FCM (chemotherapy)

Last updated

FCM, or FMC in the context of chemotherapy is an acronym for a chemotherapy regimen that is used in the treatment of indolent B cell non-Hodgkin's lymphomas. In combination with Rituximab, this regimen is called R-FCM or R-FMC, or FCM-R, FMC-R.

Contents

The [R]-FCM regimen contains

  1. Rituximab - anti-CD20 monoclonal antibody that can kill both normal and malignant CD20-bearing B cells;
  2. Fludarabine - an antimetabolite;
  3. Cyclophosphamide - an alkylating antineoplastic agent from the oxazafosforine group;
  4. Mitoxantrone - a synthetic anthracycline analogue (anthraquinone) that can intercalate DNA, thereby preventing cell division. [1]

Clinical use

The addition of monoclonal antibodies like rituximab to chemotherapy regimens has increased treatment outcomes for patients with indolent B cell non-Hodgkin's lymphomas, including chronic lymphocytic leukemia. [2] R-FCM regimens were recommended prior to the discovery of targeted therapies, such as Bruton tyrosine kinase inhibitors and Bcl-2 inhibitors, but trials have shown the superiority of targeted therapies in terms of survival and side effect profiles. [3] [4] R-FCM can be considered in resource-limited settings without access to targeted therapies. R-FCM should not be considered in patients with a 17p deletion, a TP53 mutations, and in patients with unmutated immunoglobulin heavy chain variable (IGHV), as R-FCM is less effective than targeted therapies. [5]

Dosing regimen

The recommended dosing schedule for R-FCM is based on patient weight and general fitness. Each cycle lasts 28 days for a maximum of 6 cycles. [6]

DrugDoseModeDays
Rituximab 375 mg/m2IV infusion [7] Day 0
Fludarabine 25 mg/m2IV infusion over 30 min [7] Days 1-3
Cyclophosphamide 250 mg/m2IV infusion over 4 hours [7] Days 1-3
Mitoxantrone 8 mg/m2IV infusion over 30 min [8] Day 1

Related Research Articles

<span class="mw-page-title-main">Chronic lymphocytic leukemia</span> Medical condition

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes. Early on, there are typically no symptoms. Later, non-painful lymph node swelling, feeling tired, fever, night sweats, or weight loss for no clear reason may occur. Enlargement of the spleen and low red blood cells (anemia) may also occur. It typically worsens gradually over years.

<span class="mw-page-title-main">Rituximab</span> Pharmaceutical drug

Rituximab, sold under the brand name Rituxan among others, is a monoclonal antibody medication used to treat certain autoimmune diseases and types of cancer. It is used for non-Hodgkin lymphoma, chronic lymphocytic leukemia, rheumatoid arthritis, granulomatosis with polyangiitis, idiopathic thrombocytopenic purpura, pemphigus vulgaris, myasthenia gravis and Epstein–Barr virus-positive mucocutaneous ulcers. It is given by slow intravenous infusion. Biosimilars of Rituxan include Blitzima, Riabni, Ritemvia, Rituenza, Rixathon, Ruxience, and Truxima.

<span class="mw-page-title-main">Fludarabine</span> Chemical compound

Fludarabine is a purine analogue and antineoplastic agent. It is generally used as its 5-O-phosphorylated form known as fludarabine phosphate, sold under the brand name Fludara among others. It is a chemotherapy medication used in the treatment of leukemia and lymphoma. These include chronic lymphocytic leukemia, non-Hodgkin's lymphoma, acute myeloid leukemia, and acute lymphocytic leukemia. It is given by injection into a vein or by mouth.

CHOP is the acronym for a chemotherapy regimen used in the treatment of non-Hodgkin lymphoma. CHOP consists of:

<span class="mw-page-title-main">Follicular lymphoma</span> Medical condition

Follicular lymphoma (FL) is a cancer that involves certain types of white blood cells known as lymphocytes. The cancer originates from the uncontrolled division of specific types of B-cells known as centrocytes and centroblasts. These cells normally occupy the follicles (nodular swirls of various types of lymphocytes) in the germinal centers of lymphoid tissues such as lymph nodes. The cancerous cells in FL typically form follicular or follicle-like structures (see adjacent Figure) in the tissues they invade. These structures are usually the dominant histological feature of this cancer.

