Systemic Anti-Cancer Therapy Regimen Library
LYM NHL B-cell PCNSL - MT-R [metHOTREXate, temozolomide and RITUximab] followed by EA [etoposide and cytarabine]
Treatment Overview
This regimen consists of two parts:
- MT-R [metHOTREXATe, temozolomide and RITUximab] Remission Induction, followed by
- EA [etoposide and cytarabine] Consolidation.
Evaluate following Cycle 6:
- If complete response (CR) proceed to Cycles 7 and 8 of this regimen, followed by Consolidation.
- If partial response (PR) treat with 3 to 5 additional cycles of remission induction therapy before Consolidation.
Follows at least 8 cycles of a metHOTREXATe-based remission induction therapy and when stable disease or better is achieved.
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Variable |
| Antiviral prophylaxis for hepatitis B virus: | Required for anti–HBc positive patients at risk of reactivation |
| Antiviral prophylaxis for herpes virus: | Variable |
| Emetogenicity: | Variable |
| Folinic acid rescue for high dose methotrexate: | Variable |
| Growth factor support: | Variable |
| Hydration: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Variable |
| Ocular toxicity risk: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis may be considered |
References
Medicines and Hepatitis B Reactivation Prescriber Update 38(1): 2-3 March 2017 https://medsafe.govt.nz/profs/PUArticles/March2017/MedicinesAndHepatitisB.htm
Rituximab and Hepatitis B Reactivation Prescriber Update 34(3):27 September 2013 https://www.medsafe.govt.nz/profs/PUArticles/Sept2013RituximabHepB.htm
* 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.