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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN MM - BTD [bortezomib, thalidomide and dexamethasone] induction

PCN MM - BTD [bortezomib, thalidomide and dexamethasone] induction

Treatment Overview

3 to 8 cycles may be administered.

Cycles 1 to 8 - 28 days

Cycle length:
28

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg ONCE a week in older or frail patients.

Cycle details

Cycles 1 to 8 - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
bortezomib * 1.3 mg/m² subcutaneous injection 1, 8, 15,
22
thalidomide * 100 mg Once daily oral administration 1 to 28

Bortezomib is ONLY to be administered subcutaneously or intravenously as per protocol. Other routes of administration may be fatal.


Dexamethasone dose: Consider dose reduction of dexamethasone to 20 mg ONCE a week in older or frail patients.

Full details

Cycles 1 to 8 - 28 days

Day: 1

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

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients
bortezomib * 1.3 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: 2

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: 3

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: 4

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: 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
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
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients
bortezomib * 1.3 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
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
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients
bortezomib * 1.3 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: 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
dexamethasone * 40 mg flat dosing oral administration
Instructions:

Take in the morning with food.

Consider dose reduction to 20 mg in older or frail patients
bortezomib * 1.3 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: 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
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Minimal to low
Gastroprotection: Gastroprotection may be considered
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.

References

Kaufman JL, Nooka A, Vrana M, et al., Bortezomib, thalidomide, and dexamethasone as induction therapy for patients with symptomatic multiple myeloma: a retrospective study. Cancer. 2010 Jul 1;116(13):3143-51. doi: 10.1002/cncr.25143., PMID: 20564642

Philippe Moreau, Cyrille Hulin, Margaret MACRO, et al, Michel Attal; Bortezomib, Thalidomide and Dexamethasone (VTD) Is Superior to Bortezomib, Cyclophosphamide and Dexamethasone (VCD) Prior to Autologous Stem Cell Transplantation for Patients with De Novo Multiple Myeloma. Results of the Prospective IFM 2013-04 Trial. Blood 2015; 126 (23): 393. doi: https://doi.org/10.1182/blood.V126.23.393.393

Rosiñol L, Oriol A, Teruel AI, et al., Programa para el Estudio y la Terapéutica de las Hemopatías Malignas/Grupo Español de Mieloma (PETHEMA/GEM) group. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: a randomized phase 3 PETHEMA/GEM study. Blood. 2012 Aug 23;120(8):1589-96. doi: 10.1182/blood-2012-02-408922. Epub 2012 Jul 12., PMID: 22791289

Cavo M, Tacchetti P, Patriarca F, et al., GIMEMA Italian Myeloma Network. Bortezomib with thalidomide plus dexamethasone compared with thalidomide plus dexamethasone as induction therapy before, and consolidation therapy after, double autologous stem-cell transplantation in newly diagnosed multiple myeloma: a randomised phase 3 study. Lancet. 2010 Dec 18;376(9758):2075-85. doi: 10.1016/S0140-6736(10)61424-9. Epub 2010 Dec 9. Erratum in: Lancet. 2011 Nov 26;378(9806):1846., PMID: 21146205

Juno Pharmaceuticals NZ Ltd. Bortezomib JUNO New Zealand medicine datasheet 6 April 2020 https://www.medsafe.govt.nz/profs/datasheet/b/bortezomibjunoinj.pdf (Accessed 31 March 2022).

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.