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.

regimen-monograph

A - Regimen Name

DPACE Regimen
Dexamethasone-PLATINOL® (CISplatin)-ADRIAMYCIN® (DOXOrubicin)-Cyclophosphamide-Etoposide


Disease Site
Hematologic - Multiple Myeloma

Intent
Palliative

Regimen Category
Local : A regimen not widely used by Regional Cancer Centres in this disease site.

Rationale and Uses
Salvage Therapy for Multiple Myeloma

Supplementary Public Funding

dexamethasone
ODB - General Benefit (dexamethasone)

 
B - Drug Regimen

dexamethasone
40 mg PO Daily Days 1 to 4
CISplatin
10 mg /m²/day IV over 24 hours as continuous infusion Days 1 to 4
DOXOrubicin
10 mg /m²/day IV over 24 hours as continuous infusion Days 1 to 4

(Continued on next page)

 
cyclophosphamide
400 mg /m²/day IV over 24 hours as continuous infusion Days 1 to 4
etoposide
40 mg /m²/day IV over 24 hours as continuous infusion Days 1 to 4
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C - Cycle Frequency

REPEAT EVERY 4-6 WEEKS

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.

Dosage with toxicity

See Appendix 6 for general recommendations.

 



Hepatic Impairment

Bilirubin (µmol/L)
% usual dose
1-2 x ULN
REDUCE Doxorubicin to 50% dose and
REDUCE Etoposide to 50% dose
2-4 x ULN
 
REDUCE Doxorubicin to 25% dose and
REDUCE Etoposide to 25% dose
> 4 X ULN
OMIT Doxorubicin and Etoposide


Renal Impairment

Creatinine Clearance
% usual dose
0.5 - 1 mL/sec
REDUCE Cisplatin* to 50% dose
0.2 - 0.8 mL/sec
REDUCE Etoposide to 75% dose
< 0.2 mL/sec
REDUCE Etoposide to 50% dose

Cyclophosphamide:  Dosage may be halved or interval increased by 50-100% if   CrCl < 0.3 mL/second (suggested action).
 
*Upon the discretion of the prescriber, less dose reduction may be suggested. See Dosing section of Cisplatin drug monograph. (Dosage reduction).

 
F - Adverse Effects
Refer to dexamethasone, CISplatin, DOXOrubicin, cyclophosphamide, etoposide drug monograph(s) for additional details of adverse effects

Most Frequently Occurring Adverse Effects

  • Neurotoxicity (Ototoxicity)
  • Myelosuppression
  • Stomatitis
  • Vesicant
  • Cardiotoxicity
  • Nausea and Vomiting
  • Fatigue
  • Nepthrotoxicity
  • Hemorrhagic cystitis
  • Hypotension
  • Hyperglycemia
  • Gastric irritation – peptic ulcer
  • Fluid retention
  • Cataracts
  • Insomnia
  • Mood changes
  • Cushingoid symptoms
  • Muscle weakness
 
G - Interactions
Refer to dexamethasone, CISplatin, DOXOrubicin, cyclophosphamide, etoposide drug monograph(s) for additional details
 
H - Drug Administration and Special Precautions
Refer to dexamethasone, CISplatin, DOXOrubicin, cyclophosphamide, etoposide drug monograph(s) for additional details
 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

  • Clinical toxicity assessment (including gastrointestinal, neurotoxicity, ototoxicity, hemorrhagic cystitis, stomatitis, local toxicity, cardiotoxicity).
  • Routine blood glucose test.
  • CBC before each cycle.
  • Clinical exam for proximal muscle myopathy.
  • Baseline ophthalmologic exam for evidence of cataracts.
  • Full assessment by ophthalmologist if cataracts suspected.
  • Baseline and regular liver & renal function (including electrolytes and magnesium) tests and urinalysis.
  • Baseline and regular cardiac examination for patients with cardiac risk factors (including prior therapy with Epirubicin, Mitoxantrone, or other cardiotoxic drug) and cumulative doxorubicin doses > 450mg/m2.
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

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J - Administrative Information

Approximate Patient Visit
Inpatient regimen; If given as outpatient via ambulatory infusion pump: 1-1.5 hours
Pharmacy Workload (average time per visit)
17.8 minutes
Nursing Workload (average time per visit)
88 minutes
 
K - References

Barlogie B, Desikan R, Munshi N et al. Single course D.T. pace anti-antiochemotherapy effects CR in plasma cell leukemia and fulminant multiple myeloma. Blood (1998) 92; suppl 1: part2: 273b (Abst 4180)

Munshi N, Desikan R, Zangari M,et al. Chemoangiotherapy with DT-Pace for previously treated multiple myeloma. Blood (1999) 94; Suppl 1: 123a (Abstr.540)

October 2017 Formatted public funding info; revised July 2010


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M - Disclaimer

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.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, 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.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.


Last Updated: July 21, 2026