Systemic Anti-Cancer Therapy Regimen Library
PCN - CTD [CYCLOPHOSPHamide, thalidomide and dexamethasone]
Treatment Overview
Continuous until disease progression or unacceptable toxicity; or 6 cycles prior to transplant.
Cycle 1 (and all further cycles) - 21 days
Thalidomide dose: Consider increasing thalidomide dose to 200 mg orally ONCE daily in patients only if they can tolerate this dose.
Cycle details
Cycle 1 (and all further cycles) - 21 days
Medication | Dose | Route | Days | Max Duration |
---|---|---|---|---|
dexamethasone * | 40 mg flat dosing | oral administration | 1, 8, 15 | |
CYCLOPHOSPHamide | 500 mg flat dosing | oral administration | 1, 8, 15 | |
thalidomide * | 100 mg Once daily | oral administration | 1 to 21 |
Thalidomide dose: Consider increasing thalidomide dose to 200 mg orally ONCE daily in patients only if they can tolerate this dose.
Full details
Cycle 1 (and all further cycles) - 21 days
Day: 1
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
CYCLOPHOSPHamide | 500 mg flat dosing | oral administration |
Instructions:
Take with food and a large glass of water, preferably in the morning. |
|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 2
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 3
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 4
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 5
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 6
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 7
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 8
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
CYCLOPHOSPHamide | 500 mg flat dosing | oral administration |
Instructions:
Take with food and a large glass of water, preferably in the morning. |
|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 9
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 10
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 11
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 12
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 13
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 14
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 15
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
dexamethasone * | 40 mg flat dosing | oral administration |
Instructions:
Take in the morning with food. |
|
CYCLOPHOSPHamide | 500 mg flat dosing | oral administration |
Instructions:
Take with food and a large glass of water, preferably in the morning. |
|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 16
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 17
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 18
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 19
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 20
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
Day: 21
Medication | Dose | Route | Max duration | Details |
---|---|---|---|---|
thalidomide * | 100 mg Once daily | oral administration |
Instructions:
Additional details:
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. Consider increasing dose to 200 mg only if tolerated. |
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 may be considered |
Emetogenicity: | Variable |
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.
Emetogenicity: MEDIUM to HIGH days 1, 8, 15; Thalidomide alone MINIMAL to LOW.
References
Celgene Limited Thalomid New Zealand Medicine datasheet 31 January 2022 https://www.medsafe.govt.nz/profs/datasheet/t/thalomidcap.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.