INITIATING VENCLEXTA1
When you’re ready to start VENCLEXTA, here is information to help you assess, prep, and initiate your patients. VENCLEXTA can cause rapid reduction in tumor and thus poses a risk for tumor lysis syndrome (TLS). The 3-step initiation protocol is designed to help reduce the risk of TLS.
TUMOR BURDEN
Perform tumor burden assessment, including radiographic evaluation (eg, CT scan). The risk of TLS may decrease as tumor burden decreases.
TUMOR BURDEN
| LOW | MEDIUM | HIGH | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
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BLOOD CHEMISTRY ASSESSMENT
Assess blood chemistry and correct preexisting abnormalities prior to initiation of treatment.
- Potassium
- Phosphorus
- Creatinine
- Uric acid
- Calcium
MEDICATION RECONCILIATION
Determine if your patient is currently taking any of the following, which may require VENCLEXTA dose modifications:
- Posaconazole or other strong CYP3A inhibitor
- Moderate CYP3A inhibitor
- P-gp inhibitor
ADDITIONAL CONSIDERATIONS
Consider all patient comorbidities before final determination of prophylaxis and monitoring schedule.
- Renal function
- Splenomegaly
- Other patient comorbidities
ALC=absolute lymphocyte count; CT=computed tomography; CYP3A=cytochrome P450 3A; LN=lymph node; P-gp=P-glycoprotein.
At least 2 days prior to the first dose:
HYDRATION
TUMOR BURDEN
| LOW | MEDIUM | HIGH | ||||||
|---|---|---|---|---|---|---|---|---|
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ANTI-HYPERURICEMICS
TUMOR BURDEN
| LOW | MEDIUM | HIGH | |||||
|---|---|---|---|---|---|---|---|
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*1.5 to 2 L (~56 oz) of water should be consumed every day starting at least 2 days before the first dose and throughout the ramp-up phase, especially the first day of each dose increase. Administer IV hydration for any patient who cannot tolerate oral hydration.
†Start allopurinol or xanthine oxidase inhibitor 2 to 3 days prior to initiation of VENCLEXTA.
IV=intravenous.
Monitor blood chemistry*† for first dose of each ramp-up week.
LOW Tumor Burden OR MEDIUM Tumor Burden
OUTPATIENT
DAY 1, WEEK
1
2
3
4
5
Dosage
20 mg
50 mg
100 mg
200 mg
400 mg
Blood chemistry labs
Pre-dose
6 to 8 hrs
24 hrs
For the first doses of 20 mg and 50 mg, consider hospitalization for patients with medium tumor burden and CLcr <80 mL/min; for these patients, see table on the right for monitoring in hospital.
HIGH Tumor Burden
HOSPITAL
OUTPATIENT
DAY 1, WEEK
1
2
3
4
5
Dosage
20 mg
50 mg
100 mg
200 mg
400 mg
Blood chemistry labs
Pre-dose
4 hrs
8 hrs
12 hrs
24 hrs
*Evaluate blood chemistries (potassium, uric acid, phosphorus, calcium, and creatinine); review in real time.
†For patients at risk of TLS, monitor blood chemistries at 6 to 8 hours and at 24 hours at each subsequent dose ramp-up.
CLcr=creatinine clearance.