Non-Hodgkin's Lymphoma Drug Summary

Last updated: 24 October 2025
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Antidotes & Detoxifying Agents

Drug Dosage Remarks
Leucovorin
(Calcium folinate)		 15 mg PO/IM/IV 6 hourly x 10 doses within 24 hours after initiation of Methotrexate
infusion
Continue administration until
Methotrexate serum level is <0.05
µM		 Adverse Reactions
  • GI effects (nausea/vomiting); Dermatologic effects (rash, pruritus, erythema, urticaria); Other effect (pyrexia)
Special Instructions
  • Not to be given intrathecally or intraventricularly
  • Contraindicated in patients with pernicious anemia and other megaloblastic anemias secondary to vitamin B12 deficiency
  • Use with caution in patients with undiagnosed megaloblastic anemia, folate dependent tumors, renal insufficiency
  • Monitor CBC, electrolytes, liver function tests (LFTs), calcium levels (if given with 5-FU)
Mesna 600 mg/m2/day IV after initiation of Cyclophosphamide infusion Adverse Reactions
  • CV effects (palpitations, chest pain); GI effects (abdominal pain/colic, diarrhea, nausea/vomiting, dry mouth, mucosal irritation, constipation, flatulence, gingival bleeding, epigastric pain/burning); CNS effects (headache, light headedness, lethargy, drowsiness, dizziness, paresthesia, hyperesthesia, hypoesthesia, syncope); Respiratory effects (dyspnea, bronchospasm, epistaxis, nasal congestion, cough, laryngeal discomfort, pleuritic pain, hypoxia, respiratory distress); Dermatologic effects (drug rash with eosinophilia and systemic symptoms [DRESS], pruritus, hyperhidrosis, Stevens-Johnson syndrome, toxic epidermal necrolysis); Musculoskeletal effects (arthralgia, myalgia, back pain, extremity pain, jaw pain, rigors); Other effects (fatigue, malaise, pyrexia, infusion site reactions, influenza-like illness, flushing)
Special Instructions
  • May be taken with or without food
  • Use with caution in patients with autoimmune disorders, urothelium damage associated with oxazaphosphorines or pelvic irradiation, conditions associated with inadequate response at standard doses (eg history of urinary tract disease), history of hypersensitivity to thiol compounds

Cancer Immunotherapy

Drug Dosage Remarks
Interferon alfa-2b Cutaneous T-cell lymphoma:
1-2 MIU/injection site IM/SC 3x/week x 4 weeks
NHL: 5 MIU SC 3x/week		 Adverse Reactions
  • CNS effects (asthenia, headache); Hematologic effects (decreased leukocytes and platelets); GI effects (nausea, diarrhea, anorexia); Other effects (pain at injection site, flu-like syndrome, fever, hyperthermia, myalgia)
Special Instructions
  • Contraindicated in patients with severe cardiac disease, epilepsy and/or compromised CNS function, current or history of psychiatric condition, severe renal or hepatic impairment
  • Use with caution in patients DM, hepatic impairment
  • Monitor CBC with differential, LFTs, electrolytes and lipid levels at baseline and periodically during treatment

Cytotoxic Chemotherapy

Drug Dosage Remarks
Belinostat Peripheral T-cell lymphoma (relapsed/refractory):
1,000 mg/m2 IV infusion over 30 minutes 24 hourly on days 1-5 every 21 days until disease progression or unacceptable toxicity		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, leukopenia, anemia); GI effects (nausea/vomiting, diarrhea); Other effects (tumor lysis syndrome, LFT abnormalities)
Special Instructions
  • Contraindicated in patients with active infections
  • Use with caution in patients with history of extensive or intensive chemotherapy, advanced disease and/or high tumor burden, hepatic impairment
  • Monitor CBC with platelets and differential at baseline and weekly thereafter; serum chemistries, electrolytes, LFT, kidney function at baseline and before each cycle; signs and symptoms of GI toxicity, tumor lysis syndrome, bleeding and infection
Bendamustine Recommended dose:
120 mg/m2 IV over 60 minutes on day 1 and 2 of a 21-day cycle, up to 8 cycles		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, dry mouth, constipation, stomatitis); Respiratory effects (cough, pneumonia, pulmonary fibrosis); CNS effect (headache); Hematologic effects (febrile neutropenia, hypokalemia, myelodysplastic syndrome); CV effect (cardiac failure); Renal effect (renal failure); Other effects (pyrexia, fatigue, malaise, weakness, mucosal inflammation, dehydration)
Special Instructions
  • Monitor for signs of infection, infusion reactions, anaphylaxis, tumor lysis syndrome, skin reactions
  • Contraindicated in patients with CrCl <40 mL/min, moderate-severe hepatic impairment
  • Use with caution in patients with mild-moderate renal impairment, mild hepatic dysfunction
Bleomycin 15-30 mg IV/IM/SC twice weekly
or
5-15 mg intra-arterial twice weekly
May be adjusted to 24 hourly or weekly		 Adverse Reactions
  • Respiratory effects (interstitial pneumonia, pulmonary fibrosis); GI effects (anorexia, nausea/vomiting, stomatitis); Dermatologic effects (change of nail, skin sclerosis, pigmentation, alopecia, rash, urticaria); Other effects (weight loss, general malaise, fever, rigors)
Special Instructions
  • Watch out for signs of appearance/worsening of infection, bleeding tendencies
  • Contraindicated in patients with serious pulmonary function impairment, fibrotic lesions, serious renal function disorder, serious cardiac disease, radiation on the chest area
Chlorambucil Monotherapy:
Initial dose: 100-200 mcg/kg PO 24 hourly x 4-8 weeks
or
150 mcg/kg/day PO until the total leukocyte count falls to 10,000 mL
Maintenance dose:
30-100 mcg/kg/day PO
Max dose:
100 mcg/kg/day		 Adverse Reactions
  • Hematologic effects (leukopenia, neutropenia, acute secondary malignancies, bone marrow suppression, thrombocytopenia, pancytopenia, anemia); CNS effects (seizures in children with nephrotic syndrome, movement disorders, seizures, peripheral neuropathy); Respiratory effects (interstitial pneumonia, interstitial pulmonary fibrosis); Hepatic effects (hepatotoxicity, jaundice); GI effects (nausea/vomiting, oral ulceration, diarrhea); Other effects (irreversible bone marrow failure, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug fever, sterile cystitis, allergic reactions)
Special Instructions
  • Should be taken on an empty stomach
  • Use with caution in patients with renal/hepatic impairment, seizure disorder, acute secondary malignancies, children with nephrotic syndrome
  • Contraindicated in patients with recent chemoradiotherapy
  • Vaccination with live vaccines is not recommended
  • Not to exceed >0.1 mg/kg body wt/day in patients with bone marrow lymphocytic infiltration
Cladribine Hairy cell leukemia:
90 mcg/kg IV infusion 24 hourly x 7 days or
140 mcg/kg SC 24 hourly x 5 days		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia, thrombocytopenia, bone marrow hypocellularity, hemolytic anemia); GI effects (nausea, abdominal pain, GI disturbance); Respiratory effects (abnormal breath/chest sounds, cough, dyspnea, lung infiltration, interstitial lung disease, pneumonitis, pulmonary fibrosis); CNS effects (confusion, neuropathy, ataxia, insomnia, somnolence, peripheral sensory and motor neuropathies, polyneuropathy); Dermatologic effects (rash, pruritus, urticaria, purpura); Other effects (fever, chills, diaphoresis, fatigue, malaise, headache, anxiety, dizziness, edema, tachycardia, hypotension, arthralgia, myalgia, conjunctivitis)
