From the Guidelines
Venclexta (venetoclax) is an oral medication primarily used to treat certain blood cancers, including chronic lymphocytic leukemia (CLL), small lymphocytic lymphoma (SLL), and acute myeloid leukemia (AML) in specific patient populations, by blocking the BCL-2 protein, which helps cancer cells survive, causing them to die instead. The use of Venclexta is supported by several studies, including a phase Ib study that evaluated the combination of venetoclax with decitabine or azacitidine in older patients with previously untreated AML 1. The study found that the combination of venetoclax with decitabine or azacitidine resulted in a complete remission (CR) or complete remission with incomplete hematologic recovery (CRi) rate of 61% in patients with AML. Some key points to consider when using Venclexta include:
- The typical starting dose for CLL/SLL is 20 mg daily for one week, then gradually increased weekly to 50 mg, 100 mg, 200 mg, and finally 400 mg daily to reduce the risk of tumor lysis syndrome (TLS) 1.
- For AML, Venclexta is usually given in combination with other drugs, such as azacitidine or decitabine, and the recommended dose is 400 mg daily 1.
- Venclexta requires careful monitoring, especially during the initial dose ramp-up period, as it can cause serious side effects including TLS, which may require hospitalization during initiation 1.
- Common side effects include low blood counts, diarrhea, nausea, and fatigue, and patients should avoid grapefruit products and certain medications that interact with Venclexta 1.
- Regular blood tests are necessary throughout treatment to monitor for side effects and treatment response 1. It's also important to note that Venclexta is metabolized by CYP3A4/5, and specific attention must be paid when combined with other drugs that inhibit CYP3A, such as erythromycin, ciprofloxacin, or triazoles 1. Overall, Venclexta is a valuable treatment option for patients with certain blood cancers, and its use should be carefully considered and monitored by healthcare professionals.
From the Research
Use of Venclexta (Venetoclax)
- Venclexta (Venetoclax) is a highly selective, oral B-cell lymphoma 2 inhibitor used for the treatment of chronic lymphocytic leukemia (CLL) 2, 3, 4, 5, 6
- It is approved for the treatment of adults with relapsed or refractory CLL, including those with high-risk del(17p)/mutated-TP53 and immunoglobulin heavy variable region unmutated CLL 2, 4
- Venetoclax is also approved for the treatment of newly diagnosed acute myeloid leukemia (AML) in adults who are ≥ 75 years or have comorbidities that preclude use of intensive induction chemotherapy, in combination with azacitidine, decitabine, or low-dose cytarabine 3
- The drug has shown efficacy and safety in clinical trials, with durable responses and a manageable safety profile, including in patients with adverse prognostic factors 4, 5, 6
Administration and Management
- Venetoclax initiation carries a risk of tumor lysis syndrome (TLS), which requires prompt and appropriate management 2, 3, 5, 6
- The recommended dosing schedule involves gradual, stepwise increases in daily venetoclax dosing from 20 mg to 400 mg (target dose) over 5 weeks 2
- Key components of safe venetoclax therapy include assessment, preparation, and initiation, with monitoring of blood chemistry and adequate hydration 2
- Management of venetoclax-associated side effects, such as neutropenia and nonhematologic adverse events, is essential for optimal patient care 3, 6