<span class="mw-page-title-main">MALT lymphoma</span> Medical condition

MALT lymphoma is a form of lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequently of the stomach, but virtually any mucosal site can be affected. It is a cancer originating from B cells in the marginal zone of the MALT, and is also called extranodal marginal zone B cell lymphoma.

<span class="mw-page-title-main">Diffuse large B-cell lymphoma</span> Type of blood cancer

Diffuse large B-cell lymphoma (DLBCL) is a cancer of B cells, a type of lymphocyte that is responsible for producing antibodies. It is the most common form of non-Hodgkin lymphoma among adults, with an annual incidence of 7–8 cases per 100,000 people per year in the US and UK. This cancer occurs primarily in older individuals, with a median age of diagnosis at ~70 years, although it can occur in young adults and, in rare cases, children. DLBCL can arise in virtually any part of the body and, depending on various factors, is often a very aggressive malignancy. The first sign of this illness is typically the observation of a rapidly growing mass or tissue infiltration that is sometimes associated with systemic B symptoms, e.g. fever, weight loss, and night sweats.

Lumiliximab is an IgG1k monoclonal antibody that targets CD23. It acts as an immunomodulator and was awarded orphan drug status and fast track designation by the FDA.

Richter's transformation (RT), also known as Richter's syndrome, is the conversion of chronic lymphocytic leukemia (CLL) or its variant, small lymphocytic lymphoma (SLL), into a new and more aggressively malignant disease. CLL is the circulation of malignant B lymphocytes with or without the infiltration of these cells into lymphatic or other tissues while SLL is the infiltration of these malignant B lymphocytes into lymphatic and/or other tissues with little or no circulation of these cells in the blood. CLL along with its SLL variant are grouped together in the term CLL/SLL.

<span class="mw-page-title-main">Pixantrone</span> Chemical compound

Pixantrone is an experimental antineoplastic (anti-cancer) drug, an analogue of mitoxantrone with fewer toxic effects on cardiac tissue. It acts as a topoisomerase II poison and intercalating agent. The code name BBR 2778 refers to pixantrone dimaleate, the actual substance commonly used in clinical trials.

<span class="mw-page-title-main">B-cell prolymphocytic leukemia</span> Medical condition

B-cell prolymphocytic leukemia, referred to as B-PLL, is a rare blood cancer. It is a more aggressive, but still treatable, form of leukemia.

<span class="mw-page-title-main">Mantle cell lymphoma</span> Medical condition

Mantle cell lymphoma (MCL) is a type of non-Hodgkin's lymphoma, comprising about 6% of cases. It is named for the mantle zone of the lymph nodes.

Chemoimmunotherapy is chemotherapy combined with immunotherapy. Chemotherapy uses different drugs to kill or slow the growth of cancer cells; immunotherapy uses treatments to stimulate or restore the ability of the immune system to fight cancer. A common chemoimmunotherapy regimen is CHOP combined with rituximab (CHOP-R) for B-cell non-Hodgkin lymphomas.

<span class="mw-page-title-main">Bendamustine</span> Chemical compound

Bendamustine, sold under the brand name Treanda among others, is a chemotherapy medication used in the treatment of chronic lymphocytic leukemia (CLL), multiple myeloma, and non-Hodgkin's lymphoma. It is given by injection into a vein.

Obinutuzumab, sold under the brand name Gazyva among others, is a humanized anti-CD20 monoclonal antibody, originated by GlycArt Biotechnology AG and developed by Roche as a cancer treatment.