Special Instructions
  • Contraindicated in patients with moderate-severe renal/hepatic impairment
  • Use with caution in patients with pre-existing hematologic or immunologic abnormalities, active infection, high tumor burden, at risk of developing hyperuricemia, hepatic/renal impairment
Cyclophosphamide 2-6 mg/kg PO weekly in
divided doses or IV as a
single dose
Continuous treatment:
3-6 mg/kg IV 24 hourly or
50-200 mg PO 24 hourly
Intermittent dose regimen: 10-15 mg/kg IV every 2-5 days
High-dose intermittent regimen: 20-40 mg/kg IV every 10-20 days
Maintenance dose:
50-200 mg PO 24 hourly		 Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, mucositis, GI disturbances); GU effects (acute hemorrhagic cystitis, urinary fibrosis, renal tubular necrosis); Dermatologic effects (alopecia, rash, pigment changes in palms, fingernails and soles); Respiratory effects (rhinorrhea, nasal congestion); Other effects (fertility impairment, syndrome of inappropriate antidiuretic hormone secretion [SIADH] may occur with doses >50 mg/kg, leukopenia, headache)
Special Instructions
  • Should be taken on an empty stomach
  • Use with caution in patients with hepatic/renal impairment, electrolyte imbalance, previous radiotherapy, DM, pre-existing heart disease, weakened immune system, elderly, debilitated patients
  • Contraindicated in patients with bladder hemorrhage, bone marrow aplasia, acute infection, drug-/radiation-induced urothelial toxicity, porphyria, severe hepatic impairment
Cytarabine Adult: 100-200 mg/m2
BSA via rapid IV 12 hourly
or 100 mg/m2 BSA via continuous IV infusion 24 hourly x 5-7 days
depending on response and toxicity
Maintenance dose:
1-1.5 mg/kg IV/IM/SC 1-2x weekly
Refractory disease:
3 g/m2 BSA IV infusion 12 hourly x 6 days
Should be given as IV infusion over at least 1 hour
Children: 100 mg/m2 BSA
via rapid IV 12 hourly or via continuous IV infusion 24 hourly x 5-7 days		 Adverse Reactions
  • Hematologic effects (bone marrow depression, leukopenia); CNS effects (dementia, neurotoxicity, cerebellar dysfunction); Dermatologic effects (rashes, ulceration, erythroderma or erythema, mottled skin, pruritus); GI effects (nausea/vomiting, diarrhea, GI disturbances, GI hemorrhage, esophagitis, oral/anal ulceration); Other effects (hepatic/renal dysfunction, conjunctivitis, flu-like syndrome, anaphylactoid reactions)
  • Potentially fatal: Respiratory distress syndrome, pulmonary edema, bone marrow suppression, infections
Special Instructions
  • Contraindicated in patients with severe bone marrow depression, severe hepatic/renal impairment, pre-existing severe infections, peptic ulcer & recent surgery
  • Use with caution in patients with renal/hepatic dysfunction
  • Avoid concomitant immunization with live vaccines
  • Monitor WBC, platelet count, serum uric acid levels, renal/hepatic function, CNS and lung function
Denileukin
diftitox		 9-18 mcg/kg/day IV over 30-60 minutes for 5 consecutive days every 21 days for 8 cycles Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, anorexia, dysgeusia); CV effects (peripheral edema, hypotension); Musculoskeletal effects (rigor, myalgia, back pain, arthralgia); Ophthalmologic reaction (visual loss); CNS effects (headache, dizziness); Respiratory effects (cough, upper respiratory tract infection [URTI], dyspnea); Dermatologic effects (rash, pruritus); Other effects (infusion reactions, capillary leak syndrome, pyrexia, fatigue, asthenia, chest pain)
Special Instructions
  • Should not be given as bolus injection, with serum albumin <3.0 g/dL, or with presence of adverse infusion reactions
Doxorubicin 60-75 mg/m2 IV 3 weekly
Cumulative dose:
450-550 mg/m2		 Adverse Reactions
  • Dermatologic effects (injection site reaction, alopecia, urticaria, rash, skin and nail hyperpigmentation); GI effects (nausea/vomiting, stomatitis, GI ulceration, diarrhea, loss of appetite); GU effects (urinary frequency, hematuria); Hematologic effects (leukopenia, anemia, neutropenia, thrombocytopenia); CV effects (transient ECG abnormalities, decreased ejection fraction, CHF); Other effects (fever, chills discoloration of body fluids, hyperuricemia, infertility, bronchospasm, dyspnea, conjunctivitis)
  • Potentially fatal: Bone marrow suppression, cardiotoxicity
Special Instructions
  • Not to be given as IM/SC
  • Contraindicated in patients with severe cardiac disease, severe myelosuppression secondary to antitumor chemo/radiotherapy, hypersensitivity to anthracyclines, severe hepatic impairment
  • Use with caution in patients with history of mediastinal irradiation, hepatic impairment, hypertensive cardiomegaly
  • Avoid concomitant administration with live vaccines
  • Monitor CBC and ECG prior to, during and post-therapy
Epirubicin Monotherapy:
60-90 mg/m2 IV 3-4 weekly
May divide dose over 2-3 days
May administer as slow injection for 3-5 minutes or as IV infusion over 30 minutes
Max dose:
0.9-1 g/m2
Palliative dose:
12.5-25 mg/m2 IV 1x weekly		 Adverse Reactions
  • CNS effects (changes in sensorium, fever); GI effects (nausea/vomiting, diarrhea, loss of appetite, mucositis, esophagitis, stomatitis); Dermatologic effects (injection site reaction, alopecia, anaphylaxis, rash); Hematologic effects (leukopenia, thrombocytopenia, anemia, granulocytopenia, febrile neutropenia); Other effects (menstrual dysfunction, hot flushes, infection, dehydration)
Special Instructions
  • Do not give via IM/SC
  • Avoid in patients with cardiac disease (severe myocardial insufficiency, severe arrhythmias and recent MI), severe hepatic impairment, previous treatment with maximum cumulative dose of anthracyclines and in patients with baseline neutrophil count 1,500 cells/mm3
  • Use with caution in patients with pre-existing cardiac disease, hepatic and renal dysfunction and in patients who have previously received anthracyclines
  • Avoid concomitant administration of live vaccines
  • Monitor cardiac function, blood counts, total bilirubin, AST and creatinine prior to and throughout therapy
  • May cause secondary leukemia
Etoposide 50-100 mg/m2/day IV infusion over 30-60 minutes for 1-5 consecutive days
Max dose: 400 mg/m2/cycle
(21 days/cycle)		 Adverse Reactions
  • GI effects (nausea/vomiting, abdominal pain, anorexia, diarrhea, stomatitis); Other effects (myelosuppression, arterial hypotension, cardiotoxicity)
Special Instructions
  • Contraindicated in patients with severe bone marrow suppression, severe hepatic/renal dysfunction, acute infections
  • Use with caution in patients with hepatic/renal dysfunction, alcoholism, epilepsy
  • Monitor hematologic function prior to initiation, during, and after treatment
Fludarabine 40 mg/m2 BSA PO 24 hourly x 5 days
or
25 mg/m2 BSA IV via bolus injection or infusion over 30 minutes 24 hourly x 5 days
May repeat every 28 days x 6 cycles		 Adverse Reactions
  • CNS effects (peripheral neuropathy, agitation, confusion, visual disturbances, coma, progressive encephalopathy); Resp effects (cough, dyspnea, pneumonia); GI effects (nausea/vomiting, diarrhea, stomatitis); Hematologic effects (hemolytic anemia, neutropenia, thrombocytopenia); Other effects (infections, fever, chills, edema, tumor lysis syndrome, skin rashes, blindness, fatigue, weakness)
