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FCM (chemotherapy)

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(Redirected from R-FMC) Chemotherapy regimen

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.

The -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.

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. 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. 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.

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.

Drug Dose Mode Days
Rituximab 375 mg/m IV infusion Day 0
Fludarabine 25 mg/m IV infusion over 30 min Days 1-3
Cyclophosphamide 250 mg/m IV infusion over 4 hours Days 1-3
Mitoxantrone 8 mg/m IV infusion over 30 min Day 1

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. ^ 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.
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