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regimen-monograph

A - Regimen Name

MELP(PO) Regimen
Melphalan (oral)


Disease Site
Gynecologic

Intent
Palliative

Regimen Category
Archived : No longer in use and listed for reference purposes only, although the use of such a regimen may be appropriate in a situation where a Standard Regimen cannot be used for clinical reasons. Note: The Disease Site Group considers this regimen archived. It is listed for historical reference only and is no longer updated.

Rationale and Uses
For recurrent ovarian cancer
 
B - Drug Regimen

melphalan

(Round to nearest 2 mg)
0.2 mg /kg PO Daily for 5 days

(Outpatient prescription in multiples of 2mg tablets)

 

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C - Cycle Frequency

REPEAT EVERY 4 to 5 WEEKS
Until disease progression or unacceptable toxicity

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Minimal

 
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.

Do not retreat until platelets > 100 x 109/L and neutrophils > 1.5 x 109/L. Reduce melphalan after grade 4 neutropenia or grade 3 thrombocytopenia.

Discontinue if hypersensitivity or pneumonitis / pulmonary fibrosis occurs.

 

 

 


Renal Impairment

Increased incidence of severe myelosuppression has been observed in patients with BUN ≥ 10.7 mmol/L. Dose reduction should be considered in patients with renal insufficiency receiving melphalan.

Creatinine Clearance Dose
1. If CrCl = 10 – 50 mL/min
REDUCE to 75% of dose; monitor
2. If CrCl < 10 mL/min
REDUCE to 50% of dose; monitor


 
F - Adverse Effects
Refer to melphalan drug monograph(s) for additional details of adverse effects
 
G - Interactions
Refer to melphalan drug monograph(s) for additional details
 
H - Drug Administration and Special Precautions
Refer to melphalan drug monograph(s) for additional details
 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring


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J - Administrative Information
Outpatient prescription for home administration

 
K - References

Young RC, Chabner BA, Hubbard SP, Fisher RI, Bender RA, Anderson T et al. Advanced ovarian adenocarcinoma. A prospective clinical trial of melphalan (LPAM) versus combination chemotherapy. N Eng J Med 1978; 299(23):1261-6.

Young RC, Canellos GP, Chabner BA, Schein PS, Hubbard SP, De Vita VT, Jr. Chemotherapy of advanced ovarian carcinoma: a prospective randomized comparison of phenylalanine mustard and high dose cyclophosphamide. Gynecol Oncol 1974; 2(4):489-97.

 

 


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L - Other Notes
March 2012:  Modified regimen cateogry
 
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