  • Potentially fatal: Myelosuppression, autoimmune hemolytic anemia
Special Instructions
  • Contraindicated in patients with renal impairment (CrCl <30 mL/min), decompensated hemolytic anemia
  • Use with caution in patients with renal/hepatic impairment
  • Not to be given with live vaccines
  • Monitor CBC and Hgb concentration, signs of autoimmune hemolytic anemia, tumor lysis syndrome in patients with high tumor burden
Ifosfamide Individualize dosing
30-60 mg/kg/day IV infusion for 30-120 minutes x 5 consecutive
days
or
125-200 mg/kg as 24 hour IV infusion
May repeat every 3-4 weeks		 Adverse Reactions
  • Hematologic effects (thrombocytopenia, anemia, leukocytopenia); GI effects (nausea/vomiting); GU effects (hemorrhagic cystitis, renal tubular and glomerular dysfunction); Other effects (encephalopathy, alopecia, ovulation disturbances)
Special Instructions
  • Contraindicated in patients with severe bone marrow impairment, renal/severe hepatic impairment, urinary obstruction, bladder inflammation, acute infections
  • Use with caution in patients with unilateral nephrectomies, urinary tract obstruction, cystitis, brain metastasis, cerebral symptoms, electrolyte imbalance, previous radiotherapy, DM, hepatic/renal impairment
  • Monitor renal function, urinalysis, blood count regularly
Methotrexate Burkitt lymphoma:
10-25 mg PO 24 hourly for 4-8 days
May repeat dose after 7-10 days
Acute lymphoblastic leukemia:
Maintenance dose:
15 mg/m2 IM/PO once-twice weekly or
2.5 mg/kg IV every 14 days
Given with other antitumor agents
Mycosis fungoides:
50 mg IM weekly in 1-2 divided doses or
2.5-10 mg PO 24 hourly to induce remission		 Adverse Reactions
  • GI effects (stomatitis, gingivitis, nausea/vomiting, diarrhea, loss of appetite, intestinal perforation, abdominal pain); Dermatologic effects (alopecia, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis); Hematologic effects (leukopenia, anemia, thrombocytopenia); Other effects (hyperuricemia, menstrual dysfunction, fever, chills, dizziness, fatigue)
  • Potentially fatal: Pulmonary reactions (interstitial lung disease); neurotoxicity (leukoencephalopathy, paresis, demyelination)
Special Instructions
  • Should be taken on an empty stomach; may be taken with meals to reduce GI discomfort; avoid taking with milk-rich products
  • Use with caution in patients with pre-existing bone marrow suppression, renal or hepatic impairment, peptic ulcer disease and ulcerative colitis
  • Contraindicated in patients with poor nutritional status, active infections, pre-existing blood dyscrasias, severe renal/hepatic impairment, alcoholic liver disease, AIDS
  • Monitor hematological, renal/hepatic function, and GI toxicity regularly
Mitoxantrone Monotherapy:
Initial dose:
14 mg/m2 IV
Repeat dose after 21 days
May adjust dose depending on degree of myelosuppression
May reduce dose to 12 mg/m2 in debilitated patients or patients with previous chemotherapy
Combination regimen:
Initial dose:
10-12 mg/m2 IV		 Adverse Reactions
  • CV effects (arrhythmia, edema, ECG changes); GI effects (abdominal pain, anorexia, nausea/vomiting, constipation, diarrhea, GI bleeding, mucositis, stomatitis, dyspepsia, weight gain/loss); Dermatologic effects (alopecia, nail bed changes); GU effects (abnormal urine, UTI, hematuria); Respiratory effects (cough, dyspnea, URTI); Musculoskeletal effects (weakness, fatigue); Other effects (elevated LFTs, fever, pain, headache, amenorrhea, menstrual disorder, infection, sepsis, hyperglycemia, increased BUN and creatinine)
  • Potentially fatal: Myelosuppression, cardiotoxicity
Special Instructions
  • Use with caution in patients with pre-existing myelosuppression, hepatic impairment, extravasation, prior chest radiotherapy and concomitant cytotoxic therapy
  • Contraindicated in patients with multiple sclerosis with left ventricular ejection fraction (LVEF) <50% or clinically significant reduction in LVEF
  • Assess CBC and cardiac function regularly
Pegaspargase Acute lymphoblastic leukemia:
Children with BSA<0.6 m2:
82.5 u/kg IM/IV every 14 days
Children with BSA ≥0.6 m2 and adult ≤21 years old: 2,500 u/m2 IM/IV every 14 days
Adult >21 years old:
2,000 u/m2 IM/IV every 14 days		 Adverse Reactions
  • Hematologic effects (febrile neutropenia, hypofibrinogenemia, anemia, coagulopathy, prolonged prothrombin time, decreased blood fibrinogen, prolonged aPTT, increased INR); GI effects (diarrhea, abdominal pain, nausea/vomiting, stomatitis, ascites, hepatotoxicity, fatty liver, pancreatitis); CV effects (embolism, thrombosis); CNS effects (seizure, peripheral motor neuropathy, syncope); Respiratory effects (hypoxia); Dermatologic effects (rash, urticaria); Metabolic effects (increased ALT/AST, lipase, amylase, blood bilirubin, blood cholesterol, γ-glutamyl transferase, hyperglycemia, hypertriglyceridemia, hyperlipidemia, hypercholesterolemia, hypokalemia, hypoalbuminemia); Other effects (hypersensitivity, anaphylactic reaction, decreased appetite, decreased weight, infections, sepsis, pain in extremities)
Special Instructions
  • Contraindicated in patients with hypersensitivity, severe hepatic impairment (bilirubin >3 times ULN, transaminases >10x ULN, history of serious thrombosis or hemorrhagic events with prior L-asparaginase therapy, history of pancreatitis
  • Use with caution in patients with presence of anti-asparaginase Ab, risk of hypersensitivity reactions, pancreatitis, serious thrombotic events, osteonecrosis in the presence of glucocorticoids, infection due to myelosuppression, severe hepatic toxicity with other hepatotoxic products, increased prothrombin time, partial thromboplastin time, and hypofibrinogenemia, hyperbilirubinemia, CNS signs and symptoms manifesting as somnolence, confusion, convulsions, myelosuppression
Pralatrexate 30 mg/m2 IV push over 3-5 minutes once weekly x 6 weeks in 7-week cycles Adverse Reactions
  • Hematologic effects (thrombocytopenia, neutropenia, anemia, leukopenia); GI effects (mucositis, nausea/vomiting, constipation, diarrhea, abnormal LFTs, abdominal pain); Respiratory effects (cough, dyspnea, pharyngolaryngeal pain, URTI); Dermatologic effects (rash, pruritus); Other effects (fatigue, pyrexia, edema, hypokalemia, night sweats, asthenia, tachycardia)
Special Instructions
  • Use with caution in patients with bone marrow suppression, tumor lysis syndrome, mucositis, moderate-severe renal impairment
  • Monitor renal and liver function and systemic toxicity
  • Avoid use in patients with end stage renal disease including those undergoing dialysis
Romidepsin Cutaneous T-cell lymphoma with ≥1 prior systemic therapy:
14 mg/m2 BSA IV over a 4-hour period on days 1, 8 and 15 of a
28-day cycle		 Adverse Reactions
  • Hematologic effects (anemia, thrombocytopenia, neutropenia, leukopenia, lymphopenia); GI effects (nausea/vomiting, anorexia); Metabolic effects (hypomagnesemia, hypokalemia); Other effects (infections, fatigue, ECG T-wave changes, asthenia, pyrexia)
Special Instructions
  • Administer only in patients with normal serum potassium and magnesium