<span class="mw-page-title-main">Marginal zone B-cell lymphoma</span> Group of lymphomas

Marginal zone B-cell lymphomas, also known as marginal zone lymphomas (MZLs), are a heterogeneous group of lymphomas that derive from the malignant transformation of marginal zone B-cells. Marginal zone B cells are innate lymphoid cells that normally function by rapidly mounting IgM antibody immune responses to antigens such as those presented by infectious agents and damaged tissues. They are lymphocytes of the B-cell line that originate and mature in secondary lymphoid follicles and then move to the marginal zones of mucosa-associated lymphoid tissue, the spleen, or lymph nodes. Mucosa-associated lymphoid tissue is a diffuse system of small concentrations of lymphoid tissue found in various submucosal membrane sites of the body such as the gastrointestinal tract, mouth, nasal cavity, pharynx, thyroid gland, breast, lung, salivary glands, eye, skin and the human spleen.

<span class="mw-page-title-main">Ibrutinib</span> Medication used in cancer treatment

Ibrutinib, sold under the brand name Imbruvica among others, is a small molecule drug that inhibits B-cell proliferation and survival by irreversibly binding the protein Bruton's tyrosine kinase (BTK). Blocking BTK inhibits the B-cell receptor pathway, which is often aberrantly active in B cell cancers. Ibrutinib is therefore used to treat such cancers, including mantle cell lymphoma, chronic lymphocytic leukemia, and Waldenström's macroglobulinemia. Ibrutinib also binds to C-terminal Src Kinases. These are off-target receptors for the BTK inhibitor. Ibrutinib binds to these receptors and inhibits the kinase from promoting cell differentiation and growth. This leads to many different side effects like left atrial enlargement and atrial fibrillation during the treatment of Chronic Lymphocytic Leukemia.

CEPP is a chemotherapy regimen that is intended for treatment of aggressive non-Hodgkin lymphomas. It consists of cyclophosphamide, etoposide, procarbazine, and prednisone. Unlike CHOP, this chemotherapy regimen does not contain doxorubicin or any other anthracycline. Thus, it can be used in patients with severe cardiovascular diseases and contraindications for doxorubicin-containing regimens. This regimen also does not contain vincristine and can be used in patients with neuropathy.

FM in the context of chemotherapy means a chemotherapy regimen used as first-line therapy in indolent lymphomas. In combination with rituximab it is called R-FM or RFM or FM-R or FMR.

FLAG is a chemotherapy regimen used for relapsed and refractory acute myeloid leukemia (AML). The acronym incorporates the three primary ingredients of the regimen:

  1. Fludarabine: an antimetabolite that, while not active toward AML, increases formation of an active cytarabine metabolite, ara-CTP, in AML cells;
  2. Arabinofuranosyl cytidine : an antimetabolite that has been proven to be the most active toward AML among various cytotoxic drugs in single-drug trials; and
  3. Granulocyte colony-stimulating factor (G-CSF): a glycoprotein that shortens the duration and severity of neutropenia.

