Romidepsin Treatment: Uses, Dosage & Side Effects

Summary of Key Points

Romidepsin is a prescription medication primarily used to treat specific types of lymphoma, including peripheral T-cell lymphoma (PTCL) and cutaneous T-cell lymphoma (CTCL). This cancer therapy works by interfering with the growth and spread of cancer cells. It is administered intravenously under the supervision of a healthcare professional. Common side effects include nausea, fatigue, and an increased risk of infections. It is essential to consult your doctor before starting or adjusting your treatment plan. Our telemedicine providers are available to support you in managing your care effectively.

Names of the Medication

US Brand Name: Istodax

Generic Name: Romidepsin

The generic name, Romidepsin, refers to the active ingredient in this medication. It is often listed alongside its brand name, Istodax, for clarity.

Pharmacologic Category

Romidepsin belongs to a class of medications called Histone Deacetylase Inhibitors (HDAC inhibitors), which are a form of targeted cancer therapy. Other medications in this category include:

1. Vorinostat (Zolinza)
2. Belinostat (Beleodaq)
3. Panobinostat (Farydak)

Romidepsin Dosage and Administration

Romidepsin is prescribed for the treatment of various types of lymphoma in adults. The dosage and treatment schedule may vary depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dosage. For personalized guidance, you can schedule a telemedicine appointment with one of our providers.

Peripheral T-cell Lymphoma (PTCL)

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Cutaneous T-cell Lymphoma (CTCL)

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Adult T-cell Leukemia/Lymphoma

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Non-Hodgkin Lymphoma

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Hodgkin Lymphoma

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Mycosis Fungoides

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Sézary Syndrome

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

T-cell Lymphoblastic Lymphoma

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Angioimmunoblastic T-cell Lymphoma

Dosage: 14 mg/m² administered intravenously over 4 hours on days 1, 8, and 15 of a 28-day cycle.

Frequency: Every 28 days (1 cycle).

Length of Treatment: Continue until the disease progresses or side effects become intolerable.

Dosage Forms and Strengths

Romidepsin, marketed under the brand name Istodax, is available exclusively as an intravenous injection. The medication is supplied in the following strength:

1. 10 mg vial for injection

Administration Instructions

Romidepsin is administered as an intravenous (IV) infusion, delivered directly into a vein over a period of four hours. This treatment must be provided by a qualified healthcare professional in a clinical setting. It is crucial to attend all scheduled infusion appointments and adhere closely to your doctor’s instructions. If you miss a dose, contact your healthcare provider promptly to determine the appropriate course of action.

Contraindications

Contraindications refer to specific conditions or circumstances in which a medication should not be used due to potential risks. For Romidepsin, the following contraindications must be carefully considered:

1. Severe liver disease: Romidepsin is processed by the liver. In cases of severe liver disease, the body may struggle to metabolize the medication properly, increasing the likelihood of side effects or toxicity.
2. Allergic reaction to Romidepsin: If you have previously experienced an allergic reaction to Romidepsin or any of its components, this medication should be avoided. Allergic reactions can range from mild skin rashes to severe, potentially life-threatening conditions such as anaphylaxis.
3. Heart problems: Romidepsin can influence the heart’s electrical activity, potentially leading to abnormal heart rhythms (arrhythmias). Patients with a history of heart conditions, particularly those involving rhythm disturbances, should not use this medication.
4. Low blood cell counts: Romidepsin can lower blood cell counts, including white blood cells, red blood cells, and platelets. If you already have reduced blood cell levels, this treatment may heighten the risk of infections, anemia, or bleeding complications.

If any of these conditions apply to you, it is essential to discuss them with your healthcare provider. Our telemedicine team is available to review your medical history and help determine whether Romidepsin is a suitable treatment option for your cancer care.

Drug-to-Drug Interactions

Romidepsin may interact with other medications, potentially increasing side effects or diminishing its effectiveness. Below are some medications and supplements known to interact with Romidepsin:

1. Ketoconazole (Nizoral): This antifungal medication can raise Romidepsin levels in the body, which may lead to more pronounced side effects.
2. Rifampin (Rifadin): This antibiotic can reduce the effectiveness of Romidepsin by speeding up its breakdown in the liver.
3. Amiodarone (Pacerone): This heart medication may increase the risk of abnormal heart rhythms when used alongside Romidepsin.
4. Warfarin (Coumadin): Combining Romidepsin with blood thinners like warfarin may elevate the risk of bleeding complications.
5. St. John’s Wort: This herbal supplement can decrease the effectiveness of Romidepsin by altering how it is metabolized in the liver.

It is vital to inform your healthcare provider about all medications, supplements, and herbal products you are currently taking before beginning Romidepsin treatment. Our telemedicine team can assist in reviewing your medication list to help prevent harmful interactions and ensure your treatment is as safe and effective as possible.