  • Use with caution in patients with hematologic toxicity, congenital long QT syndrome, history of significant CV disease, taking anti-arrhythmic medicines or medicinal products that can cause significant QT prolongation
  • Monitor CBC and platelet count, ECG, electrolytes during treatment
Tazemetostat 800 mg PO 12 hourly Adverse Reactions
  • Respiratory effect (URTI); GI effects (nausea, abdominal pain); Other effects (fatigue, musculoskeletal pain)
Special Instructions
  • May be taken with or without food
  • Monitor patients long-term for the development of secondary malignancies
Vincristine <10 kg or BSA<1 m2:
0.05 mg/kg weekly IV
Children: 1.5-2 mg/m2 BSA IV
Adult: 0.4-1.4 mg/m2 BSA IV
Doses to be given at weekly intervals		 Adverse Reactions
  • Psychiatric effects (depression, agitation, insomnia, hallucinations, episodes of altered consciousness); Hematologic effects (leukopenia, anemia, thrombocytopenia); GI effects (constipation, paralytic ileus, nausea/vomiting, diarrhea, stomatitis, stomach ulceration); GU effects (hyperuricemia, uric acid nephropathy, polyuria, dysuria, urinary retention due to bladder atony); CNS effects (myoclonic jerks, abnormal Valsalva response, headache, convulsions, coma, peripheral neuropathy, loss of deep tendon reflexes, peripheral paresthesias); Other effects (neurotoxicity, ADH hypersecretion, hyponatremia, fever, alopecia, diminished libido, impotence, hyper/hypotension)
Special Instructions
  • Should not be given IM, SC or intrathecally
  • Use with caution in patients with pre-existing neuromuscular disease, hepatic impairment, biliary obstruction, leukopenia or complicating infection, respiratory distress syndrome
  • Contraindicated in patients with demyelinating form of Charcot-Marie-Tooth syndrome, those receiving radiation therapy through ports that include the liver
  • Avoid extravasation
Vorinostat Cutaneous T-cell lymphoma
(progressive, persistent or
recurrent on or after 2 systemic
therapies):
400 mg PO 24 hourly until disease
progression or unacceptable toxicity		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, anorexia, constipation, decreased weight); Hematologic effects (thrombocytopenia, anemia); Other effects (fatigue, hyperglycemia, chills, dysgeusia, dry mouth, pulmonary embolism)
Special Instructions
  • Should be taken with food
  • Contraindicated in patients with severe hepatic impairment
  • Use with caution in patients with mild to moderate hepatic impairment, prior history of thromboembolic events
  • Monitor CBC, blood chemistry, electrolytes, glucose and serum creatinine every 2 weeks during the first 2 months of treatment and monthly thereafter

Targeted Cancer Therapy

Drug Dosage Remarks
Acalabrutinib Mantle cell lymphoma (with at least 1 prior therapy)
Monotherapy:
100 mg PO 12 hourly until disease progression or unacceptable toxicity 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, constipation, abdominal pain); Hematologic effects (hemorrhage/hematoma, decreased absolute neutrophil count, Hgb and platelets); Dermatologic effects (rash, bruising); CV effects (atrial fibrillation, atrial flutter); Other effect (epistaxis)
Special Instructions
  • Contraindicated in patients with severe hepatic impairment
  • Avoid concomitant use of H2-receptor antagonists
  • Use with caution in patients receiving antiplatelet or anticoagulant therapy, with serious infections
  • Monitor CBC, for signs and symptoms of infection, atrial fibrillation and atrial flutter, bleeding, skin cancers
Alemtuzumab Initial dose: 3 mg IV
infusion for 2-8 hours 24 hourly
May increase dose to 10 mg IV 24 hourly
Maintenance dose: 30 mg
IV 3x/week on alternate days
May be given up to 12 weeks
Max dose: 30 mg IV 3x/week 		Adverse Reactions
  • Respiratory effects (bronchospasm, syncope, pulmonary infiltrates, acute respiratory distress syndrome, respiratory arrest); CV effects (MI, cardiac arrest); Hematologic effects (neutropenia, thrombocytopenia, anemia, pancytopenia); Other effects (infusion-related reactions)
  • Potentially fatal: Serious infections, hematotoxicity, severe myelosuppression
Special Instructions
  • Contraindicated in patients with active systemic infection or underlying immunodeficiency
  • Assess CBC and platelet count weekly
  • Discontinue if signs of severe myelosuppression or infection occurs
Axicabtagene
ciloleucel		 Diffuse large B-cell lymphoma (relapsed/refractory):
Target dose:
2 x 106 CAR-positive viable
T-cells/kg body weight
Max dose:
2 x 108 CAR-positive viable
T-cells/kg body weight
Pre-treatment with lymphodepleting
chemotherapy regimen:
Cyclophosphamide 500 mg/m2 IV plus
Fludarabine 30 mg/m2 IV on 5th, 4th and 3rd day before infusion 		Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, constipation); CV effects (tachycardia, hypotension, cardiac arrhythmias); CNS effects (dizziness, tremor, headache, encephalopathy, aphasia, delirium, insomnia, anxiety); Hematologic effects (thrombocytopenia, neutropenia, anemia, febrile neutropenia); Other effects (cytokine release syndrome, fever, fatigue, decreased appetite, chills, infections, hypoxia, cough)
Special Instructions
  • Central venous access is recommended for infusion
  • Infuse within 30 minutes by either gravity or peristaltic pump
  • Premedicate with Paracetamol and Diphenhydramine 1 hour before infusion
  • Avoid prophylactic use of systemic corticosteroids
  • Avoid vaccination with live vaccines 6 weeks before lymphodepleting chemotherapy, during treatment and until immune recovery following treatment
  • Monitor CBC, for signs and symptoms of infection, neurologic toxicity, secondary malignancies
  • Screen for HBV, HCV and HIV prior to treatment
Bexarotene Cutaneous T-cell lymphoma
(refractory):
Initial dose: 300 mg/m2 PO 24 hourly
May increase dose if well tolerated to
Maintenance dose: 400 mg/m2 PO 24 hourly 		Adverse Reactions
  • CV effect (peripheral edema); CNS effects (headache, chills, insomnia); Dermatologic effects (exfoliative dermatitis, skin rash, xeroderma, alopecia); Endocrine/metabolic effects (hyperlipidemia, hypercholesterolemia, hypothyroidism, increased LDH); GI effects (diarrhea, anorexia, nausea/vomiting, abdominal pain); Hematologic effects (leukopenia, anemia); Other effects (weakness, back pain, flu-like symptoms, fever)
Special Instructions
  • Use with caution in patients with DM, hepatic impairment
  • Monitor CBC with differential at baseline and periodically during treatment, LFTs, thyroid function tests, fasting lipid panel
Blinatumomab MRD-positive B-cell precursor ALL:
Single cycle treatment consist of continuous IV infusion for 28 days followed by a 14-day treatment-free interval
Induction cycle 1:
<45 kg: 15 mcg/m2/day but not >28 mcg/day on days 1-28
≥45 kg: 28 mcg/day on days 1-28
Consolidation cycles 2-4:
<45 kg: 15 mcg/m2/day but not >28 mcg/day on days 1-28
≥45 kg: 28 mcg/day on days 1-28
Relapsed/refractory B-cell precursor
ALL:
Induction and consolidation cycles are followed by 14-day treatment-free intervals
Continued therapy cycles are followed by 56-day treatment-free intervals
Induction cycle 1:
<45 kg: 5 mcg/m2/day but not >9 mcg/day on days 1-7 followed by 15 mcg/m2/day but not >28 mcg/day on days 8-28
≥45 kg: 9 mcg/day on days 1-7 followed by 28 mcg/day on days 8-28
