Lymphoid malignancies are often treated with chemo regimens that include intrathecal prophylaxis with cytarabine or methotrexate. DepoCyt® (cytarabine liposome injection) is indicated for the intrathecal treatment of lymphomatous meningitis, not for prophylaxis. While is is a newer formulation of the old drug, cytarabine, it should work whenever cytarabine works. One can look at the situation in one of two ways: 1.Every new formulation of a drug requires all supporting studies to be repeated, or 2. off-label use for accepted indications does not require experimental corroboration.
In this case, there appears to be no compellng reason to use Depocyt instead of the standard of care cytarabine. I do not consider it to be medically necessary.
Glantz, Michael J., Jaeckle, Kurt A., Chamberlain, Marc C., Phuphanich, Surasak, Recht, Lawrence, Swinnen, Lode J., Maria, Bernard, LaFollette, Susan, Schumann, G. Berry, Cole, Bernard F., Howell, Stephen B.
A Randomized Controlled Trial Comparing Intrathecal Sustained-release Cytarabine (DepoCyt) to Intrathecal Methotrexate in Patients with Neoplastic Meningitis from Solid Tumors
Clin Cancer Res 1999 5: 3394-3402
D. Mazhar, J. Stebbing, R. Lewis, M. Nelson, B. G. Gazzard, and M. Bower
The management of meningeal lymphoma in patients with HIV in the era of HAART: intrathecal depot cytarabine is effective and safe
Blood, April 15, 2006; 107(8): 3412 – 3414.
Depocyt, Prescribing information