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Systemic Anti-Cancer Therapy Regimen Library

PCN MM - CyBorDex High [CYCLOPHOSPHamide, bortezomib and dexamethasone]

Treatment Overview

Usually 4 cycles. More cycles may be required depending on transplant eligibility and response.

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

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

Cycle details

Cycle 1 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 40 mg flat dosing oral administration 1, 8, 15,
22
CYCLOPHOSPHamide 300 mg/m² oral administration 1, 8, 15,
22
bortezomib * 1.5 mg/m² subcutaneous injection 1, 8, 15,
22

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

Full details

Cycle 1 (and all further cycles) - 28 days

Day: 1

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

Take in the morning with food.

CYCLOPHOSPHamide 300 mg/m² oral administration
Instructions:

Take each dose with food and a large glass of water, preferably in the morning.

Round each dose to closest multiple of 50 mg tablets.

bortezomib * 1.5 mg/m² subcutaneous injection
Instructions:

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

Day: 8

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

Take in the morning with food.

CYCLOPHOSPHamide 300 mg/m² oral administration
Instructions:

Take each dose with food and a large glass of water, preferably in the morning.

Round each dose to closest multiple of 50 mg tablets.

bortezomib * 1.5 mg/m² subcutaneous injection
Instructions:

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

Day: 15

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

Take in the morning with food.

CYCLOPHOSPHamide 300 mg/m² oral administration
Instructions:

Take each dose with food and a large glass of water, preferably in the morning.

Round each dose to closest multiple of 50 mg tablets.

bortezomib * 1.5 mg/m² subcutaneous injection
Instructions:

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

Day: 22

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

Take in the morning with food.

CYCLOPHOSPHamide 300 mg/m² oral administration
Instructions:

Take each dose with food and a large glass of water, preferably in the morning.

Round each dose to closest multiple of 50 mg tablets.

bortezomib * 1.5 mg/m² subcutaneous injection
Instructions:

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

Supportive Care Factors

Factor Value
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: Medium to high
Gastroprotection: Gastroprotection may be considered
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis 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

Ong, S. Y., H. Y. Ng, S. Surendran, et al. 2015. "Subcutaneous bortezomib combined with weekly cyclophosphamide and dexamethasone is an efficient and well tolerated regime in newly diagnosed multiple myeloma." Br J Haematol 169(5):754-756. , PMID: 25413901

Bringhen S, Larocca A, Rossi D et al. 2010. "Efficacy and safety of once-weekly bortezomib in multiple myeloma patients". Blood. Dec 2;116(23):4745-53., PMID: 20807892

Tuchman, S. A., J. O. Moore, C. D. DeCastro, et al. 2017. "Phase II study of dose-attenuated bortezomib, cyclophosphamide and dexamethasone ("VCD-Lite") in very old or otherwise toxicity-vulnerable adults with newly diagnosed multiple myeloma." J Geriatr Oncol 8(3):165-169. , PMID: 28256432

Morgan, G. J., J. A. Child, W. M. Gregory, et al. 2011. "Effects of zoledronic acid versus clodronic acid on skeletal morbidity in patients with newly diagnosed multiple myeloma (MRC Myeloma IX): secondary outcomes from a randomised controlled trial." Lancet Oncol 12(8):743-752. , PMID: 21771568

Kropff, M., G. Bisping, E. Schuck, et al. 2007. "Bortezomib in combination with intermediate-dose dexamethasone and continuous low-dose oral cyclophosphamide for relapsed multiple myeloma." Br J Haematol 138(3):330-337. , PMID: 17614819

Mateos, M. V., S. Bringhen, P. G. Richardson, et al. 2014. "Bortezomib cumulative dose, efficacy, and tolerability with three different bortezomib-melphalan-prEDNIsone regimens in previously untreated myeloma patients ineligible for high-dose therapy." Haematologica 99(6):1114-1122. , PMID: 24763402

Tanaka, K.,Toyota, S., Akiyama M., et al. 2018 “Efficacy and Safety of a Weekly Cyclophosphamide-Bortezomib-Dexamethasone Regimen as Induction Therapy Prior to Autologous Stem Cell Transplantation in Japanese Patients with Newly Diagnosed Multiple Myeloma: A Phase 2 Multicenter Trial.” Acta Haematology 141:111-118., PMID: 30726834

Reeder, C. B., D. E. Reece, V. Kukreti, et al. 2010. "Once- versus twice-weekly bortezomib induction therapy with CyBorD in newly diagnosed multiple myeloma." Blood 115(16):3416-3417. , PMID: 20413666

Simpson, D., R. McCulloch, J. Liang, et al. 2013. "Weekly Subcutaneous Bortezomib Is Well Tolerated and Effective As Initial Therapy Of Symptomatic Myeloma." 53rd ASH Annual Meeting, Abstract: 3229.

Reece, D. E., G. P. Rodriguez, C. Chen, S. Trudel, V. Kukreti, J. Mikhael, M. Pantoja, W. Xu and A. K. Stewart. 2008. "Phase I-II trial of bortezomib plus oral cyclophosphamide and prEDNIsone in relapsed and refractory multiple myeloma." J Clin Oncol 26(29):4777-4783. , PMID: 18645194

Moore, S., S. Atwal, S. Sachchithanantham, et al. 2013. "Weekly intravenous bortezomib is effective and well tolerated in relapsed/refractory myeloma." Eur J Haematol 90(5):420-425. , PMID: 23294279

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.