Induction cycle 2:
<45 kg: 15 mcg/m2/day but not >28 mcg/day on days 1-28
≥45 kg: 28 mcg/day on days 1-28
Consolidation cycles 3-5:
<45 kg: 15 mcg/m2/day but not >28 mcg/day on days 1-28
≥45 kg: 28 mcg/day on days 1-28
Continued therapy cycles 6-9:
<45 kg: 15 mcg/m2/day but not >28 mcg/day on days 1-28
≥45 kg: 28 mcg/day on days 1-28 		Adverse Reactions
  • Hematologic effects (lymphopenia, neutropenia, anemia, febrile neutropenia, thrombocytopenia); CNS effects (headache, tremor, encephalopathy, aphasia, seizure); GI effects (abdominal pain, nausea); Other effects (pyrexia, device-related infection, staphylococcal infection, overdose, edema, hypokalemia)
Special Instructions
  • Administer only as IV infusion at a constant flow rate using an infusion pump
  • Premedicate with Prednisone or equivalent 1 hour prior to first dose of each cycle or when restarting infusion after ≥4 hours interruption for patients with MRD-positive B-cell precursor ALL
  • Premedicate with Dexamethasone 1 hour prior to the first dose of each cycle, prior to a step dose and when restarting an infusion rate after an interruption of ≥4 hours for patients with refractory/relapsed B-cell precursor ALL
  • Use with caution in patients with serious infections, risk of neurological toxicities, history of neurologic signs and symptoms
  • Monitor for cytokine release syndrome, infusion reactions, serious adverse events, signs and symptoms of infections, tumor lysis syndrome, pancreatitis and progressive multifocal leukoencephalopathy which may require temporary interruption or discontinuation of treatment
  • Monitor CBC, absolute neutrophil count, renal function and fluid balance during infusion, and ALT, AST, gamma-glutamyl transferase and total bilirubin prior to start and during treatment
  • Vaccination with live vaccines is not recommended for at least 2 weeks prior to start, during treatment and until immune recovery after last cycle
Bortezomib Relapsed Mantle cell lymphoma:
Monotherapy:
Initial dose: 1.3 mg/m2/dose given as 3-5 seconds IV bolus twice weekly x 2 weeks followed by a 10-day rest period
Extended therapy:
1.3 mg/m2/dose given as 3-5 seconds IV bolus weekly x
4 weeks followed by a 13-day
rest period
Previously untreated Mantle cell lymphoma not eligible for
hematopoietic SCT:
Combination regimen (with Rituximab, Cyclophosphamide,
Doxorubicin and Prednisolone [VR-CAP]):
1.3 mg/m2/dose given as 3-5 seconds IV bolus twice weekly x 2 weeks followed by a 10-day rest period x 6 cycles		 Adverse Reactions
  • Hematologic effects (anemia, neutropenia, thrombocytopenia); CNS effects (peripheral neuropathy, paresthesias, headache, dizziness, dysesthesia); CV effects (hypotension, development/exacerbation of CHF, new onset of decreased LV ejection fraction); GI effects (nausea/vomiting, diarrhea, constipation); Respiratory effects (acute diffuse infiltrative pulmonary disease, acute respiratory distress syndrome, cough, dyspnea); Other effects (asthenia, pyrexia, decreased appetite, anorexia, fatigue, myalgia, arthralgia, rash)
Special Instructions
  • May re-initiate treatment at 25% reduced dose once toxicity resolves (1.3 mg/m2/dose reduced to 1 mg/m2/dose; 1 mg/m2/dose reduced to 0.7 mg/m2/dose)
  • Watch out for GI and hematological toxicities, clinical and laboratory signs of active HBV infection, neurological signs and symptoms suggestive of PML, new or worsening peripheral neuropathy
  • Use with caution in patients with high tumor burden, history of syncope, orthostatic/postural hypotension, dehydration, hepatic or renal impairment
  • Contraindicated in patients with hypersensitivity to boron, Mannitol and nitrogen and with acute diffuse infiltrative pulmonary and pericardial disease
  • Monitor platelet count prior to each dose
Brentuximab
vedotin		 1.8 mg/kg 30-min IV infusion 3 weekly
Max duration: 16 cycles		 Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, constipation, abdominal pain); Respiratory effects (pneumonia, URTI, cough, dyspnea); Hematologic effects (thrombocytopenia, anemia, neutropenia); Dermatologic effects (rash, alopecia, pruritus); Other effects (infections, peripheral sensory neuropathy, increased AST/ALT, arthralgia, myalgia, fatigue, pyrexia, infusion-related reactions, chills, decreased weight)
Special Instructions
  • Watch out for new or worsening neurological, cognitive/ behavioral signs/symptoms, abdominal pain, emergence of possible serious and opportunistic infections, immediate and delayed infusion-related reactions, neuropathy
  • Use with caution in patients with elevated BMI with or without DM, renal/hepatic impairment, on controlled Na diet
  • Obtain baseline CBC, serum glucose, LFTs
Brexucabtagene
autoleucel		 2 × 106 CAR-positive viable T cells/kg body weight IV
Max dose: 2 × 108 CAR-positive viable T cells/kg body wt		 Adverse Reactions
  • CV effects (tachycardia, hypotension, arrhythmia); GI effects (nausea, constipation, diarrhea); Respiratory effects (hypoxia, cough, dyspnea, pleural effusion); CNS effects (insomnia, aphasia, headache, encephalopathy); Other effects (pyrexia, cytokine release syndrome, fatigue, rash, infection – pathogen unspecified, chills, tremor, edema, musculoskeletal pain, motor dysfunction, decreased appetite)
Special Instructions
  • For autologous use only
  • Watch out for emergence of possible infections and hypogammaglobulinemia
  • Monitor CBC
Dabrafenib Unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options:
150 mg PO 12 hourly in combination with Trametinib until disease progression or
unacceptable toxicity		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, diarrhea); Musculoskeletal effects (arthralgia, myalgia); Other effects (headache, fatigue, pyrexia, chills, rash, hemorrhage, cough, edema)
Special Instructions
  • Taken on an empty stomach
  • Use with caution in patients with severe renal impairment, moderate to severe hepatic impairment
  • Monitor CBC at baseline and periodically during treatment, LFTs every 4 weeks after initiation of treatment and as clinically indicated; serum glucose, electrolytes and renal function regularly
Duvelisib Follicular lymphoma after ≥2 prior therapies:
25 mg PO 12 hourly		 Adverse Reactions
  • GI effects (diarrhea, colitis, nausea); Hematologic effects (anemia, neutropenia); Respiratory effects (cough, URTI, pneumonia); Other effects (rash, fatigue, pyrexia, musculoskeletal pain, sepsis)
Special Instructions
  • Use with caution in patients with serious infections, diarrhea or colitis, elevated ALT/AST, cutaneous reactions
  • Provide prophylaxis for Pneumocystis jirovecii and CMV
  • Use with caution in patients with infections, non-infectious diarrhea or colitis, cutaneous reactions, non-infectious pneumonitis, elevated AST/ ALT, thrombocytopenia, neutropenia
  • Monitor blood counts, hepatic function, signs and symptoms of infection, development of severe diarrhea and colitis
Epcoritamab Diffuse large B-cell lymphoma
and high-grade B-cell lymphoma with relapsed/refractory disease:
Cycle 1: 0.16 mg SC on day 1, 0.8 mg SC on day 8 followed by 48 mg SC on days 15 and 22 of a 28-day cycle
Cycles 2-3: 48 mg SC on days 1, 8, 15 and 22
Cycles 4-9: 48 mg SC on days 1 and 15
