Patients and clinicians alike have welcomed the news that a targeted combination treatment is now available through the PBS as a first line therapy for Chronic Lymphocytic Leukaemia (CLL).

The Federal Minister for Health, The Hon. Greg Hunt MP, recently announced that CLL patients unsuitable for standard chemotherapy-based treatments will now have affordable access to venetoclax in combination with obinutuzumab.

Mr Robert Richards, 65, was diagnosed with CLL in 2001 and is now being treated with venetoclax at the Peter MacCallum Cancer Centre in Melbourne.

“What started as a regular lunch-break walk ended up in a visit to my GP, and a diagnosis of CLL”, he told HealthTimes.

“Chemotherapy was the first treatment option for me and it did work. However, after 6 years the CLL came back. I have now been on venetoclax for the past 12 months and it is working great for me.”

“I think having access to novel and, more importantly, reasonably-priced treatment options are crucial to CLL patients in Australia. It just gives us a whole new range of choices”, Mr Richards said.

Leukaemia Foundation General Manager of Blood Cancer Partnerships, Tim Murphy, said that while conventional chemotherapy is often the starting point for CLL treatment, there has been a strong unmet need for access to additional first-line treatment options for this blood cancer.

“Unfortunately some CLL patients are unfit for chemotherapy or struggle tolerating its side effects, and it is crucial that these Australians have an accessible and affordable alternate option available to them as they undertake what can be a lengthy blood cancer journey.”

While CLL is a relatively rare type of cancer, it is the most common type of leukaemia diagnosed in Australia. Currently, 1,875 Australians are diagnosed with CLL each year, however this figure is projected to reach 3,800 by 2035.

The number of Australians losing their life to this blood cancer each year is also expected to more than triple during this time, from 306 Australians annually in 2020 to 1109 in 2035.

Professor Stephen Opat, Consulting Haematologist at Melbourne Haematology and Director of Clinical Haematology at Monash Health, described venetoclax therapy for CLL as a targeted, chemo-free treatment which taps into the body’s biological processes.

“There is a natural process called apoptosis that the body uses to remove damaged or unrequired cells”, he told HealthTimes.

“The main problem with tumour cells in CLL is that they don't die – they’re immortalised, accumulate and cause disease. And this drug tips the balance in favour of cell death.”

Previously, the treatment was only available for patients with relapsed CLL who had already received primary therapy.

“But this listing now means that the patients who are older, with comorbidities, and are unsuitable for intense chemotherapy can receive this drug in combination with the antibody, obinutuzumab”, Professor Opat explained.

“This is based on the results of the CLL14 Trial. While there is no difference in survival of patients at this point – the follow up is still short – there are much deeper responses, and these sorts of responses really weren’t available before to older patients with CLL.”

“The treatment offers older patients a high level of disease control, molecular remission, and this is associated with prolonged periods of disease control.”

Mr Murphy added that as a daily, orally-administered treatment, older patients can mostly take the drug at home.

“Venetoclax in combination with obinutuzumab is an effective and relatively unobtrusive option for these patients which avoids the debilitating side effects they would otherwise face with chemotherapy-based therapies, thereby improving their quality of life and simplifying access to the treatment they need.”

Professor Opat said that unlike conventional chemotherapy, where there is a pronounced link between efficacy and toxicity, targeted venetoclax can be given as a very strong treatment with a much better side effect profile.

“When I started as a haematologist training in the 80s, we only had two chemotherapy drugs; chlorambizil and fludarabine.”

“If you were young and fit, you got fludarabine, while older patients got chlorambizil. One was stronger IV chemotherapy and the other was in tablet form.”

Professor Opat said it had been encouraging to see the evolution and improvement in CLL treatments over the last 20 years.

“Before, you would treat people and the disease might go away 12 months and then you’d treat them again, but eventually the disease would be resistant, and the patient would die from disease.”

“Sequentially over the time, there’s been really been good news for our patients with better treatments, much better responses, and much less toxicity.”