Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
CODOXM+RITU
(Burkitt's Lymphoma)
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)
Note: Different rituximab products are NOT INTERCHANGEABLE.
Adapted for outpatient administration:
Cycle 1: All patients must receive their first dose of rituximab by IV infusion.
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riTUXimab 1 | 375 mg /m² | IV | Day 1 |
| cyclophosphamide | 800 mg /m² | IV | Day 1 |
| vinCRIStine | 1.5 mg /m² | IV (maximum 2 mg) | Days 1 and 8 |
| DOXOrubicin | 40 mg /m² | IV | Day 1 |
| cytarabine | 70 mg | IT | Days 1 and 3 |
| cyclophosphamide | 200 mg /m² | IV | Days 2 to 5 |
| methotrexate | 12 mg | IT | Day 15 |
|
Rituximab IV: |
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riTUXimab 1 | 375 mg /m² | IV | Day 1 |
|
OR Rituximab (subcut): |
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riTUXimab (subcut) 1 | 1400 mg | Subcut | Day 1 |
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| cyclophosphamide | 800 mg /m² | IV | Day 1 |
| vinCRIStine | 1.5 mg /m² | IV (maximum 2 mg) | Days 1 and 8 |
| DOXOrubicin | 40 mg /m² | IV | Day 1 |
| cytarabine | 70 mg | IT | Days 1 and 3 |
| cyclophosphamide | 200 mg /m² | IV | Days 2 to 5 |
| methotrexate | 12 mg | IT ` | Day 15 |
1 dose may be postponed to later in the cycle if clinically indicated
Note: High-dose methotrexate (day 10) and leucovorin (start day 11) are given as inpatient.
REPEAT EVERY 21 DAYS
The MAGRATH regimen comprises of CODOX-M ± IVAC*.
Three cycles of CODOX-M are used for low-risk patients.
Four cycles of alternating CODOX-M and IVAC (total of 2 cycles of CODOX-M and 2 cycles of IVAC) are used for high-risk patients.
(*IVAC is given as inpatient.)
Moderate (D1-5)
Minimal (D8, 15)
Other Supportive Care:
Also refer to CCO Antiemetic Recommendations.
Barnes JA, Lacasce AS, Feng Y, et al. Evaluation of the addition of rituximab to CODOX-M/IVAC for Burkitt's lymphoma: a retrospective analysis. Ann Oncol 2011;22(8):1859-64.
Lacasce A, Li HS, Fisher D, et al. Modified Magrath regimens for adults with Burkitt and Burkitt-like lymphomas: preserved efficacy with decreased toxicity. Leukemia & Lymphoma 2004;45(4):761–7.
Magrath IT, Adde M, Shad A et al. Adults and children with small non-cleaved-cell lymphoma have a similar excellent outcome when treated with the same chemotherapy regimen. J Clin Oncol 1996;14:925-34.
Magrath IT, Janus C, Edwards BK, et al. An effective therapy for both undifferentiated (including Burkitt’s) lymphomas and lymphoblastic lymphomas in children and young adults. Blood 1984;63:1102-11.
Maruyama D, Watanabe T, Maeshima AM, et al. Modified cyclophosphamide, vincristine, doxorubicin, and methotrexate (CODOX-M)/ifosfamide, etoposide, and cytarabine (IVAC) therapy with or without rituximab in Japanese adult patients with Burkitt lymphoma (BL) and B cell lymphoma, unclassifiable, with features intermediate between diffuse large B cell lymphoma and BL. Int J Hematol 2010;92(5):732-43.
Mead GM, Sydes MR, Walewski J, et al. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002;13(8):1264-74.
Mead GM, Barrans SL,Qian W, et al. A prospective clinicopathologic study of dose-modified CODOX-M/IVAC in patients with sporadic Burkitt lymphoma defined using cytogenetic and immunophenotypic criteria (MRC/NCRI LY10 trial). Blood 2008;112:2248-60.
Mohamedbhai SG, Sibson K, Marafioti T, et al. Rituximab in combination with CODOX-M/IVAC: a retrospective analysis of 23 cases of non-HIV related B-cell non-Hodgkin lymphoma with proliferation index >95%. Br J Haematol 2011;152(2):175-81.
Noy A, Lee JY, Cesarman E, et al. AMC 048: modified CODOX-M/IVAC-rituximab is safe and effective for HIV-associated Burkitt lymphoma. Blood. 2015 Jul 9;126(2):160-6.
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.
August 2020 Updated NDFP forms and interchangeability information in 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.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
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