Cycle 10 and onwards: 48 mg SC on day 1 every 4 weeks
Follicular lymphoma (relapsed/refractory):
Cycle 1: 0.16 mg SC on day 1, 0.8 mg SC on day 8 followed by 3 mg SC on day 15 and 48 mg SC on day 22 of a 28-day cycle
Cycles 2-3: 48 mg SC on days 1, 8, 15 and 22
Cycles 4-9: 48 mg SC on days 1 and 15
Cycle 10 and onwards: 48 mg SC on day 1		 Adverse Reactions
  • GI effects (abdominal pain, nausea, diarrhea); Hematologic effects (decreased lymphocyte count, neutrophil count, white blood cell count, hemoglobin and platelets); Other effects (cytokine release syndrome, fatigue, rash, musculoskeletal pain, injection site reactions, pyrexia)
Special Instructions
  • Premedicate with a corticosteroid, an antihistamine and antipyretic before each dose in cycle1
  • Ensure adequate hydration before administration
  • Monitor CBC during treatment; monitor for signs and symptoms of infection and treat appropriately
Glofitamab Diffuse large B-cell lymphoma
(relapsed/refractory):
Cycle 1:
Administer Obinutuzumab on day 1 followed by Glofitamab 2.5 mg IV infusion on day 8 and 10 mg IV infusion on day 15 of a 21-day cycle
Cycles 2-12: 30 mg IV infusion on day 1		 Adverse Reactions
  • Most common include cytokine release syndrome, fatigue, rash, and musculoskeletal pain
Special Instructions
  • Premedicate with a corticosteroid, an antihistamine and antipyretic before each dose
  • Ensure adequate hydration before administration
  • Monitor patients for signs and symptoms of neurologic toxicity and infection
Ibritumomab
tiuxetan		 Day 1: Rituximab 250 mg/m2
IV infusion
Day 7, 8 or 9: Rituximab
250 mg/m2 IV infusion followed within 4 hours by 0.4 mCi/kg (14.8 MBq/kg) IV infusion over 10 minutes in patients with ≥150,000/mm3 platelet count or
0.3mCi/kg (11.1 MBq/kg) IV infusion over 10 minutes in patients with relapsed/refractory disease with 100,000-149,000/mm3 platelet count
Max dose: 32.0 mCi (11.84 MBq)		 Adverse Reactions
  • Hematologic effects (anemia, leukocytopenia, neutropenia, thrombocytopenia, febrile neutropenia, lymphocytopenia, pancytopenia); GI effects (nausea/vomiting, abdominal pain, diarrhea, constipation, dyspepsia, throat irritation, oral moniliasis); Musculoskeletal effects (rigors, arthralgia, back pain, myalgia, neck pain); CNS effects (headache, anorexia, insomnia; anxiety, dizziness); Respiratory effects (cough, rhinitis, pneumonia); Dermatologic effects (increased sweating, pruritus, rash); Other effects (asthenia, pyrexia, hemorrhage while thrombocytopenic, malaise, pain, peripheral edema, infection, flu syndrome)
Special Instructions
  • Premedicate with Paracetamol and Diphenhydramine prior to Rituximab infusion
  • Do not administer in patients with <100,000/mm3 platelet count, ≥25% lymphoma marrow involvement and/or impaired bone marrow reserve
  • Avoid vaccination with live vaccines following recent infusion
  • Use with caution in patients with signs of hematological toxicity, prior external beam radiation of >25% active bone marrow, neutrophil count <1,500/mm3, history of bone marrow/stem cell transplant
  • Monitor CBC and platelet count weekly, signs of hematological toxicity, secondary malignancies
Ibrutinib Chronic lymphocytic leukemia:
420 mg PO 24 hourly
Mantle cell lymphoma (relapsed/refractory):
560 mg PO 24 hourly
Marginal zone lymphoma (relapsed/refractory):
560 mg PO 24 hourly		 Adverse Reactions
  • Respiratory effects (pneumonia, URTI, sinusitis); Hematologic effects (neutropenia, leukocytosis, thrombocytopenia, anemia, lymphocytosis, bruising, petechiae); GI effects (nausea/vomiting, diarrhea, constipation, dry mouth, stomatitis);Musculoskeletal effects (arthralgia, pain); Other effects (UTI, epistaxis, subdural hematoma, pyrexia, peripheral edema)
Special Instructions
  • Should be taken with food
  • Use with caution in patients with bleeding-related events, severe hepatic/renal impairment, concomitantly using Warfarin, other vitamin K antagonists or other anticoagulant therapy
  • Concomitant use of St John’s wort-containing preparations are contraindicated
  • Monitor for fever, neutropenia and infections, atrial fibrillation; monitor CBC monthly
Lenalidomide Mantle cell leukemia  (relapsed/refractory):
25 mg PO 24 hourly on days 1-21 of repeated 28-day cycles until disease progression or
unacceptable toxicity
Follicular lymphoma or  marginal zone lymphoma:
With Rituximab: 20 mg PO 24 hourly on days 1-21 of repeated 28-day cycles up to 12 cycles		 Adverse Reactions
  • Hematologic effects (neutropenia, thrombocytopenia, anemia, leukopenia); GI effects (diarrhea, constipation, nausea); Respiratory effects (cough, URTI); Other effects (fatigue, pyrexia, rash)
Special Instructions
  • Contraindicated in patients with severe hypersensitivity to Lenalidomide
  • Use with caution in patients with hepatic impairment, pre-existing viral liver disease, at risk of tumor lysis syndrome, hematologic toxicity, history of arterial/venous thromboembolic events
  • Monitor CBC, liver function, thyroid function, signs of infection
  • Females must avoid pregnancy for at least 4 weeks before, after and during therapy
Lisocabtagene
maraleucel		 Follicular lymphoma or mantle cell lymphoma (relapsed/refractory): 90-110 x 106 CAR-positive viable T cells IV
Large B-cell lymphoma (relapsed refractory): After 1 line of systemic therapy:
90-110 x 106 CAR-positive viable T cells IV
After ≥2 lines of systemic therapy: 50-110 × 106 CAR-positive viable T cells IV		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, diarrhea, abdominal pain); Respiratory effect (cough); CNS effects (headache, dizziness, encephalopathy); CV effects (hypotension, tachycardia); Other effects (fatigue, cytokine release syndrome, musculoskeletal pain, infections - pathogen unspecified, decreased appetite, edema)
Special Instructions
  • For autologous use only
  • Watch out for emergence of possible infections and hypogammaglobulinemia
  • Monitor CBC
Loncastuximab
tesirine		 0.15 mg/kg IV infusion over 30 minutes on day 1 of a 21-day cycle x 2 cycles, then 0.075 mg/kg IV infusion over 30 minutes on day 1 of a 21-day cycle for subsequent cycles Adverse Reactions
  • GI effect (nausea); Hematologic effects (anemia, thrombocytopenia, neutropenia); Metabolic effects (hyperglycemia, hypoalbuminemia, increased gamma-glutamyl transferase, transaminase elevation); Other effects (fatigue, musculoskeletal pain, rash, edema)
Special Instructions
  • Monitor for the development of pleural effusion, pericardial effusion, ascites, peripheral edema, general edema, infection, new or worsening cutaneous reactions, including photosensitivity reactions
  • Monitor CBC
Mogamulizumab Mycosis fungoides/Sézary syndrome (relapsed/refractory):
1 mg/kg IV infusion over 1 hour on days 1, 8, 15 and 22 of the first 28-day cycle and on days 1 and 15 of each subsequent cycle until disease progression or unacceptable toxicity		 Adverse Reactions
  • Most common include infusion-related reactions, rash, fatigue, diarrhea, musculoskeletal pain, URTI
Special Instructions
  • Not for SC or rapid IV administration
  • Premedicate with Diphenhydramine and Paracetamol for first infusion
  • Use with caution in patients with infection
