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HYPERCVAD+RITU
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
This Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
riTUXimab
New Drug Funding Program
(Rituximab (Biosimilar IV) and Rituximab SC - Aggressive Histology Lymphoma)
riTUXimab
New Drug Funding Program
(Rituximab (Biosimilar IV) and Rituximab SC - HIV-Related Aggressive Histology B-cell Lymphoma)
riTUXimab (subcut)
New Drug Funding Program
(Rituximab (Biosimilar IV) and Rituximab SC - Aggressive Histology Lymphoma)
riTUXimab (subcut)
New Drug Funding Program
(Rituximab (Biosimilar IV) and Rituximab SC - HIV-Related Aggressive Histology B-cell Lymphoma)
dexamethasone
ODB - General Benefit
(dexamethasone)
Note: Different rituximab products are NOT INTERCHANGEABLE.
This regimen consists of 8 alternating courses of Course A (cyclophosphamide, vincristine, doxorubicin, dexamethasone and rituximab) and Course B (methotrexate, cytarabine and rituximab), given every 21 to 28 days (A-B-A-B-A-B-A-B).
The following includes regimen details for Course A, adapted for outpatient administration.
Cycle 1 of Course A (Cycle 1 of HYPERCVAD):
Rituximab IV - All patients must receive their first dose of rituximab by IV infusion.
| riTUXimab | 375 mg /m² | IV | Day 1 |
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cyclophosphamide † | 300 mg /m² | IV | q12h, on Days 1 to 3 |
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(Total dose per cycle = 1800 mg/m2) |
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| DOXOrubicin | 50 mg /m² | IV | Day 4* |
| vinCRIStine | 1.4 mg /m² | IV (max 2 mg) | Days 4* and 11 |
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dexamethasone ^ | 40 mg | PO | Days 1, 2, 3, 4, 11, 12, 13, 14 |
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Rituximab IV |
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| riTUXimab | 375 mg /m² | IV | Day 1 |
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Rituximab (subcut):
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| riTUXimab (subcut) | 1400 mg | Subcut | Day 1 |
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cyclophosphamide † | 300 mg /m² | IV | q12h, on Days 1 to 3 |
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(Total dose per cycle = 1800 mg/m2) |
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| DOXOrubicin | 50 mg /m² | IV | Day 4* |
| vinCRIStine | 1.4 mg /m² | IV (max 2 mg) | Days 4* and 11 |
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dexamethasone ^ | 40 mg | PO | Days 1, 2, 3, 4, 11, 12, 13, 14 |
Consider CNS prophylaxis with IT methotrexate and cytarabine.
†Consider mesna, as per local protocols.
*some centres may administer on day 3
^On Day 1 to be given as part of premedication before riTUXimab
For Course B (inpatient), refer to local protocols.
REPEAT EVERY 21 TO 28 DAYS (alternating with Course B) for a usual total of 8 cycles unless disease progression or unacceptable toxicity
Thomas DA, Faderl S, O'Brien S, et al. Chemoimmunotherapy with hyper-CVAD plus rituximab for the treatment of adult Burkitt and Burkitt-type lymphoma or acute lymphoblastic leukemia. Cancer 2006;106(7):1569-80.
Thomas DA, Kantarjian HM, Cortes J, et al. Long-term outcome after hyper-CVAD and rituximab chemoimmunotherapy for Burkitt (BL) or Burkitt-like (BLL) leukemia/lymphoma and mature B-cell acute lymphocyte leukemia (ALL) [abstract]. Blood 2008;112:Abstract 1929.
Lugtenburg P, Avivi I, Berenschot H et al. Efficacy and safety of subcutaneous and intravenous rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone in first-line diffuse large B-cell lymphoma: the randomized MabEase study. Haematologica. 2017;102(11):1913-1922.
Rummel M, Kim TM, Aversa F et al. Preference for subcutaneous or intravenous administration of rituximab among patients with untreated CD20+ diffuse large B-cell lymphoma or follicular lymphoma: results from a prospective, randomized, open-label, crossover study (PrefMab). Ann Oncol. 2017;28(4):836-842.
April 2022 Updated Drug regimen section
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
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