Ibrutinib in addition to rituximab is being developed for young and fit untreated patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL). CLL is a type of cancer in which too many white blood cells are produced. As these cells develop abnormally, they are unable to function, fight infection and reduce the production of healthy blood cells. The disease is chronic and develops slowly. Treatment for CLL is complex and depends on a number of factors, including the extent of disease, previous treatment, patient’s age, symptoms and general state of health. Patients whose CLL is not causing any symptoms or is getting worse only very slowly may not need treatment. Treatment for CLL is started only if symptoms become troublesome.
Ibrutinib works against cancerous B lymphocytes, which are a type of white blood cells affected by these diseases. It does this by blocking an enzyme called Bruton’s tyrosine kinase (BTK), which promotes survival of B lymphocytes and their migration to the organs where these cells normally divide. By blocking BTK, ibrutinib decreases the survival and migration of B lymphocytes, thereby delaying the progression of cancer. Ibrutinib is available in tablets taken orally. If licensed, ibrutinib in addition to rituximab will offer an additional first-line treatment option for untreated young and fit patients with CLL or SLL.
Pembrolizumab is an immunomodulatory medicinal product, meaning that it helps the immune system to recognise and attack cancer cells. It is administered by intravenous infusion and is currently licensed in the UK for melanoma, non-small cell lung cancer and urothelial cancer – amongst others. If licensed, pembrolizumab, in addition to chemotherapy, would offer an alternative treatment for those with advanced, recurrent or metastatic cervical cancer.