  • Discontinue permanently in case of infusion reactions, life-threatening skin reactions
  • Monitor for signs and symptoms of infection
Mosunetuzumab Follicular lymphoma (relapsed/refractory):
Cycle 1: 1 mg IV infusion on day 1 followed by 2 mg IV infusion on day 8 followed by 60 mg IV infusion on day 15 of a 21-day cycle
Cycle 2: 60 mg IV infusion on day 1
Cycles 3-8: 30 mg IV infusion on day 1		 Adverse Reactions
  • Most common include cytokine release syndrome, fatigue, rash, pyrexia and headache
Special Instructions
  • Premedicate with a corticosteroid, an antihistamine and antipyretic at least 30 minutes before each dose in cycle 1 and 2 and in succeeding cycles if patients experienced cytokine release syndrome
  • Monitor patients for signs and symptoms of neurologic toxicity and infection; monitor CBC during treatment
Obinutuzumab Chronic lymphocytic leukemia:
With Chlorambucil:
Cycle 1: 1,000 mg IV on days 1 and 2 (day 1: 100 mg; day 2: 900 mg), and on days 8 and 15
If the first bag is completed without IV rate modifications or interruptions, second bag may be administered on the same day. If with IV rate modifications or interruptions during the first 100 mg, second bag must be administered the next day
Cycles 2 to 6: 1,000 mg administered on day 1
Duration of treatment:
28 days/cycle x 6 cycles
Follicular lymphoma (untreated):
Induction: 28-days/cycle x 6 cycles (with Bendamustine) or
21 days/cycle x 6 cycles (with CHOP)
Followed by 2 cycles of monotherapy or 21 days/cycle x 8 cycles in combination with CVP 
Relapsed/Refractory Follicular lymphoma:
28 days/cycle x 6 cycles in combination with Bendamustine
Cycle 1: 1,000 mg IV on days 1, 8 and 15 of the first 21- or 28-day cycle
Cycle 2-6 or 2-8: 1,000 mg IV on day 1 of each cycle
Maintenance: 1,000 mg IV every 2 months x 2 years or until disease progression		 Adverse Reactions
  • Respiratory effects (nasopharyngitis, rhinitis, pharyngitis, cough); GI effects (diarrhea, constipation, oral herpes); Dermatologic effects (squamous cell carcinoma of the skin, alopecia); Hematologic effects (neutropenia, thrombocytopenia, anemia, leukopenia, decreased WBC and neutrophil count); Musculoskeletal effects (back pain, arthralgia, chest pain); Other effects (infusion-related reactions, weight gain)
Special Instructions
  • Use with caution in patients with high tumor burden, renal impairment, cumulative illness rating scale >6 and CrCL <70 mL/min, acute life-threatening respiratory symptoms, infusion-related reactions, cardiac/pulmonary/neurologic diseases, increased risk for hypertensive crisis, tumor lysis syndrome, active/recurring/chronic infection
  • Vaccination with live virus vaccines is not recommended during treatment and until B-cell recovery
Orelabrutinib Mantle cell lymphoma (relapsed/refractory):
150 mg PO 24 hourly until disease progression or unacceptable toxicity		 Adverse Reactions
  • Hematologic effects (hemorrhage, cytopenias); CV effects (hypertension, arrhythmia); Other effects (infection, hepatitis B reactivation, second primary malignancy)
Special Instructions
  • Avoid use in patients with hepatic impairment
  • Use with caution in patients with moderate to severe renal impairment
Pembrolizumab Primary mediastinal B-cell
lymphoma (relapsed after ≥2 prior therapies):
200 mg IV infusion over 30 minutes every 3 weeks or
400 mg IV infusion over 30 minutes every 6 weeks until disease progression or unacceptable toxicity
Max duration: 2 years		 Adverse Reactions
  • GI effects (diarrhea, nausea, constipation, abdominal pain); Respiratory effects (cough, dyspnea); Other effects (fatigue, musculoskeletal pain, decreased appetite, rash, pyrexia, pruritus, pain)
Special Instructions
  • Use with caution in patients with immune-mediated pneumonitis, colitis, hepatitis, nephritis, endocrinopathies, skin reactions
  • Monitor hepatic/thyroid/renal function, blood glucose, signs and symptoms of colitis and hypophysitis
Pirtobrutinib Mantle cell lymphoma (relapsed/refractory):
200 mg PO 24 hourly until disease
progression or unacceptable toxicity		 Adverse Reactions
  • Hematologic effects (decreased hemoglobin, neutrophils, lymphocytes and platelet count, bruising); Other effects (fatigue, musculoskeletal pain, cough, diarrhea)
Special Instructions
  • Reduce dose in patients with severe renal impairment
  • Monitor CBC, for signs and symptoms of infection, bleeding, arrhythmias
Polatuzumab
vedotin		 Diffuse large B-cell lymphoma:
Previously untreated: 1.8 mg/kg IV infusion every 21 days in combination with Rituximab, Cyclophosphamide, Doxorubicin and Prednisone x 6 cycles
Relapsed/refractory: 1.8 mg/kg IV infusion every 21 days in combination with Bendamustine and Rituximab x 6 cycles
Max dose: 240 mg/cycle		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia, thrombocytopenia, febrile neutropenia, leukopenia, lymphopenia); Respiratory effects (cough, pneumonia); Metabolic effects (hypokalemia, hypoalbuminemia, hypocalcemia); CNS effects (peripheral neuropathy, dizziness, peripheral sensory neuropathy); GI effects (diarrhea, nausea/vomiting, constipation, abdominal pain, upper abdominal pain); Other effects (decreased appetite, infusion-related reactions, pruritus, fatigue, pyrexia, asthenia, chills, decreased weight)
Special Instructions
  • Vaccination with live or live-attenuated vaccines is not recommended
  • Use with caution in patients with pre-existing peripheral neuropathy, risk of neutropenia and febrile neutropenia, peripheral neuropathy, infections, including opportunistic infections, eg pneumonia (including Pneumocystis jirovecii and other fungal pneumonia), bacteremia, sepsis, herpes infection, and cytomegalovirus infection, reactivation of latent infection, progressive multifocal leukoencephalopathy, infusion-related reactions, hepatic toxicity, renal impairment, moderate or severe hepatic impairment
  • Should not be administered in patients with active severe infection
  • Discontinue or interrupt treatment if new or worsening peripheral neuropathy, serious infection, progressive multifocal leukoencephalopathy occurs; discontinue in patients with grade 3 or 4 neutropenia and thrombocytopenia
  • Monitor CBC prior to each dose; liver enzymes and bilirubin levels
Rituximab Monotherapy: 375 mg/m2 BSA IV infusion once weekly for 4 weeks
Previously untreated follicular lymphoma:
Induction: 375 mg/m2 BSA IV on day 1 of each cycle x 8 cycles administered after glucocorticoid infusion
Maintenance: 375 mg/m2 BSA IV or 1,400 mg SC every 2 months starting 2 months after last dose of induction therapy until disease progression
Relapsed/refractory follicular lymphoma:
Induction: 375 mg/m2 BSA IV on day 1 of each cycle up to 8 cycles administered after glucocorticoid infusion
Maintenance: 375 mg/m2 BSA IV or 1,400 mg SC once every 3 months starting 3 months after last dose of induction therapy until disease progression
Max treatment duration: 2 years
Diffuse large B-cell lymphoma in CHOP: 375 mg/m2 BSA IV on day 1 of each cycle up to 8 cycles administered after glucocorticoid infusion or 375 mg/m2 BSA IV on day 1 of first cycle followed by fixed dose of 1,400 mg SC/cycle for a total of 8 cycles		 Adverse Reactions
