Decision Making With Venetoclax-Based Therapy
Published: 2020-03-31 |
Author: Roxanne Nelson, RN, BSN |
Source: Oncology Nurse Advisor
Chronic lymphocytic leukemia (CLL) is the most common form of leukemia diagnosed in adults residing in Western countries, and is a monoclonal disorder that is characterized by progressive accumulation of functionally incompetent lymphocytes. Early-stage CLL is generally not treated, with therapy initiated only after symptoms appear of there is evidence of rapid disease progression. Treatment options have widened during the past decade, especially with targeted therapy.
Venetoclax received approval from the US Food and Drug Administration (FDA) in April 2016, with an indication for CLL patients harboring a 17g deletion who have received at least 1 prior therapy. It is a selective inhibitor of the B-cell lymphoma 2 (Bcl-2) regulator protein, and high levels of BCL2 protein are expressed in CLL, it was expanded to include combination therapy with rituximab in relapsed CLL. In addition, venetoclax plus obinutuzumab has improved progression-free survival, as compared to standard chemoimmunotherapy (CIT), in older patients with comorbidities.
Traditional CIT is generally administered over several courses, until remission is obtained, and then the patient is observed until progression and then treatment begins again. CIT was not considered curative for most patients but venetoclax-based treatment have demonstrated the ability to eliminate CLL and then achieve deep remission with fixed-duration therapy.