Venetoclax instructions and dosage

Tumor lysis syndrome (TLS) is a possible adverse event in patients taking Venetoclax. It is a side effect caused by the rapid breakdown of cancer cells. It usually occurs within 24-48 hours after the start of treatment and may occur as a result of treatment. For patients at a risk level for tumor lysis syndrome (TLS), physicians will assess specific factors and provide patients with prophylactic hydration and anti-hyperuricemia treatment before the first dose of veneclase to reduce the risk of TLS.

1. Recommended dosage:

(1) Recommended dosage for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): Administration of venetoclax begins with a 5-week ramp-up phase, a 5-week escalating dose regimen designed to gradually reduce tumor burden (tumor reduction) and reduce the risk of tumor lysis syndrome. The daily oral dose is 20 mg in the first week, the daily oral dose in the second week is 50 mg, and the daily oral dose is in the third week. 100mg, the daily oral dose is 200mg in the fourth week, and the daily oral dose is 400mg in the fifth week and beyond.

1) Monotherapy: The recommended dose of venetoclax is 400 mg once daily after completion of the 5-week escalating dose regimen, and treatment is continued until disease progression or unacceptable toxicity occurs.

2) Combined use with Obinutuzumab: 100mg of Obinutuzumab is taken starting on day 1 of cycle 1, 900mg on day 2, 1000mg on days 8 and 15 and subsequently on day 1 of each 28-day cycle for a total of 6 cycles. On day 22 of cycle 1, start using venetoclax according to the 5-week accelerated dosing schedule; After completing the accelerated phase on day 28 of cycle 2, continue taking venetoclax 400 mg orally once daily starting from day 1 of cycle 3 until the last day of cycle 12.

3) In combination with Rituximab: Rituximab is initiated after the patient has completed the 5-week escalating dose regimen of venetoclax and received the recommended dose of 400 mg of venetoclax orally once daily for 7 days. It is administered on the first day of each 28-day cycle for a total of 6 cycles. The intravenous dosage in the first cycle is 375 mg/m2 and the intravenous dosage in cycles 2-6 is 500 mg/m2. Venetoclax 400 mg was taken orally once daily starting on day 1 of Rituximab cycle 1 for 24 months.

(2) Acute myeloid leukemia (AML): The recommended doses and increments of venetoclax depend on the combination, following the dosing schedule, including 3-day or 4-day dose escalation, in Start taking it on the 1st day of cycle 1, the oral dose is 100mg, the dose on the second day is 200mg, the oral dose on the third day is 400mg, the daily oral dose on the 4th day and thereafter is 400mg;

Can be used simultaneously at this time: azacitidine 75 mg/m2 intravenously or subcutaneously once daily on days 1-7 of each 28-day cycle; or decitabine 20 mg/m2 intravenously once daily on days 1-5 of each 28-day cycle; or cytarabine 20 mg/m2 subcutaneously once daily on days 1-10 of each 28-day cycle.

The original drug of Venacla is already on the market in China, and can be found in the Category B medical insurance directory. The specification is 100mg*14 tablets and the price per box may be around RMB 5,000. The Turkish version of Venaclaoriginal drug, specifications100mg*112 tablets, sold overseas, costs around RMB 10,000 per box (the price may fluctuate due to exchange rates), which is even more expensive. Cheaper generic drugs are also sold overseas, and their pharmaceutical ingredients are basically the same as those of the original drugs. The price of a box of 100mg*120 tablets produced by a Bangladeshi pharmaceutical factory is around RMB 4,000 (prices may fluctuate due to exchange rates).