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Pharmacokinetics of Venetoclax, a Novel BCL-2 Inhibitor, in Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia or Non-Hodgkin Lymphoma.

Authors
  • Salem, Ahmed Hamed1, 2
  • Agarwal, Suresh K1
  • Dunbar, Martin1
  • Enschede, Sari L Heitner3
  • Humerickhouse, Rod A4
  • Wong, Shekman L1
  • 1 Clinical Pharmacology and Pharmacometrics, AbbVie Inc, North Chicago, IL, USA.
  • 2 Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt. , (Egypt)
  • 3 Global Medical Affairs, AbbVie Inc, North Chicago, IL, USA.
  • 4 Oncology Development, AbbVie Inc, North Chicago, IL, USA.
Type
Published Article
Journal
Journal of clinical pharmacology
Publication Date
Apr 01, 2017
Volume
57
Issue
4
Pages
484–492
Identifiers
DOI: 10.1002/jcph.821
PMID: 27558232
Source
Medline
Keywords
License
Unknown

Abstract

Venetoclax is a selective BCL-2 inhibitor that is approved in the United States for the treatment of patients with chronic lymphocytic leukemia (CLL) with 17p deletion who have received at least 1 prior therapy. The aim of this analysis was to characterize venetoclax pharmacokinetics in the plasma and urine of patients with hematological malignancies and evaluate the effect of dose proportionality, accumulation, weak and moderate CYP3A inhibitors, as well as low- and high-fat meals on venetoclax pharmacokinetics. Patients received a once-daily venetoclax dose of 20 to 1200 mg. Pharmacokinetic parameters were estimated using noncompartmental methods. Venetoclax peak exposures were achieved at 5 to 8 hours under low-fat conditions, and the mean terminal-phase elimination half-life ranged between 14.1 and 18.2 hours at different doses. Venetoclax steady-state exposures showed minimal accumulation and increased proportionally over the dose range of 300 to 900 mg. Low-fat and high-fat meals increased venetoclax exposures by approximately 4-fold relative to the fasting state. Moderate CYP3A inhibitors increased venetoclax exposures by 40% to 60%, whereas weak CYP3A inhibitors had no effect. A negligible amount of venetoclax was excreted in the urine. In summary, venetoclax exhibits a pharmacokinetic profile that is compatible with once-daily dosing with food regardless of fat content. Concomitant use of venetoclax with moderate CYP3A inhibitors should be avoided or venetoclax dose should be reduced during the venetoclax initiation and ramp-up phase in CLL patients. Renal excretion plays a minimal role in the elimination of venetoclax.

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