A combination of targeted drugs, offering a chemotherapy-free approach to leukaemia, have been hailed a “milestone” in cancer care by scientists following a groundbreaking UK trial.
Potentially offering better outcomes for some patients as well as being more tolerable, it could reshape the way chronic lymphocytic leukaemia (CLL) – the most common form of leukaemia in adults – is treated.
The Flair trial took place at 96 cancer centres across the UK.
Researchers from Leeds wanted to assess whether two targeted cancer drugs could perform better than standard chemotherapy among patients with CLL.
Some 786 people with previously untreated CLL were randomly assigned to receive standard chemotherapy; a single targeted drug, ibrutinib, or two targeted drugs taken together, ibrutinib and venetoclax, with treatment guided by personalised blood tests.
Ibrutinib is a type of drug known as a cancer growth blocker. It works by stopping signals that cancer cells use to divide and grow.
Venetoclax blocks the functions of a protein found in CLL cells.
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Researchers found that after five years, 94% of patients who received ibrutinib plus venetoclax were alive with no disease progression.
That compared with 79% for those on ibrutinib alone and 58% for those on standard chemotherapy, according to the study, which has been published in the New England Journal of Medicine and presented to the European Haematology Association congress in Milan, Italy.
Meanwhile 66% of patients on the new combination had no detectable cancer in their bone marrow after two years, compared with none of the people who received ibrutinib alone and 48% on chemotherapy.
Experts said that the new treatment regime was also tolerated better than traditional treatments.
‘An era of truly personalised medicine’
Dr Talha Munir, consultant haematologist at Leeds Teaching Hospitals NHS Trust, who led the study said: “Flair trial is a milestone.
“We have shown that a chemotherapy-free approach can be not only more effective but also more tolerable for patients.
“By tailoring individualised treatment based on how well the cancer responds, we’re moving into an era of truly personalised medicine.”
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Catherine Whitfield, 63, from Farnley, West Yorkshire, was diagnosed with CLL in 2018 after she noticed symptoms including bleeding gums, constant illness and neck pain.
She signed up to the trial, which was coordinated by the Leeds Cancer Research UK Clinical Trials Unit at the University of Leeds and sponsored by the University of Leeds.
She said: “After three years of treatment, I am still MRD negative – that means no cancer cells.
“I lost my husband to cancer. I have seen how hard it could be.
“My first thought after my diagnosis was, I will never see my grandchildren being born and growing up.
“Now I have two grandchildren, Drew and Alaia, and they are a delight and highlight the joys of a healthy life.”
‘Kinder, more targeted treatment’
Ms Whitfield added: “The way this trial was explained, it just made sense.
“Also, the thought of chemotherapy was scary to me. The trial felt right. And it was.”
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Dr Iain Foulkes, executive director of research and innovation at Cancer Research UK, which funded the trial along with AbbVie, and Johnson and Johnson, said: “The results of the Flair trial show that we can provide kinder, more targeted treatment for chronic lymphocytic leukaemia, which gives people with CLL more precious time with their loved ones.
“We’re hopeful that the results of the Flair trial will power new treatment options for leukaemia and other blood cancers, thanks to the efforts of researchers in Leeds and across the UK working together on this trial.”
CLL is the most common form of leukaemia in adults, affecting the blood and bone marrow.
While it cannot usually be cured, it can be managed with treatment.
There are around 4,000 new CLL cases in the UK every year.
