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Systemic Anti-Cancer Therapy Regimen Library

DAUNOrubicin, cytarabine and midostaurin induction [60 years and over] (LEU AML - DAUNOrubicin, cytarabine and midostaurin induction, high dose cytarabine and midostaurin consolidation followed by midostaurin maintenance [FLT3 mutated] [60 years and over])

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

midostaurin: Cardiovascular risk factor assessment is recommended—consult prescribing information for details.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
DAUNOrubicin * 60 mg/m² Once daily intravenous 1, 2, 3 15 minutes
cytarabine 200 mg/m² Once daily intravenous 1 to 7 24 hours Min: 24 hours
midostaurin 50 mg Twice daily oral administration 8 to 21

midostaurin: Cardiovascular risk factor assessment is recommended—consult prescribing information for details.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
DAUNOrubicin * 60 mg/m² Once daily intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 2

Medication Dose Route Max duration Details
DAUNOrubicin * 60 mg/m² Once daily intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 3

Medication Dose Route Max duration Details
DAUNOrubicin * 60 mg/m² Once daily intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.

cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 4

Medication Dose Route Max duration Details
cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 5

Medication Dose Route Max duration Details
cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 6

Medication Dose Route Max duration Details
cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 7

Medication Dose Route Max duration Details
cytarabine 200 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:

Continuous infusion, total dose 1400 mg/m2 over 168 hours (7 days).

Day: 8

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 9

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 10

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 11

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 12

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 13

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 14

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 15

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 16

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 17

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 18

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 19

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 20

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Day: 21

Medication Dose Route Max duration Details
midostaurin 50 mg Twice daily oral administration
Instructions:
  • Take with food. Swallow whole with a glass of water, do not crush, chew. 
  • Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Variable
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Antifungal prophylaxis: Azole antifungals may reduce the clearance of midostaurin and increase its toxicity. Avoid combination or monitor for midostaurin toxicity.


Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.


Emetogenicity:

  • MEDIUM days 1 to 3
  • LOW days 4 to 7
  • MEDIUM to HIGH (oral) days 8 to 21.

References

Novartis New Zealand Limited Rydapt Data sheet 14 May 2021 https://www.medsafe.govt.nz/profs/Datasheet/r/rydaptcap.pdf (accessed 14 July 2022).

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.