What other medicines can I take after becoming resistant to venetoclax/venetoclax?

The BCL-2 inhibitor venetoclax is currently approved for the treatment of hematological disorders and is widely used in monotherapy or combination strategies. It has produced promising results in the treatment of refractory or relapsed (R/R) and elderly hematological malignancies. However, with clinical use, resistance to venetoclax has emerged.

When facing resistance to venetoclax, doctors usually evaluate the patient's specific condition, including the molecular characteristics of the disease, past treatment history, and the patient's overall health. In this context, several other drugs with different mechanisms may be considered for continued treatment.

For patients with chronic lymphocytic leukemia (CLL) who are resistant to venetoclax, BTK inhibitors such as ibrutinib or acalabrutinib can be considered. These drugs achieve therapeutic effects by inhibiting Bruton's tyrosine kinase and interfering with B cell survival signals. BTK inhibitors have shown promising efficacy in patients with CLL, especially those who progress despite treatment with venetoclax.

In addition, for patients with acute myeloid leukemia (AML) who are resistant to venetoclax, other types of chemotherapy drugs or targeted therapies can be considered. For example, DNA methyltransferase inhibitors such as azacitidine or decitabine may also be considered treatment options. This type of drug can exert a therapeutic effect by affecting the gene expression of cancer cells and is suitable for some drug-resistant cases.

In addition, in some cases, combination treatments may be considered to increase efficacy. For example, combining venetoclax with other targeted drugs or chemotherapy drugs may overcome resistance to a certain extent. At the same time, immunotherapy has gradually become a hot spot in research, such as CAR-T cell therapy. Although it is currently mainly used in certain types of blood cancers, its application in venetoclax-resistant patients may be explored in future studies.

Reference materials:https://cancerci.biomedcentral.com/articles/10.1186/s12935-020-01614-z