Systemic Anti-Cancer Therapy Regimen Library
LYM Relapsed - GIVE [filgrastim, IFOSFamide, etoposide and epirubicin]
Treatment Overview
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
If for stem cell harvest, mobilise after cycle 2 or as per institutional practice.
Mesna dosing, as per Bishton 2007 (see Reference below).
Cycle details
Cycles 1 to 3 - 21 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| epirubicin | 50 mg/m² | intravenous | 1 | 15 minutes |
| etoposide (as phosphate) * | 200 mg/m² Once daily | intravenous | 1, 2, 3 | 60 minutes |
| sodium chloride | 0.9 % | intravenous | 1 | 120 minutes |
| mesna * | 1800 mg/m² | intravenous | 1 | 15 minutes |
| IFOSFamide * | 3000 mg/m² Once daily | intravenous | 1, 2, 3 | 24 hours Min: 24 hours |
| mesna | 3000 mg/m² Once daily | intravenous | 1, 2, 3 | 24 hours Min: 24 hours |
| mesna * | 5400 mg/m² | intravenous | 4 | 12 hours Min: 12 hours |
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection | 5 to 10 |
If for stem cell harvest, mobilise after cycle 2 or as per institutional practice.
Mesna dosing, as per Bishton 2007 (see Reference below).
Full details
Cycles 1 to 3 - 21 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| epirubicin | 50 mg/m² | 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. |
| etoposide (as phosphate) * | 200 mg/m² Once daily | intravenous | 60 minutes | |
| sodium chloride | 0.9 % | intravenous | 120 minutes |
Quantity:1000 mL
Instructions:
Prior to IFOSFamide infusion. |
| mesna * | 1800 mg/m² | intravenous | 15 minutes |
Instructions:
Immediately prior to the first dose of IFOSFamide. |
| IFOSFamide * | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with mesna 3000 mg/m2 and administer by continuous infusion over 24 hours. 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 | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with IFOSFamide and administer by continuous infusion over 24 hours. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| etoposide (as phosphate) * | 200 mg/m² Once daily | intravenous | 60 minutes | |
| IFOSFamide * | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with mesna 3000 mg/m2 and administer by continuous infusion over 24 hours. 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 | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with IFOSFamide and administer by continuous infusion over 24 hours. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| etoposide (as phosphate) * | 200 mg/m² Once daily | intravenous | 60 minutes | |
| IFOSFamide * | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with mesna 3000 mg/m2 and administer by continuous infusion over 24 hours. 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 | 3000 mg/m² Once daily | intravenous | 24 hours Min: 24 hours |
Instructions:
Admixed with IFOSFamide and administer by continuous infusion over 24 hours. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| mesna * | 5400 mg/m² | intravenous | 12 hours Min: 12 hours |
Instructions:
Start immediately after last IFOSFamide infusion. |
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| filgrastim | 5 microgram/kg Once daily | subcutaneous injection |
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis may be considered |
| Emetogenicity: | High |
| Growth factor support: | Recommended for primary prophylaxis |
| Hydration: | Routine hydration recommended |
| Irradiated blood components: | Variable |
| Mesna uroprotection: | Routine mesna uroprotection 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.
Irradiated blood components: Required for Hodgkin lymphoma patients at all stages of disease and therapy. Continue indefinitely.
References
New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016 https://www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/111G122.pdf (accessed 16 June 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.