Venetoclax

How it works

It selectively inhibits the anti-apoptotic protein BCL-2, restoring apoptosis in malignant cells that depend on BCL-2 for survival.

Prescribing in practice

• It carries a high risk of tumour lysis syndrome, so a gradual dose ramp-up, risk assessment, hydration, and uric-acid-lowering prophylaxis with close biochemical monitoring are required at initiation.
• Strong or moderate CYP3A4 inhibitors substantially increase exposure and the tumour lysis risk, so concomitant use needs avoidance or dose adjustment per the SPC.
• Neutropenia is common; monitor blood counts and manage with dose modification, growth factors, or infection prophylaxis as needed.

Monitoring

Monitor electrolytes and renal function closely during the dose ramp-up for tumour lysis syndrome, and check full blood count regularly thereafter.

Counselling the patient

• Maintain good fluid intake and attend all blood tests during the dose build-up phase.
• Avoid grapefruit, Seville oranges, and starfruit, which can raise drug levels.
• Report fever or signs of infection promptly.

Evidence & guidelines

Venetoclax is supported by trials such as MURANO in chronic lymphocytic leukaemia and is recommended by NICE for defined indications.