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Systemic Anti-Cancer Therapy Regimen Library

Home > LYM NHL B-cell PCNSL - MT-R [metHOTREXate, temozolomide and RITUximab] followed by EA [etoposide and cytarabine] > LYM - EA [etoposide and cytarabine]
This regimen is a component of LYM NHL B-cell PCNSL - MT-R [metHOTREXate, temozolomide and RITUximab] followed by EA [etoposide and cytarabine]

EA [etoposide and cytarabine] Consolidation (LYM NHL B-cell PCNSL - MT-R [metHOTREXate, temozolomide and RITUximab] followed by EA [etoposide and cytarabine])

Treatment Overview

Consolidation treatment for 1 cycle.

Follows at least 8 cycles of metHOTREXATe-based Remission Induction therapy and when stable disease or better is achieved.


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.

Cycle 1 - 28 days

Cycle length:
28

filgratim: Give 5 microgram/kg subcutaneously ONCE daily from Day 14 until neutrophil recovery past nadir.


Start a fluoroquinolone when absolute neutrophil count (ANC) less than 0.5 × 109/L and stopped when ANC greater than or equal to 0.5 × 109/L.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
etoposide (as phosphate) * 5 mg/kg Twice daily intravenous 1 to 4 12 hours Min: 12 hours
cytarabine * 2000 mg/m² Twice daily intravenous 1 to 4 2 hours
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye 1 to 6
filgrastim 5 microgram/kg Once daily subcutaneous injection 14

filgratim: Give 5 microgram/kg subcutaneously ONCE daily from Day 14 until neutrophil recovery past nadir.


Start a fluoroquinolone when absolute neutrophil count (ANC) less than 0.5 × 109/L and stopped when ANC greater than or equal to 0.5 × 109/L.

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
etoposide (as phosphate) * 5 mg/kg Twice daily intravenous 12 hours Min: 12 hours
Instructions:

Give by continuous infusion over 12 hours, for a total dose of 40 mg/kg over 4 days.
cytarabine * 2000 mg/m² Twice daily intravenous 2 hours
Instructions:

Every 12 hours.
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 2

Medication Dose Route Max duration Details
etoposide (as phosphate) * 5 mg/kg Twice daily intravenous 12 hours Min: 12 hours
Instructions:

Give by continuous infusion over 12 hours, for a total dose of 40 mg/kg over 4 days.
cytarabine * 2000 mg/m² Twice daily intravenous 2 hours
Instructions:

Every 12 hours.
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 3

Medication Dose Route Max duration Details
etoposide (as phosphate) * 5 mg/kg Twice daily intravenous 12 hours Min: 12 hours
Instructions:

Give by continuous infusion over 12 hours, for a total dose of 40 mg/kg over 4 days.
cytarabine * 2000 mg/m² Twice daily intravenous 2 hours
Instructions:

Every 12 hours.
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 4

Medication Dose Route Max duration Details
etoposide (as phosphate) * 5 mg/kg Twice daily intravenous 12 hours Min: 12 hours
Instructions:

Give by continuous infusion over 12 hours, for a total dose of 40 mg/kg over 4 days.
cytarabine * 2000 mg/m² Twice daily intravenous 2 hours
Instructions:

Every 12 hours.
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 5

Medication Dose Route Max duration Details
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 6

Medication Dose Route Max duration Details
prednisolone acetate 1% (10 mg/mL) eye drops * 1 Drop Every four hours application to the eye
Instructions:

Instil ONE drop into each eye every FOUR hours on days 1 to 6.

Day: 14

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
  • Give ONCE daily from Day 14 until neutrophil recovery past nadir.
  • Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for hepatitis B virus: Required for anti–HBc positive patients at risk of reactivation
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Medium
Growth factor support: Recommended for primary prophylaxis
Ocular toxicity risk: High - administer corticosteroid eyedrops to minimise corneal toxicity
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

References

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.