Systemic Anti-Cancer Therapy Regimen Library
LYM - PEP-C [prEDNISone, CYCLOPHOSPHamide, etoposide and procarbazine]
Treatment Overview
Treatment is given every day for 1 to 3 months then titrated as tolerated.
Prescribers can consider adding RITUximab to this regimen.
Cycle 1 (and all further cycles) - 28 days
In relation to CYCLOPHOSPHamide, etoposide and procarbazine, proceed with induction and maintenance treatment if:
- White blood cells are equal to or greater than 3 x 109 /L.
- Platelets are equal to or greater than 50 x 109 /L.
- Haemoglobin is greater than 80 g/L.
Maintenance dosing frequency to be determined by physician, e.g. every day, 3 weeks out of 4, 5 days out of 7, every other day, twice weekly or once weekly.
Cycle details
Cycle 1 (and all further cycles) - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration | 1 to 28 | |
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration | 1 to 28 | |
| etoposide * | 50 mg flat dosing Once daily | oral administration | 1 to 28 | |
| procarbazine | 50 mg flat dosing Once daily | oral administration | 1 to 28 |
In relation to CYCLOPHOSPHamide, etoposide and procarbazine, proceed with induction and maintenance treatment if:
- White blood cells are equal to or greater than 3 x 109 /L.
- Platelets are equal to or greater than 50 x 109 /L.
- Haemoglobin is greater than 80 g/L.
Maintenance dosing frequency to be determined by physician, e.g. every day, 3 weeks out of 4, 5 days out of 7, every other day, twice weekly or once weekly.
Full details
Cycle 1 (and all further cycles) - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 11
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 12
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 13
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 14
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 15
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 16
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 17
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 18
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 19
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 20
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 21
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 22
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 23
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 24
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 25
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 26
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 27
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Day: 28
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| prEDNISone | 20 mg flat dosing Once daily | oral administration |
Instructions:
Take in the morning with food. |
|
| CYCLOPHOSPHamide | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at lunchtime with food and a large glass of water. |
|
| etoposide * | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take in the evening on an empty stomach - one hour before OR two hours after food. Grapefruit or grapefruit juice may interact with this medicine. Discuss with your pharmacist. |
|
| procarbazine | 50 mg flat dosing Once daily | oral administration |
Instructions:
Take at night with food. Do not drink alcohol and avoid large amounts of tyramine-rich foods (e.g. aged cheeses, cured meats, fermented foods and yeast extracts such as Marmite®) while being treated with this medicine. Talk to your doctor or pharmacist before taking medicines purchased over the counter from a pharmacy, supermarket or health food store. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Routine antifungal prophylaxis may be considered |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis may be considered |
| Emetogenicity: | Medium to high |
| Gastroprotection: | Gastroprotection may be considered |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis is recommended |
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.
Tumour lysis syndrome prophylaxis: Should be considered in high bulk disease and as per guidelines.
References
Cancer Care Manitoba Regimen Reference Order – LYMP – PEP-C July 4 2018 https://www.cancercare.mb.ca/export/sites/default/For-Health-Professionals/.galleries/files/treatment-guidelines-rro-files/regimen-reference-orders/lymphoproliferative-disorders/LYMP_-_PEP-C.pdf (accessed 26 January 2022).
Thames Valley Strategic Clinical Network NHS PEP-C May 2019 v 1.1 https://nssg-test.oxford-haematology.org.uk/documents/246/L-107-pep-c.pdf (accessed 26 January 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.