What is the usage and dosage of Venetoclax in Lao Da Xiong version? Scope of treatment?
Venetoclax is a BCL-2 inhibitor primarily used to treat hematological malignancies such as chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML). The dosage needs to be adjusted through a 5-week incremental plan, and the treatment scope covers various blood tumors with specific genetic abnormalities, strictly following the principle of individualized administration.
1. Standard usage and dosage
(1) CLL/Small Lymphocytic Lymphoma (SLL): The initial dose is 20mg/day, which is gradually increased to 400mg/day within 5 weeks for maintenance. It needs to be used in combination with Ottuzumab or Rituximab.
(2) AML: When used in combination with demethylating drugs, increase to 400mg/day for maintenance; When used in combination with low-dose cytarabine, it is 600mg/day.
(3) Administration method: Take orally with meals once a day, swallow the whole tablet, avoid crushing or chewing.
2. Principle of dose adjustment
(1) Risk of tumor lysis syndrome (TLS): Initial hospitalization monitoring is required, and patients with creatinine clearance rate<80ml/min need to extend the escalation period.
(2) Hematological toxicity: Suspend administration when grade 3-4 neutropenia occurs, and restart with a dose reduction of 25% -50% after recovery.
(3) Combination use of strong CYP3A inhibitors: The dosage should be reduced by 75% -90%, and avoid taking with intermediate acting inhibitors.
3. Scope of treatment
(1) FDA approved indications: 17p deletion CLL, first-line/relapsed refractory CLL, combination therapy for AML.
(2) Approved indications in China: Adult CLL/SLL and AML, requiring confirmation of CD19/CD5/CD20 positivity.
(3) Medication restrictions: Not applicable to patients without TLS prophylaxis or severe liver and kidney dysfunction.
4. Special precautions
(1) Omission treatment: If it exceeds 8 hours, skip and continue with the original dose the next day.
(2) Drug interactions: Avoid co administration with P-gp inhibitors and grapefruit products.
(3) Treatment cycle: Continue medication until disease progression or intolerable toxicity, AML patients usually receive combined chemotherapy.
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