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Systemic Anti-Cancer Therapy Regimen Library

Home > PCN - CTDa [CYCLOPHOSPHamide, thalidomide and dexamethasone] [attenuated dose]

PCN - CTDa [CYCLOPHOSPHamide, thalidomide and dexamethasone] [attenuated dose]

Treatment Overview

Cycle 1 (and all further cycles) - 28 days

Cycle length:
28

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

CYCLOPHOSPHamide: Clinicians may choose to omit the day 22 dose.

Thalidomide dose: Consider increasing once every 4 weeks in 50 mg increments as tolerated up to 200 mg orally ONCE daily.

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 500 mg flat dosing oral administration 1, 8, 15,
22
thalidomide * 50 mg Once daily oral administration 1 to 28

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

CYCLOPHOSPHamide: Clinicians may choose to omit the day 22 dose.

Thalidomide dose: Consider increasing once every 4 weeks in 50 mg increments as tolerated up to 200 mg orally ONCE daily.

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.

Consider dose reduction to 20 mg in older or frail patients.
CYCLOPHOSPHamide 500 mg flat dosing oral administration
Instructions:

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

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Day: 2

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Day: 3

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Day: 4

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Day: 6

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.
CYCLOPHOSPHamide 500 mg flat dosing oral administration
Instructions:

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

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Day: 11

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.
CYCLOPHOSPHamide 500 mg flat dosing oral administration
Instructions:

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

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.
CYCLOPHOSPHamide 500 mg flat dosing oral administration
Instructions:

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

Clinicians may choose to omit this dose.
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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

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.

Consider increasing dose once every 4 weeks in 50 mg increments as tolerated up to 200 mg.

Additional details:

Additional details

Section 1: Teratogenic effects

All patients must fulfil the requirements of the pregnancy protection 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, 22; Thalidomide alone MINIMAL to LOW.

References

King, T. and B. Faiman. 2017. "Steroid-Associated Side Effects: A Symptom Management Update on Multiple Myeloma Treatment." Clin J Oncol Nurs 21(2):240-249., PMID: 28315528

Rajkumar, S. V., S. Jacobus, N. S. Callander, R. et al. 2010. "Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial." Lancet Oncol 11(1):29-37. , PMID: 19853510

Kyriakou, C., K. Thomson, S. D'Sa, A. Flory, J. Hanslip, A. H. Goldstone and K. L. Yong. 2005. "Low-dose thalidomide in combination with oral weekly cyclophosphamide and pulsed dexamethasone is a well tolerated and effective regimen in patients with relapsed and refractory multiple myeloma." Br J Haematol 129(6):763-770. , PMID: 15953002

Morgan, G. J., F. E. Davies, W. M. Gregory, et al. 2012. "Cyclophosphamide, thalidomide, and dexamethasone as induction therapy for newly diagnosed multiple myeloma patients destined for autologous stem-cell transplantation: MRC Myeloma IX randomized trial results." Haematologica 97(3):442-450. , PMID: 22058209

Hungria, V. T., E. Q. Crusoe, A. Maiolino, et al. 2016. "Phase 3 trial of three thalidomide-containing regimens in patients with newly diagnosed multiple myeloma not transplant-eligible." Ann Hematol 95(2):271-278. , PMID: 26518211

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

Delforge, M., J. Blade, M. A. Dimopoulos, et al. 2010. "Treatment-related peripheral neuropathy in multiple myeloma: the challenge continues." Lancet Oncol 11(11):1086-1095. , PMID: 20932799

Rajkumar SV, Jacobus S, Callander NS et al. 2010 " Lenalidomide plus high-dose dexamethasone versus lenalidomide plus low-dose dexamethasone as initial therapy for newly diagnosed multiple myeloma: an open-label randomised controlled trial."Lancet Oncol. 2010 Jan;11(1):29-37. , PMID: 19853510

Dimopoulos, M. A., G. Hamilos, A. Zomas, D. Gika, E. Efstathiou, V. Grigoraki, C. Poziopoulos, I. Xilouri, M. P. Zorzou, N. Anagnostopoulos and A. Anagnostopoulos. 2004. "Pulsed cyclophosphamide, thalidomide and dexamethasone: an oral regimen for previously treated patients with multiple myeloma." Hematol J 5(2):112-117. , PMID: 15048060

Garcia-Sanz, R., J. R. Gonzalez-Porras, J. M. Hernandez, . et al. 2004. "The oral combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) is effective in relapsed/refractory multiple myeloma." Leukemia 18(4):856-863. , PMID: 14973508

Sidra, G., C. D. Williams, N. H. Russell, S. Zaman, B. Myers and J. L. Byrne. 2006. "Combination chemotherapy with cyclophosphamide, thalidomide and dexamethasone for patients with refractory, newly diagnosed or relapsed myeloma." Haematologica 91(6):862-863. , PMID: 16769594

Wechalekar, A. D., H. J. Goodman, H. J. Lachmann, M. Offer, P. N. Hawkins and J. D. Gillmore. 2007. "Safety and efficacy of risk-adapted cyclophosphamide, thalidomide, and dexamethasone in systemic AL amyloidosis." Blood. 109(2):457-464. , PMID: 16990593

Venner, C. P., J. D. Gillmore, S. Sachchithanantham, et al. 2014. "A matched comparison of cyclophosphamide, bortezomib and dexamethasone (CVD) versus risk-adapted cyclophosphamide, thalidomide and dexamethasone (CTD) in AL amyloidosis." Leukemia 28(12):2304-2310. , PMID: 25027514

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.