating, fever, especially in the evening, and itching. He may also notice a widespread increase in the volume of the lymph nodes in the neck, armpits, and groin.

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Tumor: For the diagnosis, Laurenti continues, a complete blood count and a smear of peripheral blood are usually enough. Flow cytometry helps us name the lymphocytes and ascertain that these lymphocytes are sick with CLL.

A chest X-ray is also performed to rule out the presence of problems in the mediastinum (the part of the chest between the two lungs) and an ultrasound of the abdomen to study the spleen, liver, and lymph nodes. “

Tumor: It is generally not necessary, at least initially, to do a bone marrow aspirate or a total body CT scan. “In the event that the patient has to start therapy, Professor Laurenti adds, second-level tests are performed (the search for the deletion of chromosome 17p or a TP53 mutation or abnormalities of the IGHV immunoglobulin heavy chain) which give information on the prognosis and response to any therapies “.


The therapy of CLL in the last 7-8 years has completely changed with the arrival of targeted therapies, which have made it possible to abandon chemotherapy. «The founder of these drugs, Laurenti remembers, was ibrutinib (BTK inhibitor), a tablet drug that inhibits a receptor present on the cancer cell, thus sending it to die.

This therapy does not give the typical toxic effects of chemotherapy (reduction of platelets and white blood cells, nausea, vomiting, hair loss) and must be continued continuously, for life. After 7-8 years from the beginning of the treatment, more than half of the patients show no progression of the disease.

Tumor: Today, Laurenti continues, «we also have new target-based drugs of the latest generation, which we use in the second line in patients who show disease progression after initial treatment with ibrutinib, alone or in combination with immunotherapy (eg rituximab). These are only administered for a fixed period of time. In the future, we will try to personalize the patient’s treatment even more. The use of several target therapies together (doublets or triplets) could give a further therapeutic advantage “.

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