The shrinking role of chemotherapy in the treatment of chronic lymphocytic leukemia.

The therapeutic landscape of chronic lymphocytic leukemia (CLL) has changed significantly since the first targeted therapy, rituximab, was approved for the treatment of symptomatic patients. Areas covered: Multiple monoclonal antibodies (mAbs) and small molecule inhibitors (SMIs) that target the B-cell receptor (BCR) and BCL-2 pathways are now approved treatments for CLL patients. Recent and emerging clinical data investigating the use of targeted therapies in the treatment of CLL patients will be reviewed. The changing role of cytotoxic chemotherapy in the treatment of the CLL patient as a result of the increasing availability of novel targeted therapies will be discussed. Expert commentary: Use of novel therapies is progressively shifting much of the treatment of CLL patients towards a targeted therapeutic approach. Increasing availability of targeted agents such as SMIs will likely reduce the role of cytotoxic chemotherapy in the treatment of both front-line and relapsed/refractory CLL patients.