Romidepsin in Pregnancy

Is Romidepsin Safe During Pregnancy?

Romidepsin is not considered safe for use during pregnancy. As a histone deacetylase inhibitor, it can harm an unborn baby, potentially causing birth defects or other serious complications. If you are pregnant or planning to become pregnant, it is essential to discuss alternative cancer treatment options with your healthcare provider.

Women of childbearing age should use reliable contraception during Romidepsin treatment and for a specified period after completing therapy. If you become pregnant while undergoing treatment with Romidepsin, contact your healthcare provider immediately to discuss the associated risks and determine the next steps.

Romidepsin While Breastfeeding

Is it safe to take Romidepsin while breastfeeding?

Breastfeeding is not recommended during treatment with Romidepsin. While there is limited information on whether Romidepsin passes into breast milk, the potential risk of serious side effects in a nursing infant makes it inadvisable. It is essential to discuss your options with your healthcare provider, who can help you decide whether to discontinue breastfeeding or consider alternative medications that may be safer for your situation.

Estimated Cost of Romidepsin

The cost of Romidepsin can vary significantly depending on your location and the pharmacy you use. Without insurance, a 30-day supply typically ranges from $15,000 to $20,000 when using a GoodRX coupon. For the most accurate pricing, contact your pharmacy directly. Additionally, explore financial assistance programs that may help offset the cost of this cancer treatment. Your healthcare provider or pharmacist can guide you toward resources that may be available to you.

Possible Alternatives to Romidepsin

If Romidepsin is not the right fit for your treatment plan, there are other therapies and strategies that may help manage your condition. Always consult your healthcare provider before making any changes to your treatment regimen. Our telemedicine providers are also available to discuss these options with you in detail.

Peripheral T-Cell Lymphoma

For peripheral T-cell lymphoma, alternative treatments include chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or stem cell transplantation. Immunotherapy drugs like brentuximab vedotin (Adcetris) may also be effective options.

Cutaneous T-Cell Lymphoma

For cutaneous T-cell lymphoma, potential alternatives include phototherapy, topical corticosteroids, or systemic treatments such as interferon. Your healthcare provider can help determine the most appropriate approach based on your specific condition.

Adult T-Cell Leukemia/Lymphoma

Treatment options for adult T-cell leukemia/lymphoma often include chemotherapy, antiviral therapies, and, in some cases, stem cell transplantation. Your provider will tailor the treatment plan to your individual needs and disease progression.

Non-Hodgkin Lymphoma

For non-Hodgkin lymphoma, commonly used alternatives include rituximab (Rituxan) and chemotherapy regimens such as R-CHOP. These therapies are often effective in managing the disease and improving outcomes.

Lymphoma

Depending on the specific type of lymphoma, treatment options may include chemotherapy, radiation therapy, or targeted therapies like ibrutinib (Imbruvica). Your healthcare provider can guide you in selecting the most suitable treatment based on your diagnosis.

Hodgkin Lymphoma

For Hodgkin lymphoma, chemotherapy regimens such as ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) or targeted therapies like brentuximab vedotin (Adcetris) are often considered. These treatments have been shown to be effective in many cases.

Mycosis Fungoides

Alternative treatments for mycosis fungoides include topical therapies, phototherapy, or systemic treatments such as bexarotene (Targretin). Your provider can help determine the best course of action based on the stage and severity of your condition.

Sézary Syndrome

For Sézary syndrome, treatment options may include photopheresis, interferon, or other systemic therapies. These approaches aim to manage symptoms and improve quality of life.

T-Cell Lymphoblastic Lymphoma

Intensive chemotherapy regimens and stem cell transplantation are commonly used alternatives for T-cell lymphoblastic lymphoma. These treatments are designed to target the aggressive nature of this disease.

Angioimmunoblastic T-Cell Lymphoma

For angioimmunoblastic T-cell lymphoma, chemotherapy regimens such as CHOP or targeted therapies like pralatrexate (Folotyn) may be considered. Your healthcare provider will work with you to determine the most effective treatment plan.

Recent Updates on Romidepsin Research

Recent research on Romidepsin has focused on its use in combination with other therapies to improve outcomes for patients with T-cell lymphoma. For instance, clinical trials are investigating the combination of Romidepsin with immune checkpoint inhibitors like pembrolizumab (Keytruda) to enhance the immune system’s ability to combat cancer. Researchers are also exploring the potential benefits of using Romidepsin earlier in the treatment process to improve long-term survival rates.

While these studies are still ongoing, preliminary findings are encouraging. It’s important to discuss the latest research with your healthcare provider to understand how these advancements might influence your treatment plan. Our telemedicine providers are available to review the most up-to-date information and help you make well-informed decisions about your care.

James Kingsley

Learn More