References

  1. ↑ Forstpointner, R.; Dreyling, M.; Repp, R.; Hermann, S.; Hänel, A.; Metzner, B.; Pott, C.; Hartmann, F.; Rothmann, F.; Rohrberg, R.; Böck, H. P.; Wandt, H.; Unterhalt, M.; Hiddemann, W.; German Low-Grade Lymphoma Study Group (2004). "The addition of rituximab to a combination of fludarabine, cyclophosphamide, mitoxantrone (FCM) significantly increases the response rate and prolongs survival as compared with FCM alone in patients with relapsed and refractory follicular and mantle cell lymphomas: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group". Blood. 104 (10): 3064–3071. doi: 10.1182/blood-2004-04-1323 . PMID   15284112 . Retrieved 2023-07-11.
  2. ↑ Bosch, Francesc; Abrisqueta, Pau; Villamor, Neus; Terol, María José; González-Barca, Eva; Ferra, Christelle; González Diaz, Marcos; Abella, Eugenia; Delgado, Julio; Carbonell, Félix; García Marco, José Antonio; Escoda, Lourdes; Ferrer, Secundino; Monzó, Encarnación; González, Yolanda (2009-09-20). "Rituximab, fludarabine, cyclophosphamide, and mitoxantrone: a new, highly active chemoimmunotherapy regimen for chronic lymphocytic leukemia". Journal of Clinical Oncology. 27 (27): 4578–4584. doi: 10.1200/JCO.2009.22.0442 . ISSN   1527-7755. PMID   19704063.
  3. ↑ Woyach, Jennifer A.; Ruppert, Amy S.; Heerema, Nyla A.; Zhao, Weiqiang; Booth, Allison M.; Ding, Wei; Bartlett, Nancy L.; Brander, Danielle M.; Barr, Paul M.; Rogers, Kerry A.; Parikh, Sameer A.; Coutre, Steven; Hurria, Arti; Brown, Jennifer R.; Lozanski, Gerard (2018-12-27). "Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL". New England Journal of Medicine. 379 (26): 2517–2528. doi:10.1056/NEJMoa1812836. ISSN   0028-4793. PMC   6325637 . PMID   30501481.
  4. ↑ Shanafelt, Tait D.; Wang, Xin V.; Kay, Neil E.; Hanson, Curtis A.; O’Brien, Susan; Barrientos, Jacqueline; Jelinek, Diane F.; Braggio, Esteban; Leis, Jose F.; Zhang, Cong C.; Coutre, Steven E.; Barr, Paul M.; Cashen, Amanda F.; Mato, Anthony R.; Singh, Avina K. (2019-08-01). "Ibrutinib–Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia". New England Journal of Medicine. 381 (5): 432–443. doi:10.1056/NEJMoa1817073. ISSN   0028-4793. PMC   6908306 . PMID   31365801.
  5. ↑ Cramer, Paula; Langerbeins, Petra; Eichhorst, Barbara; Hallek, Michael (2015-09-02). "Advances in first-line treatment of chronic lymphocytic leukemia: current recommendations on management and first-line treatment by the German CLL Study Group (GCLLSG)". European Journal of Haematology. 96 (1): 9–18. doi: 10.1111/ejh.12678 . PMID   26332019. S2CID   25952767.
  6. ↑ Szász, Róbert; Telek, Béla; Illés, Árpád (2021-04-27). "Fludarabine-Cyclophosphamide-Rituximab Treatment in Chronic Lymphocytic Leukemia, Focusing on Long Term Cytopenias Before and After the Era of Targeted Therapies". Pathology & Oncology Research. 27: 1609742. doi: 10.3389/pore.2021.1609742 . ISSN   1219-4956. PMC   8262186 . PMID   34257611.
  7. 1 2 3 Tam, Constantine S.; O'Brien, Susan; Wierda, William; Kantarjian, Hagop; Wen, Sijin; Do, Kim-Anh; Thomas, Deborah A.; Cortes, Jorge; Lerner, Susan; Keating, Michael J. (2008-08-15). "Long-term results of the fludarabine, cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic leukemia". Blood. 112 (4): 975–980. doi:10.1182/blood-2008-02-140582. ISSN   0006-4971. PMC   3952498 . PMID   18411418.
  8. ↑ Bosch, Francesc; Ferrer, Anna; López-Guillermo, Armando; Giné, Eva; Bellosillo, Beatriz; Villamor, Neus; Colomer, Dolors; Cobo, Francesc; Perales, María; Esteve, Jordi; Altés, Albert; Besalduch, Joan; Ribera, Josep M.; Montserrat, Emili; GELCAB (Grup per l'Estudi dels Limfomes a Catalunya i Balears) (2002-12-11). "Fludarabine, cyclophosphamide and mitoxantrone in the treatment of resistant or relapsed chronic lymphocytic leukaemia". British Journal of Haematology. 119 (4): 976–984. doi:10.1046/j.1365-2141.2002.03959.x. ISSN   0007-1048. PMID   12472576. S2CID   9622709.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.