Idelalisib is a targeted therapy drug that has demonstrated unique clinical value in selected leukemia patients. Its indications and applicable population should strictly follow medical guidelines to avoid adverse effects or delay in the condition of first-time patients.

Indications and applicable population of Idelalisib

Idelalisib is mainly used for the treatment of specific types of leukemia, and its indications and applicable population need to be comprehensively evaluated based on the specific condition and physiological status of the patient.

Indications and treatment limitations

Idelalisib is approved in combination with rituximab for the treatment of relapsed chronic lymphocytic leukemia (CLL), especially in patients who are unable to receive other therapies due to comorbidities. Its target is PI3Kδ kinase, which slows disease progression by inhibiting the B cell signaling pathway. It is not specifically indicated for follicular lymphoma, small lymphocytic lymphoma, and other indolent non-Hodgkin lymphomas, and is contraindicated as first-line treatment or in combination with bendamustine.

Characteristics of the applicable population

The main applicable population is adult patients with relapsed CLL who need to meet the conditions of rituximab monotherapy. Older patients (≥ 65 years) account for 55% of patients, but because of their high risk of adverse effects (eg, hepatotoxicity, infection), increased monitoring is required. Children, pregnant women and lactating women are prohibited, women of childbearing potential need strict contraception during treatment and within 1 month after discontinuation of the drug, and male patients need to use contraception within 3 months after stopping the drug.

Patients with abnormal liver and kidney function should be cautious with medication, and patients with abnormal baseline liver function (ALT/AST> 2.5 times normal or bilirubin >1.5 times) have limited data, and relevant indicators need to be reviewed regularly during treatment.

Notes from Zydelig

The side effects of Idelalisib are complex and potentially fatal, and multidimensional monitoring and timely intervention are required during treatment.

Hepatotoxicity and infection management

Severe hepatotoxicity occurred in 16% of patients, with ALT/AST elevated more than 5 times the upper limit of normal, and liver enzymes should be monitored every 2 weeks for the first 3 months of treatment, and the drug should be suspended if abnormal. Severe infections (pneumonia, sepsis, etc.) occurred in 48% of patients, and active infection control and Pneumocystis jirovecii pneumonia prophylaxis were required before treatment. Patients who are seropositive for CMV require monthly monitoring of the virus.

Treatment of severe adverse reactions

20% of patients have grade 3 or higher diarrhea or colitis and need to stop taking corticosteroids. Intestinal perforation is rare but fatal, and new abdominal pain requires immediate evaluation. Skin toxicity (eg, SJS, TEN) and hypersensitivity reactions should be permanently discontinued once the diagnosis is confirmed. Grade 3 to 4 neutropenia occurred in 58% of patients, and routine blood count monitoring and dose adjustment were required weekly.

Avoid concomitant hepatotoxic drugs or strong CYP3A inhibitors/inducers during treatment to prevent abnormal drug concentrations. Elderly patients have a high discontinuation rate due to adverse reactions, and individualized protocols are needed.

Daily dietary taboos in Idelalisib

Proper dietary management can reduce the risk of drug side effects and improve treatment tolerance.

Avoid foods that burden the gastrointestinal tract

Diarrhoea is a common adverse effect, and it is important to reduce the intake of high-fiber, spicy, or greasy foods during treatment to prevent worsening of symptoms. It is advisable to choose a light diet that is easy to digest, such as rice porridge, steamed vegetables, and maintain adequate water intake. Avoid foods containing lactose or artificial sweeteners to reduce intestinal irritation.

Limit diets that affect liver function

Alcohol and high-fat foods may aggravate liver toxicity, so it is necessary to strictly abstain from alcohol and control fat intake. Foods rich in vitamin K (e.g., spinach, broccoli) may interfere with blood clotting and should be consumed in moderation by patients with neutropenia. It is recommended to add high-quality protein (e.g., fish, soy products) to support immune function.

Idelalisib should be stored at 15-30°C, away from moisture and light. During the treatment, the changes in diet and symptoms were recorded, and the plan was adjusted regularly with the doctor. If there are precursors of low blood pressure such as dizziness and fatigue, you can supplement electrolyte-containing drinks in moderation. Patients should strictly follow the doctor's instructions and avoid self-medication of health supplements or Chinese medicines to prevent unknown interactions.

A correct understanding of drug characteristics and the key points of life management is the key to ensuring the efficacy of Idelalisib. If any abnormal symptoms occur during treatment, you should seek medical attention in time and clarify whether it is related to medication.