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Venclexta

  • 1.  Venclexta

    Posted 08-12-2019 16:54
    For those who've had patients on Venclexta (venetoclax tablets) - What are the challenges you've faced with patient initiation and SE management?

    Thank you for your input!
    Shari Bates


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    Shari Bates, BSN, RN, OCN
    Auburn WA
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  • 2.  RE: Venclexta

    Posted 08-12-2019 21:14
    Shari,
    Our center participated in the trial for treatment naive CLL patients using obinutuzumab and venetoclax. What you see in the package insert regarding initiation of the dosing is what we used on the trial. The trial gave 3 weekly obinutuzumab doses to reduce the tumor burden before starting venetoclax. Allopurinol was started prophylactically at least 2-3 days prior to dosing. Several patients with high disease burden were hospitalized overnight during initial dosing. In 8 patients at our center we saw no TLS. We had to give growth factor support to 1 patient for neutropenia. The remaining patients had minimal side effects- occasional diarrhea.
    Elyce

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    Elyce Turba MSN RN
    Clinical Research Nurse
    H Lee Moffitt Cancer Center
    Tampa FL
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  • 3.  RE: Venclexta

    Posted 08-13-2019 10:02
    Hey Shari; I, too, am starting a new Venetoclax patient soon (single agent) and am wondering if you gave IVF with the very first dose to anyone with a low TLS risk?  My pharmacy is recommending it but the MD is saying the patient can take enough fluid by mouth.
    Your input would be greatly appreciated.

    Anne Marie Haynes RN,OCN,JD
    Hematology Practice Nurse
    MGH North Shore Cancer Center
    Danvers, MA​

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    Anne Marie Haynes RN, OCN, JD
    Hematology Practice Nurse
    MGH/North Shore Cancer Center
    Danvers, MA 01923
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  • 4.  RE: Venclexta

    Posted 08-13-2019 11:37
    Our physicians give fluids if there is a high tumor burden but it is usually not necessary in our experience. If the patient is able to understand the need for an increased fluid intake prior to and after the dosing, IV fluids may not be necessary. You may need to follow your institutional policy as well as the package insert.

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    Elyce Turba MSN RN
    Clinical Research Nurse
    H Lee Moffitt Cancer Center
    Tampa FL
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  • 5.  RE: Venclexta

    Posted 08-14-2019 09:12
    Hi Shari,

    We have started multiple patients on venetoclax for its various indications and have found it generally well tolerated with many of our patients reaching full dose after the scheduled ramp ups.

    Key considerations include:

    • Dosing appropriate for diagnosis (CLL vs AML)
    • Determining TLS risk and planning appropriate prophylaxis – hospitalization(rare) vs. IV fluids in clinic vs. pushing oral intake, and allopurinol
    • Laboratory monitoring 6-8 hours after first dose, at 24 hours, and with each weekly ramp up
    • Timing start date when given with obinutuzumab (day 22 ) 
    Biggest challenge: Treating patients with venetoclax requires close communication and collaboration with the provider, nursing team, pharmacy and patient.
    • Have designated personnel to oversee acquisition and scheduling appointments on start date
    • Instruct the patient do not start the medication without communicating with the team in advance,
    • Track patients at least weekly in person for adherence and toxicity checks with the weekly labs and ramp up.
    The manufacturer has wonderful patient education materials including a color-coded calendar that corresponds to each weekly blister pack. So be sure to reach out to your rep if you have not already done so!​

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    Mary K Anderson BSN RN OCN
    Oral Oncolytic Nurse Navigator
    Norton Cancer Institute
    Louisville KY
    mary.anderson@nortonhealthcare.org
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  • 6.  RE: Venclexta

    Posted 08-15-2019 12:21

    Thanks, Mary...this is also very helpful.  Can folks tell me when, exactly, the weekly labs are drawn after week 1?  Do you draw them before the patient takes the next higher dose, or 24 hours afterwards?

    Curious to know...thanks.

     

    Anne Marie

     

    Anne Marie Haynes, RN, OCN, JD

    Hematology Practice Nurse

    MGH North Shore Cancer Center

    Danvers, MA  01923

     

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  • 7.  RE: Venclexta

    Posted 08-15-2019 22:01
    Actually, we do both. We make sure there is no neutropenia before increasing the dose, then 24 hours after. It's seen as inconvenient by the patient but once explained it is for safety, they will agree.





  • 8.  RE: Venclexta

    Posted 08-16-2019 09:02
    Makes perfect sense; thanks, Elyce.
    Anne Marie​

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    Anne Marie Haynes RN, OCN, JD
    Hematology Practice Nurse
    MGH/North Shore Cancer Center
    Danvers, MA 01923
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