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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 [R]-FCM regimen contains
- Rituximab - anti-CD20 monoclonal antibody that can kill both normal and malignant CD20-bearing B cells;
- Fludarabine - an antimetabolite;
- Cyclophosphamide - an alkylating antineoplastic agent from the oxazafosforine group;
- 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]
| Drug | Dose | Mode | Days |
|---|---|---|---|
| Rituximab | 375 mg/m2 | IV infusion[7] | Day 0 |
| Fludarabine | 25 mg/m2 | IV infusion over 30 min[7] | Days 1-3 |
| Cyclophosphamide | 250 mg/m2 | IV infusion over 4 hours[7] | Days 1-3 |
| Mitoxantrone | 8 mg/m2 | IV infusion over 30 min[8] | Day 1 |
References
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