Electrolyte disorders secondary to venetoclax

Area of Science:

• Nephrology
• Oncology
• Clinical Pharmacology

Background:

• Emerging cancer therapeutics, such as venetoclax, are associated with novel forms of nephrotoxicity.
• Electrolyte disorders can manifest as a consequence of cancer drug-induced kidney injury.

Observation:

• A patient with non-Hodgkin lymphoma developed severe hypokalemia, hypophosphatemia, hypocalcemia, and hypomagnesemia during venetoclax treatment.
• Previous reports of electrolyte disturbances with venetoclax were attributed to tumor lysis syndrome prophylaxis.

Findings:

• Temporal association and urinary studies suggest venetoclax directly causes these electrolyte abnormalities.
• The mechanism likely involves direct toxicity to the proximal and distal convoluted tubules of the kidney.

Implications:

• Venetoclax can induce significant electrolyte derangements independent of tumor lysis syndrome.
• Recommend vigilant electrolyte monitoring in patients undergoing venetoclax therapy.
• Caution against co-medications that may exacerbate electrolyte imbalances during venetoclax treatment.