Ilene Galinsky Highlights Optimal Venetoclax Dosing Strategies in AML

Ilene Galinsky, BSN, MSN, ANP-C, senior leukemia protocol research nurse practitioner at Dana-Farber Cancer Institute, underscores key prescribing considerations with venetoclax.

The risk factors associated with venetoclax (Venclexta) differ for patients with acute myeloid leukemia (AML) compared with other hematologic malignancies, such as chronic lymphocytic leukemia and multiple myeloma, explains Ilene Galinsky, BSN, MSN, ANP-C.

Galinsky, who is the senior leukemia protocol research nurse practitioner, at Dana-Farber Cancer Institute, presented on the efficacy and practical treatment considerations with BCL2 inhibitors at the 47th Annual Oncology Nursing Society Congress. In an interview with Oncology Nursing News®, she highlights optimal dosing strategies with venetoclax.

Important factors to consider include a patient’s disease burden and concomitant medications, Galinsky said. Venetoclax should not be initiated if a patient has a high white blood count and hydroxyurea should be used to achieve counts below 25,000 cells/μL. Further, tumor lysis syndrome, though rare, has been observed with venetoclax, and providers should closely monitor patients’ hydration levels during ramp up to reduce that risk of occurrence.

CYP3A4 inhibitors can also affect the pharmacokinetics of venetoclax, she said. If a patient is receiving one of those drugs, dose modifications may be necessary to get the patient to their target venetoclax dose.

Another important consideration is the likelihood of myelosuppression, she added. A mid-cycle bone marrow biopsy is recommended between days 21 to 28 to dictate if–and when–the second 28-day cycle can begin.

If a patient is not in remission after 1 cycle, treatment should be continued despite low blood counts, and a second barrow biopsy should be repeated, she said. If a patient is in remission, and has neutropenia, providers should wait until the patient has recovered to grade 1 or 2 neutropenia before initiating a second dose. If, following a second dose, neutropenia is persisting, providers should hold the dose and, upon resuming, prescribe a 21-day cycle instead of a 28-day cycle.