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On April 12, 2016, under accelerated approval conditions, the US Food and Drug Administration approved venetoclax tablets, the first BCL-2 inhibitor in relapsed/refractory chronic lymphocytic leukemia patients with 17p deletion who have received at least one prior treatment. This drug is co-developed by AbbVie, Inc. and Genentech USA, Inc.

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  • Venetoclax is indicated for the treatment of patients with chronic lymphocytic leukemia (CLL) with 17p deletion, as detected by an FDA-approved test, who have received at least one prior therapy
  • This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial



  • Concomitant use of venetoclax with strong CYP3A inhibitors at initiation and during ramp-up phase is contraindicated

Tumor Lysis Syndrome

  • Tumor lysis syndrome (TLS), including fatal events and renal failure requiring dialysis, has occurred in previously treated CLL patients with high tumor burden treated with venetoclax
  • Venetoclax poses a risk for TLS in the initial 5-week ramp-up phase. Changes in blood chemistries consistent with TLS that require prompt management can occur as early as 6 to 8 hours following the first dose of venetoclax and at each dose increase
  • Patients should be assessed for TLS risk, including evaluation of tumor burden and comorbidities, and should receive appropriate prophylaxis for TLS, including hydration and anti-hyperuricemics. Reduced renal function (CrCl <80 mL/min) further increases the risk. Monitor blood chemistries and manage abnormalities promptly. Interrupt dosing if needed. Employ more intensive measures (IV hydration, frequent monitoring, hospitalization) as overall risk increases
  • Concomitant use of venetoclax with strong or moderate CYP3A inhibitors and P- gp inhibitors may increase the risk of TLS at initiation and during the ramp-up phase, and may require dose adjustment due to increases in venetoclax exposure


  • Grade 3 or 4 neutropenia occurred in 41% (98/240) of patients treated with venetoclax. Monitor complete blood counts throughout treatment. Interrupt dosing or reduce dose for severe neutropenia


  • Do not administer live attenuated vaccines prior to, during, or after treatment with venetoclax until B-cell recovery

Embryo-Fetal Toxicity

  • Venetoclax may cause embryo-fetal harm when administered to a pregnant woman. Advise females of reproductive potential to avoid pregnancy during treatment

Adverse Reactions

  • Serious adverse reactions were reported in 43.8% of patients. The most frequent serious adverse reactions (≥2%) were pneumonia, febrile neutropenia, pyrexia, autoimmune hemolytic anemia, anemia, and TLS
  • The most common adverse reactions (≥20%) of any grade were neutropenia, diarrhea, nausea, anemia, upper respiratory tract infection, thrombocytopenia, and fatigue

Drug Interactions

  • For patients who have completed the ramp-up phase and are on a steady daily dose of venetoclax, reduce the dose by at least 75% when used concomitantly with strong CYP3A inhibitors
  • Avoid concomitant use of moderate CYP3A inhibitors or P-gp inhibitors. If an inhibitor must be used, reduce the venetoclax dose by at least 50%
  • Patients should avoid grapefruit products, Seville oranges, and starfruit during treatment as they contain inhibitors of CYP3A
  • Avoid concomitant use of strong or moderate CYP3A inducers
  • Avoid concomitant use of narrow therapeutic index P-gp substrates. If these substrates must be used, they should be taken at least 6 hours before venetoclax
  • Monitor international normalized ratio (INR) closely in patients receiving warfarin

Access this drug's prescribing information now.