FCM (chemotherapy)

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 lymphomas. In combination with Rituximab, this regimen is called R-FCM or R-FMC, or FCM-R, FMC-R.

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.

Clinical use

The addition of monoclonal antibodies like rituximab to chemotherapy regimens has increased treatment outcomes for patients with indolent B cell non-Hodgkin 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/m2	IV infusion	Day 0
Fludarabine	25 mg/m2	IV infusion over 30 min	Days 1-3
Cyclophosphamide	250 mg/m2	IV infusion over 4 hours	Days 1-3
Mitoxantrone	8 mg/m2	IV infusion over 30 min	Day 1