What is the recommended timing of administration for Dacarbazine (DTIC-Dome)

Dacarbazine Administration Timing

Dacarbazine should be administered intravenously on days 1 and 15 of a 28-day cycle when used in the ABVD regimen for Hodgkin lymphoma, or as a single daily dose for 5 consecutive days every 3-4 weeks in melanoma. 1, 2

Standard Dosing Schedules by Indication

Hodgkin Lymphoma (ABVD Regimen)

• Dacarbazine 375 mg/m² IV on days 1 and 15 of each 28-day cycle 1
• This biweekly schedule is administered alongside doxorubicin, bleomycin, and vinblastine on the same days 1
• The 28-day cycle allows for adequate recovery between treatments while maintaining efficacy 1

Malignant Melanoma

Multiple-dose schedule (traditional):

• 2-4.5 mg/kg/day IV for 10 consecutive days, repeated every 4 weeks 2
• Alternative: 250 mg/m²/day IV for 5 consecutive days, repeated every 3 weeks 2

Single-dose schedule (modern standard):

• 850-1000 mg/m² IV as a single dose every 3 weeks 3
• This single-administration approach is now considered the standard reference therapy for advanced melanoma 3
• Equally effective as multiple-dose schedules but better tolerated and more convenient 3

Reconstitution and Administration Timing

Preparation Stability

• After reconstitution with sterile water, the solution may be stored at 4°C for up to 72 hours or at room temperature for up to 8 hours 2
• If further diluted in 5% dextrose or normal saline, storage is limited to 24 hours at 4°C or 8 hours at room temperature 2

Infusion Method

• Administer only by intravenous route 2
• Can be given as direct IV injection or diluted for IV infusion 2
• The reconstituted solution contains 10 mg/mL with pH 3.0-4.0 2

Clinical Considerations

Time of Day

• No specific time-of-day requirement exists in guidelines, though antiemetic premedication should be given 30-60 minutes before dacarbazine administration 3
• The introduction of potent antiemetics has enabled more flexible scheduling 3

Cycle Timing Rationale

• The 3-4 week intervals allow for bone marrow recovery between cycles 2, 3
• In ABVD, the 28-day cycle with day 1 and 15 dosing provides optimal balance between efficacy and toxicity 1

Common Pitfalls to Avoid

• Do not confuse the melanoma single-dose schedule (every 3 weeks) with the ABVD schedule (days 1 and 15 of 28-day cycles) 1, 2, 3
• Ensure adequate antiemetic coverage, as nausea/vomiting is the most common toxicity 3, 4
• Do not extend storage times beyond recommended limits, as dacarbazine degrades over time 2