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Systemic Anti-Cancer Therapy Regimen Library

Home > LYM NHL NK/T-cell Extra Nodal - Level 2 [100%] DeVIC [dexamethasone, etoposide, IFOSFamide, cARBOplatin] chemoradiation [nasal type]

LYM NHL NK/T-cell Extra Nodal - Level 2 [100%] DeVIC [dexamethasone, etoposide, IFOSFamide, cARBOplatin] chemoradiation [nasal type]

Treatment Overview

Commence regimen in relation to radiation therapy as per institutional policy.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 3 - 21 days

Cycle length:
21

Cycle details

Cycles 1 to 3 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing Once daily oral administration 1, 2, 3
cARBOplatin * 300 mg/m² intravenous 1 30 minutes
etoposide (as phosphate) 100 mg/m² Once daily intravenous 1, 2, 3 60 minutes
sodium chloride 0.9 % intravenous 1, 2, 3 120 minutes
mesna * 300 mg/m² intravenous 1, 2, 3 15 minutes
IFOSFamide * 1500 mg/m² Once daily intravenous 1, 2, 3 3 hours
sodium chloride 0.9 % intravenous 1, 2, 3 120 minutes
mesna * 300 mg/m² intravenous 1, 2, 3 15 minutes
mesna * 300 mg/m² intravenous 1, 2, 3 15 minutes
pegFILGRASTIM 6 mg subcutaneous injection 4

Full details

Cycles 1 to 3 - 21 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.
cARBOplatin * 300 mg/m² intravenous 30 minutes
Instructions:

Hypersensitivity risk increases with number of cycles of cARBOplatin.
etoposide (as phosphate) 100 mg/m² Once daily intravenous 60 minutes
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

Immediately prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 3 hours
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.

Day: 2

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.
etoposide (as phosphate) 100 mg/m² Once daily intravenous 60 minutes
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

Immediately prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 3 hours
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 40 mg flat dosing Once daily oral administration
Instructions:

Take in the morning with food.
etoposide (as phosphate) 100 mg/m² Once daily intravenous 60 minutes
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

Prior to IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

Immediately prior to IFOSFamide infusion over 15 minutes, or as per institutional practice.
IFOSFamide * 1500 mg/m² Once daily intravenous 3 hours
sodium chloride 0.9 % intravenous 120 minutes
Quantity:1000 mL
Instructions:

After IFOSFamide infusion.

Recommended daily hydration is 3000 ml per day as oral or IV fluid on day(s) of IFOSFamide and for 24 hours after or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 4 hours from the start of IFOSFamide infusion, or as per institutional practice.
mesna * 300 mg/m² intravenous 15 minutes
Instructions:

At 8 hours from the start of IFOSFamide infusion, or as per institutional practice.

Day: 4

Medication Dose Route Max duration Details
pegFILGRASTIM 6 mg subcutaneous injection

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis may be considered
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Growth factor support: Recommended for primary prophylaxis
Hydration: Routine hydration recommended
Mesna uroprotection: Routine mesna uroprotection recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

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: HIGH day 1, MEDIUM days 2 and 3.

References

Yamaguchi M, Tobinai K, Oguchi M, Ishizuka N, Kobayashi Y, Isobe Y, Ishizawa K, Maseki N, Itoh K, Usui N, Wasada I, Kinoshita T, Ohshima K, Matsuno Y, Terauchi T, Nawano S, Ishikura S, Kagami Y, Hotta T, Oshimi K. Phase I/II study of concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: Japan Clinical Oncology Group Study JCOG0211. J Clin Oncol. 2009 Nov 20;27(33):5594-600., PMID: 19805668

Yamaguchi M, Tobinai K, Oguchi M, et al. Concurrent chemoradiotherapy for localized nasal natural killer/T-cell lymphoma: an updated analysis of the Japan clinical oncology group study JCOG0211. J Clin Oncol. 2012;30:4044-4046., PMID: 23045573

Yamaguchi M, Suzuki R, Oguchi M, et al. Treatments and outcomes of patients with extranodal natural killer/T-cell lymphoma diagnosed between 2000 and 2013: a cooperative study in Japan. J Clin Oncol. 2018;35:32-39, PMID: 28034070

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641. , PMID: 25089112

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* 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.