Download Protocol: Carboplatin/Paclitaxel - Mid

Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Carboplatin/Paclitaxel
Indications:
Ovarian Cancer – Adjuvant, Advanced
Schedule:
Drug
Paclitaxel
Carboplatin
Dose
175mg/m2
AUC 5
Cycle frequency:
Every three weeks
iv/infusion/oral
500mls 5% dex/3hrs
500mls 5% dex/1hr
q
Day 1
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group - Moderately high
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Paclitaxel given first
• Pre-medication with dexamethasone (oral or iv), chlorpheniramine and ranitidine
• Carboplatin dose by EDTA or creatinine clearance. If calculated using formula
then AUC 6
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, fluid retention,
hypersensitivity reaction, abdominal discomfort, infertility
Symptomatic treatment of side effects: Mouth care, diuretics
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate, creatinine clearance
• LDH, CA125
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH, CA125
Mid Treatment:
Abdominal CT scan prior to fourth cycle if measurable disease
present. Ensure CA125 falling.
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
MRC ICON 3, 2002. Lancet, 360; pages 505-515
3rd Edition
55
Department of Medical Oncology
Protocol:
Paclitaxel
Indications:
Ovarian Cancer – Recurrent
Schedule:
Drug
Paclitaxel
Dose
175mg/m2
Chemotherapy Protocols
iv/infusion/oral
500mls 5% dex/3hrs
Cycle frequency: Every three weeks
q
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group – Low
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Pre-medication with dexamethasone (oral or iv), chlorpheniramine and ranitidine
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, fluid retention,
hypersensitivity reaction, abdominal discomfort, infertility
Symptomatic treatment of side effects: Mouth care, diuretics
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate, creatinine clearance
• LDH, CA125
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH, CA125
Mid Treatment:
Ensure CA125 falling
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Gore et al, 1997. J. Clin. Oncol., 15; pages 2183-2193
3rd Edition
56
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Carboplatin
Indications:
Ovarian Cancer – Advanced, Recurrent
Schedule:
Drug
Carboplatin
Dose
AUC 6
Cycle frequency:
Every three weeks
iv/infusion/oral
500mls 5% dex/1hr
q
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group - Moderately high
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Carboplatin dose by EDTA or creatinine clearance. If calculated using formula
then AUC 7
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate, creatinine clearance
• LDH, CA125
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH, CA125
Mid Treatment:
Abdominal CT scan prior to 4th cycle if measurable disease present.
Ensure CA125 falling
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Taylor et al, 1994. J. Clin. Oncol., 12; pages 2066-2070
3rd Edition
57
Department of Medical Oncology
Protocol:
Cisplatin/Paclitaxel
Indications:
Ovarian Cancer – Adjuvant
Schedule:
Drug
Paclitaxel
Cisplatin
Dose
175mg/m2
75mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
500mls 5% dex/3hrs
1L N. Saline/2hrs
q
Day 1
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group - High
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Paclitaxel given first
• Pre-medication with dexamethasone (oral or iv), chlorpheniramine and ranitidine
• Pre & post hydration, mannitol, potassium & magnesium
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, hypersensitivity
reaction, fluid retention, ototoxicity, constipation, nephrotoxicity, infertility
Symptomatic treatment of side effects: Mouth care, encourage oral fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance
• LDH, CA125
• ECG +/- Audiometry
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine
• LDH, CA125
Mid Treatment:
Abdominal CT scan prior to fourth cycle if measurable disease
present. Ensure CA125 falling
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Neijt et al, 2000. J. Clin. Oncol., 18; pages 3084-3092
3rd Edition
58
Department of Medical Oncology
Protocol:
Liposomal Doxorubicin
Indications:
Ovarian Cancer – Recurrent
Schedule:
Drug
Dose
Liposomal Doxorubicin 50mg/m2
Cycle frequency:
Chemotherapy Protocols
iv/infusion/oral
250mls 5% dex/1hr
Every 4 weeks
q
Day 1
Total number of cycles:
6-12
Dose modifications: Discuss with consultant
Administration and safety:
• Anti-emetic group - Moderate
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Do not retreat unless all previous skin lesions resolved
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, palmarplantar syndrome, nausea & vomiting, mucositis, cardiotoxicity, alopecia, amenorrhoea,
peripheral neuropathy, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, advice regarding palmar-plantar
syndrome
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH, CA125
• ECG +/- Echocardiogram
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH, CA125
Mid Treatment:
Abdominal CT scan prior to 4th cycle if measurable disease present.
Ensure CA125 falling
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Gordon et al, 2000. J. Clin. Oncol., 18; pages 3093-3100
3rd Edition
59
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
PMB (Cisplatin/Methotrexate/Bleomycin)
Indications:
Cervix Cancer – Advanced, Recurrent
Schedule:
Drug
Cisplatin
Methotrexate
Bleomycin
Dose
60mg/m2
300mg/m2
30,000iu
Cycle frequency:
Every 2 weeks
iv/infusion/oral
1L N. Saline/1hr
1L N. Saline/12hrs
200mls N. Saline/30mins
q
Day 2
Day 1
Day 1
Total number of cycles:
3
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group – High
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Ensure alkalinisation of urine
• Pre & post hydration, mannitol, potassium & magnesium
• Calcium Folinate rescue 24 hours after methotrexate infusion
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, mild alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity,
ototoxicity, pneumonitis, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, encourage oral fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance
• LDH
• ECG+/- Audiometry
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine
• LDH
Mid Treatment:
Re-assess after 3 cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Huskin and Blake, 1991. Int. J. Gynaecol. Oncol., 1; pages 75-80
3rd Edition
60
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
CF (Cisplatin/5-Fluorouracil)
Indications:
Cervix Cancer – Neoadjuvant, Advanced
Schedule:
Drug
Cisplatin
5-Fluorouracil
Dose
75mg/m2
1g/m2/24 hrs
Cycle frequency:
Every three weeks
iv/infusion/oral
1L N. Saline/2hrs
continuous infusion
q
Day 1
Days 2-5
Total number of cycles:
3
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group – High
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Ensure adequate renal function
• Pre & post hydration, mannitol, potassium & magnesium
• Concurrent radiotherapy may be necessary
• Doses may change according to Radiotherapy schedule
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, palmar-plantar
syndrome, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, anti-diarrheals, pyridoxine
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, Mg2+, Ca2+, creatinine
• LDH
Post Treatment:
Review in Medical Oncology Clinic 3 weeks after last cycle
Reference:
Morris et al, 1999. N. Engl. J. Med., 340; pages 1137-1143
3rd Edition
61