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What You Can Expect with Venetoclax Treatment for Chronic Lymphocytic Leukemia: First Two Months Can Be Rough, Then It’s ‘Smooth Sailing’

Dr. James Gerson Penn Medicine

Easing Into Treatment With Venetoclax

  • Venetoclax (Brand name: Venclexta) is a targeted treatment for chronic lymphocytic leukemia (CLL).
  • It targets a specific protein called BCL-2 in cancer cells that helps them stay alive.
  • Doctors combine Venclexta with the monoclonal antibody obinutuzumab (Gazyva).
  • The first two months on this combination therapy involves numerous doctor visits and injections to fine-tune treatment.

The drug venetoclax (brand name: Venclexta) is one of several new targeted treatments for chronic lymphocytic leukemia (CLL). Instead of attacking all rapidly-dividing cells like chemotherapy does, it blocks a specific protein called BCL-2 in cancer cells that helps them stay alive.

Though this treatment can help you avoid chemotherapy, it does have its downsides. And most of the negatives are centered in the beginning of treatment. “The first two months are annoying. There’s no sugar coating it,” Dr. James Gerson, hematologist at Penn Medicine, tells SurvivorNet.

Related: “Potentially Curative” New Drug Could Help Thousands of People With Chronic Lymphocytic Leukemia.”

In its first couple of months, this treatment regimen can be time consuming. And if you’re not a fan of needles, it’s also a little unnerving.

Getting Venclexta: What to Expect

Your doctor might recommend the targeted drug Venclexta to treat your CLL if you have a genetic change known as a 17 p deletion or you’ve already tried at least one other treatment. Venclexta is also FDA-approved as a first treatment for CLL in combination with the monoclonal antibody, obinutuzumab (Gazyva).

When you get the two drugs in combination, you’ll start with Gazyva. It comes as an infusion that your health care provider gives you into a vein. You’ll have a couple of infusions in the first week, and then one infusion a week for a couple of weeks after that. After that, you’ll switch to monthly infusions.

Near the end of your first month or at the beginning of your second month, you’ll start taking Venclexta. This drug targets a protein called CD20 on the surface of your cancer cells. Venclexta comes as a pill, which may be easier to take, but you won’t be able to avoid needles altogether.

Related: ‘The Eye of the Tiger’ — Why Mindset and Lifestyle are So Important During Treatment for CLL

“Unfortunately, because of the risk to the kidneys, we have to keep a very close eye on the kidney function using blood work,” Dr. Gerson says. You may need to get blood work the day before, the day of, and the day after your cancer treatment, he adds.

All of that blood work is essential to get your dose just right. Doctors start Venclexta at a low dose and then gradually increase it, looking all the while for evidence that the drug may be harming your kidneys.

“You start at 20 milligrams once a day, and then a week later you go to 50 milligrams, and then a week later you go to a hundred, and then a week later, two hundred, and then a week later, four hundred,” Dr. Gerson explains. “And each of those steps often requires all these blood tests. So it’s a lot of blood and a lot of trips back and forth [to the doctor].”

Smooth Sailing

The blood work and frequent trips to your doctor can be annoying, “but that’s the worst of it,” Dr. Gerson says. Once you get through that short period of time when your dose is being adjusted, you should be finished with the worst part of your treatment.

Venclexta is generally a very safe medication, according to Dr. Gerson. The most common side effects include:

  • Low white blood cell and red blood cell counts
  • Diarrhea
  • Fatigue
  • Nausea
  • Upper respiratory tract infections

If you can tolerate the side effects and the blood draws, you’ll get the benefit of a combination treatment that has been shown to be very effective against CLL. About half of people who received Gazyva and Venclexta in one study had a complete response, which means they no longer had any signs of cancer.

Related: CLL is Not Considered Curable So Treatment May Resume Years Later

“And so, if you can make it through the hassles of the first two months, then it’s a lot of smooth sailing,” Dr. Gerson says. “And usually you’re fine after that.”

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Dr. James Gerson is a hematologist and an assistant professor of clinical medicine at Penn Medicine. He specializes in the treatment of chronic lymphocytic leukemia (CLL), Hodgkin lymphoma, and non-Hodgkin lymphoma. Read More