How it is administered

Venetoclax is taken by mouth as a tablet. It is available in strengths of 10 mg, 50 mg, and 100 mg. The tablets should be swallowed whole with a meal and water, and should not be chewed, crushed, or broken.

For chronic lymphocytic leukemia (CLL), venetoclax is started with a 5-week ramp-up schedule to gradually increase the dose and reduce the risk of tumor lysis syndrome. The typical schedule is:

• Week 1: 20 mg once daily
• Week 2: 50 mg once daily
• Week 3: 100 mg once daily
• Week 4: 200 mg once daily
• Week 5 and beyond: 400 mg once daily

Venetoclax may be given alone or in combination with other medications such as obinutuzumab or rituximab.

How it works

Venetoclax is a targeted therapy known as a BCL-2 inhibitor. BCL-2 is a protein that helps cancer cells, especially those in CLL, survive longer than they should by preventing a natural process called apoptosis (programmed cell death). Many CLL cells have high levels of BCL-2, which makes them resistant to standard treatments.

Venetoclax works by selectively binding to the BCL-2 protein and blocking its function. This action releases pro-apoptotic proteins, which then trigger the cancer cell's own death mechanism. By restoring the process of apoptosis, venetoclax helps to reduce the number of cancer cells in the body. This targeted approach makes venetoclax effective in treating CLL and certain other blood cancers, especially in patients whose disease has not responded to other treatments.

Who Should take it

Venetoclax is indicated for adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). It can be used as a single agent or in combination with other therapies such as obinutuzumab (for previously untreated CLL) or rituximab (for previously treated CLL).

Venetoclax may also be used in combination with other medications for certain types of acute myeloid leukemia (AML) in adults who are 75 years or older, or who have other health conditions that prevent them from receiving intensive chemotherapy. Your doctor will determine if venetoclax is appropriate for you based on your specific diagnosis and medical history.

Who should not take it

Venetoclax should not be taken by patients who are currently using strong CYP3A inhibitors (such as certain antifungals or antibiotics) at the start of treatment and during the initial dose ramp-up phase, as this can increase the risk of dangerous side effects like tumor lysis syndrome.

It is also not recommended for use in pregnant women, as it may cause harm to an unborn baby. Women who are breastfeeding should not use venetoclax. Live vaccines should not be given before, during, or after treatment with venetoclax until your immune system has recovered. Always inform your healthcare provider about all medications and supplements you are taking before starting venetoclax.

Commonly used with

Venetoclax is commonly used in combination with other medications for CLL, such as:

• Obinutuzumab (for previously untreated CLL)
• Rituximab (for previously treated CLL)

It may also be used with azacitidine, decitabine, or low-dose cytarabine for certain types of AML. Your doctor will decide the best combination based on your specific condition.

Commonly tested with

Venetoclax has been tested in clinical trials with:

• Obinutuzumab
• Rituximab
• Azacitidine
• Decitabine
• Low-dose cytarabine

These combinations have been studied to improve outcomes in patients with CLL, SLL, and AML. Your healthcare team may recommend additional tests and monitoring while you are taking venetoclax to ensure safety and effectiveness.