BETA - What are the main classes of drugs used to treat chronic lymphocytic leukemia?

What are the main classes of drugs used to treat chronic lymphocytic leukemia? So the currently approved classes of drugs for treatment of CLL include the BTK inhibitors. We have the BCL2 inhibitors. We have monoclonal antibodies, anti-CD20 positive monoclonal antibodies. The BTK inhibitors are the Bruton tyrosine kinase inhibitors. So basically if we look at why these agents, we have to look at what is wrong with the CLL cell. So in the CLL cell there's this pathway that is deranged. It's called the B cell receptor pathway. And like in all of us, this is a pathway that's present in every normal B cell. It functions normally in our case. The antigen binds to it. It does its job and then it shuts off. That's the normal job. It does its job and then shuts off and goes back to rest. But in CLL cells it's always active, always sending down these signals, proliferative signals, always setting down so cells proliferate. And there's another thing that's wrong with the CLL cells. We normally maintain a fixed number of cells in the body by a process called apoptosis, which is also called programmed cell death. Or it's also called in layman's terms cell suicide. That's how we maintain the normal amount of cells in the body. This is another thing that's deranged in CLL cells. They forget how to die. So this programmed cell death is also a deranged function in these cells. So we have the BCR receptor that's deranged and we have the apoptosis that's deranged. BCR pathway, if you look at the pathway downstream from them, are different steps. We have the BTK. We have the PI3 kinase and other steps. And at every step we can have drugs that can block that pathway. So we have Bruton-styracin kinase inhibitors that block the BTK. So we have the covalent BTK inhibitors and the non-covalent. Of the covalent we have Abrutinib, A-calabrutinib, and Xanabrutinib. And of the non-covalent we have pertabrutinib, which is FDA approved. Now looking at the programmed cell death, that's where the BCL2 inhibitor pathway comes into a role. And the only approved blocker there is the venadoclax, which blocks that pathway. And then we also have the anti-CD20 monoclonal antibodies. It's an antigen that's expressed on these CLL cells. And we have monoclonal antibodies that can bind to this antigen. We have Rituximab and we have Obinutuzumab. Obinutuzumab has been found to be better than Rituximab. And usually Obinutuzumab is used in combination with the other classes of medications, like the BCL2 inhibitor or the BTK inhibitors. So these are the major classes of drugs that we use in the clinic nowadays. Recently, we also had the first CART therapy approved for patients with CLL. CART therapy is a very special kind of treatment. It's an immune-based treatment which harnesses the patient's own immune system to attack these CLL cells. CART therapy has been approved in other cancers also. And we are excited to have it approved for CLL also. So what we do in CART therapy is that we take the patient's own T cells. T cells are part of the immune system, T lymphocytes. And then those T cells are engineered. They undergo through processing where these T cells are made to express certain B cell antigens which can identify these CLL cells. So you turn them into super T cells basically. Then these T cells are infused back into the patient. And what these T cells do is they go out and look for these B cells and destroy them, use their own immune power to destroy these B cells. And we have seen good results with this therapy also. And it's actually FDA approved for CLL. So very exciting times for treating CLL.