  • Hematologic effects (neutropenia, leukopenia, angioedema, thrombocytopenia, febrile neutropenia); GI effect (nausea); Dermatologic effects (rash, alopecia, pruritus); Respiratory effects (bronchitis, URTI); Other effects (chills, fever, headache, asthenia, infections, decreased IgG levels, infusion-related reactions)
Special Instructions
  • Use with caution in patients with high tumor burden/high number of circulating malignant cells (>25 x 109/L), history of pulmonary insufficiency, pulmonary tumor, pulmonary tumor infiltration or other severe infusion-related symptoms, cardiac disease, severe active infections, HBV infection, history of recurring or chronic infections, PML
  • Vaccination with live vaccines is not recommended
  • Contraindicated in patients with severe hepatic impairment, severe immunocompromised state, severe heart failure/severe uncontrolled cardiac disease
  • Monitor blood counts including neutrophil and platelet count regularly during therapy
Selinexor 60 mg PO on days 1 and 3 weekly Adverse Reactions
  • GI effect (nausea/vomiting, diarrhea, constipation); Hematologic effects (anemia, lymphopenia, thrombocytopenia, neutropenia); Metabolic effect (hyponatremia); Other effects (fatigue, decreased appetite, decreased weight, pyrexia)
Special Instructions
  • Monitor for the development of infection
  • Monitor platelet count, neutrophil count, serum sodium
Tafasitamab Diffuse large B-cell lymphoma (relapsed/refractory):
Cycle 1:
12 mg/kg IV infusion on days 1, 4, 8, 15 and in combination with Lenalidomide
Cycles 2-3: 12 mg/kg IV infusion on days 1, 8, 15 and 22 in combination with Lenalidomide
Cycles 4-12: 12 mg/kg IV infusion on days 1 and 15 every 28 days in combination with Lenalidomide
Followed by Tafasitamab monotherapy until disease progression or unacceptable toxicity		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia, thrombocytopenia); Other effects (fatigue, diarrhea, cough, pyrexia, peripheral edema, respiratory tract infection, decreased appetite)
Special Instructions
  • Premedicate with a corticosteroid, an antihistamine and antipyretic before each dose
  • Ensure adequate hydration before administration
  • Monitor CBC before each cycle and throughout treatment; monitor for signs of infection
Temsirolimus Mantle cell lymphoma (refractory/relapsed):
Initial dose: 175 mg/week IV over 30-60 minutes weekly x 3 weeks
Maintenance dose: 75 mg IV over 30-60 minutes weekly		 Adverse Reactions
  • Hematologic effects (anemia, leukopenia, lymphopenia, thrombocytopenia); GI effects (nausea/vomiting, diarrhea, stomatitis, mucositis, anorexia, increased AST, dysgeusia); Dermatologic effects (rash, alopecia, pruritus, nail disorder, dry skin, acne); Metabolic effects (hyperglycemia, hyperlipemia, hypertriglyceridemia, elevated alkaline phosphatase and serum creatinine, hypophosphatemia); Respiratory effects (cough, dyspnea, pharyngitis, rhinitis); Other effects (asthenia, pyrexia, edema, epistaxis, pain, chest pain, infections, insomnia, back pain, arthralgia)
Special Instructions
  • Contraindicated in patients with bilirubin >1.5 x ULN
  • Use with caution in patients with renal and/or mild hepatic impairment, on hemodialysis, hyperglycemia, elderly ≥65 years old, and those currently on anticoagulant treatments
  • Monitor CBC, AST, bilirubin, lung CT scan/chest radiograph, cholesterol, TG, renal and hepatic function
  • Premedication with Diphenhydramine 25-50 mg IV 30 minutes prior to initiation of each dose is advised
Tisagenlecleucel Diffuse large B-cell lymphoma or follicular lymphoma (refractory/relapsed):
0.6-6.0 x 108 CAR-positive viable T-cells via IV infusion at a rate of 10-20 mL/min
Pre-treatment with lymphodepleting chemotherapy: Fludarabine 25 mg/m2 IV 24 hourly x 3 days plus Cyclophosphamide 250 mg/m2 IV 24 hourly x 3 days or
Bendamustine 90 mg/m2 IV 24 hourly x 2 days if with resistance or development of hemorrhagic cystitis with Cyclophosphamide		 Adverse Reactions
  • CNS effects (headache, encephalopathy, delirium, anxiety, sleep disorders, dizziness, tremor, peripheral neuropathy); Hematologic effects (neutropenia, thrombocytopenia); GI effects (diarrhea, nausea); Other effects (cytokine release syndrome, infections, pyrexia, fatigue, hypotension, edema, allergic reactions)
Special Instructions
  • Premedicate with Paracetamol and Diphenhydramine 30-60 minutes prior to infusion
  • Infuse 2-11 days after completion of lymphodepleting chemotherapy; omit lymphodepleting chemotherapy if WBC count is ≤1x 109/L within 1 week prior to infusion
  • Avoid prophylactic use of systemic corticosteroid
  • Vaccination with live vaccines is not recommended at least 6 weeks before lymphodepleting chemotherapy, during treatment and until immune recovery following treatment
  • Use with caution in patients with serious infections, prolonged cytopenias, hypogammaglobulinemia
  • Monitor for signs and symptoms of cytokine release syndrome and neurologic toxicities 2-3 times during the first week following infusion
  • Monitor for signs and symptoms of infection, hypersensitivity reactions, secondary malignancies
  • Screen for HBV, HCV and HIV prior to treatment
Trametinib Unresectable or metastatic
solid tumors with BRAF V600E
mutation who have
progressed following prior
treatment and have no
satisfactory alternative
treatment options:
2 mg PO 24 hourly in combination with Dabrafenib until disease
progression or unacceptable
toxicity		 Adverse Reactions
  • GI effects (nausea/vomiting, constipation, diarrhea); Musculoskeletal effects (arthralgia, myalgia); Other effects (headache, fatigue, pyrexia, chills, rash, hemorrhage, cough, edema)
Special Instructions
  • Taken on an empty stomach
  • Use with caution in patients with severe renal impairment, moderate to severe hepatic impairment, DM, impaired LV function, hypertension
  • Monitor LFTs at baseline and periodically thereafter; monitor BP, CBC, metabolic panel during treatment
Venetoclax Initial dose: 20 mg PO
24 hourly x 7 days followed by weekly ramp-up dosing schedule to
Recommended dose:
400 mg PO 24 hourly		 Adverse Reactions
  • Hematologic effects (neutropenia, anemia, thrombocytopenia); GI effects (nausea, diarrhea); Other effects (URTI, fatigue)
Special Instructions
  • Should be taken with food
  • Premedication with anti-hyperuricemic and ensure adequate hydration
  • Use with caution in patients with high tumor burden, renal and hepatic impairment, elderly
  • Avoid administration of live attenuated vaccine prior to, during and after treatment
  • Monitor blood counts and signs of infection
Zanubrutinib Mantle cell lymphoma (with at least 1 prior therapy), relapsed/refractory marginal zone lymphoma (with at least 1 prior anti-CD20-based regimen) and follicular cell lymphoma:
160 mg PO 12 hourly or
320 mg PO 24 hourly		 Adverse Reactions
  • Hematologic effects (decreased neutrophil count, decreased platelet count, decreased WBC count, decreased Hgb); Other effects (URTI, rash, bruising, diarrhea, cough)
Special Instructions
  • Use with caution in patients with severe hepatic impairment
  • Monitor for bleeding, signs and symptoms of infection, atrial fibrillation and atrial flutter
  • Monitor CBC during treatment

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.