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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM Relapsed - BTD-PACE [bortezomib, thalidomide, dexamethasone, cISplatin, DOXOrubicin, CYCLOPHOSPHamide and etoposide]

PCN MM Relapsed - BTD-PACE [bortezomib, thalidomide, dexamethasone, cISplatin, DOXOrubicin, CYCLOPHOSPHamide and etoposide]

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.

Cycle 1 - 28 days

Cycle length:
28

bortezomib: ONLY administer subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


cISplatin, CYCLOPHOSPHamide, etoposide and DOXOrubicin: Some centres may choose to admix cISplatin, CYCLOPHOSPHamide, etoposide (as phosphate) or DOXOrubicin per institutional practice and stability information.

Cycles 2 to 3 - 28 days

Cycle length:
28

bortezomib: ONLY administer subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


cISplatin, CYCLOPHOSPHamide, etoposide and DOXOrubicin: Some centres may choose to admix cISplatin, CYCLOPHOSPHamide, etoposide (as phosphate) or DOXOrubicin per institutional practice and stability information.

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing Once daily oral administration 1 to 4
bortezomib * 1 mg/m² subcutaneous injection 1, 4, 8,
11
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 10 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
DOXOrubicin 10 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
pegFILGRASTIM 6 mg subcutaneous injection 6
thalidomide * 50 mg Once daily oral administration 1 to 28

bortezomib: ONLY administer subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


cISplatin, CYCLOPHOSPHamide, etoposide and DOXOrubicin: Some centres may choose to admix cISplatin, CYCLOPHOSPHamide, etoposide (as phosphate) or DOXOrubicin per institutional practice and stability information.

Cycles 2 to 3 - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing Once daily oral administration 1 to 4
bortezomib * 1 mg/m² subcutaneous injection 1, 4, 8,
11
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 10 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
DOXOrubicin 10 mg/m² Once daily intravenous 1 to 4 24 hours Min: 24 hours
pegFILGRASTIM 6 mg subcutaneous injection 6
thalidomide * 100 mg Once daily oral administration 1 to 28

bortezomib: ONLY administer subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


cISplatin, CYCLOPHOSPHamide, etoposide and DOXOrubicin: Some centres may choose to admix cISplatin, CYCLOPHOSPHamide, etoposide (as phosphate) or DOXOrubicin per institutional practice and stability information.

Full details

Cycle 1 - 28 days

Day: 1

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

ONE hour prior to chemotherapy with food.
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin. 
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 2

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

Take in the morning with food.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin. 
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 3

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

Take in the morning with food.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin. 
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 4

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

Take in the morning with food.
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin. 
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 5

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 6

Medication Dose Route Max duration Details
pegFILGRASTIM 6 mg subcutaneous injection
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 7

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 8

Medication Dose Route Max duration Details
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 9

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 10

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 11

Medication Dose Route Max duration Details
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 12

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 13

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 14

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 15

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 16

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 17

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 18

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 19

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 20

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 21

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 22

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 23

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 24

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 25

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 26

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 27

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 28

Medication Dose Route Max duration Details
thalidomide * 50 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Cycles 2 to 3 - 28 days

Day: 1

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

ONE hour prior to chemotherapy with food.
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin.
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 2

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

Take in the morning with food.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin.
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 3

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

Take in the morning with food.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin.
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 4

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

Take in the morning with food.
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
cISplatin * 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and DOXOrubicin.
  • Ensure patient has passed urine as per institutional policy.
  • Hydration in addition to that specified is recommended as per institutional practice and may need an individualised approach.
  • Monitor potassium and magnesium levels.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
CYCLOPHOSPHamide 400 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 1600 mg/m2 over 96 hours.
  • Run concurrently with cISplatin, etoposide (as phosphate) and DOXOrubicin.
etoposide (as phosphate) * 40 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 160 mg/m2 over 96 hours.
  • Run concurrently with CYCLOPHOSPHamide, cISplatin and DOXOrubicin.
DOXOrubicin 10 mg/m² Once daily intravenous 24 hours Min: 24 hours
Instructions:
  • Continuous infusion over 24 hours.
  • Administer for 4 days, total dose 40 mg/m2 over 96 hours
  • Run concurrently with CYCLOPHOSPHamide, etoposide (as phosphate) and cISplatin.
  • Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. 
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 5

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 6

Medication Dose Route Max duration Details
pegFILGRASTIM 6 mg subcutaneous injection
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 7

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 8

Medication Dose Route Max duration Details
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 9

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 10

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 11

Medication Dose Route Max duration Details
bortezomib * 1 mg/m² subcutaneous injection
Instructions:

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol.

Other routes of administration may be fatal.
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 12

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 13

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 14

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 15

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 16

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 17

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 18

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 19

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 20

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 21

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 22

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 23

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 24

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 25

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 26

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 27

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Day: 28

Medication Dose Route Max duration Details
thalidomide * 100 mg Once daily oral administration
Instructions:

Take at night at least an hour after food.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
Additional details:

Additional details

Section 1: Teratogenic effects

All patients must fulfil the requirements of the pregnancy prevention risk management programme to ensure pregnant women are not exposed to thalidomide. 

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis may be considered
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Variable
Gastroprotection: Gastroprotection may be considered
Growth factor support: Recommended for primary prophylaxis
Hydration: Routine hydration recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Thromboprophylaxis: Thromboprophylaxis is 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 days 1 to 4;
  • MINIMAL to LOW (thalidomide).

References

Lee CK, Barlogie B, Munshi N et al. 2003. DTPACE: an effective, novel combination chemotherapy with thalidomide for previously treated patients with myeloma. J Clin Oncol 21(14):2732-2739., PMID: 12860952

Gerrie, A. S., J. R. Mikhael, L. Cheng, et al. 2013. "D(T)PACE as salvage therapy for aggressive or refractory multiple myeloma." Br J Haematol 161(6):802-810. , PMID: 23594335

Griffin PT, HoVQ, Fulp W et al. A comparison of salvage infusional chemotherapy regimens for re-current / refractory multiple myeloma. Cancer 2015: 121 (20): 3622-3630., PMID: 26149422

Ghandili S, Alihodzic D, Wiessner C, Bokemeyer C, Weisel K, Leypoldt LB. VTd-PACE and VTd-PACE-like regimens are effective salvage therapies in difficult-to-treat relapsed/refractory multiple myeloma: a single-center experience. Ann Hematol. 2023 Jan;102(1):117-124. doi: 10.1007/s00277-022-05027-y. Epub 2022 Nov 16., PMID: 36383242

Cerchione C, Nappi D, Martinelli G. Pegfilgrastim for primary prophylaxis of febrile neutropenia in multiple myeloma. Support Care Cancer. 2021 Nov;29(11):6973-6980. doi: 10.1007/s00520-021-06266-x. Epub 2021 May 14, PMID: 33990881

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.