Targeted cancer drugs and immunotherapy for acute lymphoblastic leukaemia (ALL)
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the 
to attack the cancer. They are called immunotherapies. CAR T-cell is a type of immunotherapy you might have to treat ALL.
Targeted cancer drugs
Cancer cells have changes in their genes that make them different from normal cells. These changes mean that they behave differently. Cancer cells can grow faster than normal cells and sometimes spread. Targeted cancer drugs work by ‘targeting’ those differences that a cancer cell has.
There are different types of targeted cancer drugs and they work in different ways. For ALL, you might have:
- tyrosine kinase inhibitors or TKIs
- monoclonal antibodies or MABs
Tyrosine kinase inhibitors (TKIs)
The main type of targeted cancer drug used for ALL is tyrosine kinase inhibitors or TKIs. They block signals from a protein (enzyme) called tyrosine kinase. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing.
You might have TKIs if you have a type of ALL called Philadelphia positive ALL (Ph+ ALL). About 20 to 30 out of every 100 people with ALL (about 20 to 30%) have this type.
The human body is made up of trillions of cells. Inside each cell is a nucleus and within the nucleus are the cell’s chromosomes. There are 23 pairs in total.
Chromosomes are made up of DNA, which gives the instructions that tell a cell what to do. Sections of DNA are called genes. They carry the information that makes you you. For example, they tell your body what colour your hair will be or what colour your eyes will be.
Genes also tell your cells when to divide and grow, and when to die.
When cells divide to make new cells, they make exact copies of the chromosomes.
In Philadelphia chromosome positive leukaemia an abnormal change happens to chromosomes 9 and 22. Part of chromosome 9 breaks off where the gene ABL1 is located and part of chromosome 22 breaks off where the BCR gene is located. The broken parts swap places creating a new gene on chromosome 22.
This new chromosome is called the Philadelphia chromosome and the new gene is called BCR-ABL1. This new gene tells the cell to make a large quantity of a protein called tyrosine kinase which encourages leukaemia cells to grow.
There are targeted cancer drugs that can block the protein and stop the leukaemia from growing. These drugs are called tyrosine kinase blockers. You take them as tablets.
For more information about your type of leukaemia and treatments go to CRUK.org/about-cancer/leukaemia.
You most often have a TKI called imatinib. You take it as a tablet. You usually have it alongside chemotherapy once a day for the whole of treatment.
You might have a different TKI if the ALL comes back, such as:
-
dasatinib
-
ponatinib
We have specific information about each of these drugs on our cancer drugs A to Z list
Monoclonal antibodies (MABs)
In ALL, monoclonal antibodies work by recognising and finding specific proteins on leukaemia cells. For example, the protein CD20.
This helps the immune system to find and destroy the leukaemia cell.
Rituximab
You might have a monoclonal antibody called rituximab if you have a type of ALL called precursor B cell ALL, which is CD20 positive. You have this with chemotherapy.
Blinatumomab
You may have blinatumomab if you have precursor B cell ALL which is CD19 positive. You might have this drug at different points during your treatment. Your healthcare team can talk about this more with you.
Inotuzumab ozogamicin
You may have inotuzumab if you have precursor B cell ALL which is CD22 positive. You might have this drug if your leukaemia has come back or is not responding to treatment.
You have these monoclonal antibodies through a drip into your bloodstream (intravenously).
Immunotherapy
CAR T-cell therapy is the main type of immunotherapy used for ALL treatment.
When might I have CAR T-cell therapy?
CAR T-cell therapy is a type of immunotherapy for some people with a type of ALL called B cell ALL. You might have CAR T-cell therapy if you have:
- ALL that has come back after treatment (relapsed)
- ALL that is no longer responding to treatment (refractory)
Some people have CAR T-cell therapy as part of a clinical trial.
How does CAR T-cell therapy work?
White blood cells are an important part of your immune system. They help your body fight infection and other diseases, including cancer. T cells are a type of white blood cell. Their job is to move around your body, finding and destroying abnormal cells, like those from infections or diseases. When the cells find a new infection or disease, your body makes T cells to fight these abnormal cells.
Leukaemia cells are good at hiding from T cells, so scientists are trying to find ways to get T cells to recognise the leukaemia cells. One possible way to do this is CAR T-cell therapy.
With this treatment, a specialist team take a sample of T cells from your blood. This process is called apheresis (pronounced a-feh-ree-sis).
The T cells are then sent to the laboratory. In the laboratory, they change the T cells. You might hear this called genetically engineering the T cell. The T cell is now a CAR T-cell. CAR stands for chimeric antigen receptor. These CAR T-cells are designed to recognise and target a specific protein on the leukaemia cells.
These changed T cells grow and multiply in the laboratory. Once there are enough T cells you have a drip containing these cells back into your bloodstream. The aim is for the CAR T-cells to then find and attack the leukaemia cells.
Side effects
Everyone is different and the side effects vary from person to person. The side effects you have depend on:
- which drug you have
- whether you have it alone or with other drugs
- the amount of drug you have (the dose)
- your general health
A side effect may get better or worse during your course of treatment. Or more side effects may develop as the treatment goes on. For more information about the side effects of your treatment, go to the individual drug pages.
Research into targeted drugs and immunotherapy for ALL
There is lots of research for ALL in the UK. Researchers are looking at:
- new targeted cancer drugs
- different combinations of these drugs with other treatments
