Download Protocol: AC (Doxorubicin/Cyclophosphamide) - Mid

Department of Medical Oncology
Chemotherapy Protocols
Protocol:
AC (Doxorubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant, Palliative
Schedule:
Drug
Dose
Doxorubicin
60mg/m2
Cyclophosphamide 600mg/m2
Cycle frequency:
iv/infusion/oral
iv
iv
Every three weeks
q
Day 1
Day 1
Total number of cycles:
4 (Adjuvant)
6 (Palliative)
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
• Check liver function
• Treatment every 2 weeks if given on a neo-adjuvant or accelerated basis with
pegylated G-CSF on day 2
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, haematuria, 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, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle.
Reference:
Fisher et al, 1990. J. Clin. Oncol., 8; pages 1483-1496
3rd Edition
18
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Paclitaxel
Indications:
Breast Cancer – Adjuvant (high risk), Palliative
Schedule:
Drug
Paclitaxel
Dose
175mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
500mls 5% dex/3hrs
q
Day 1
Total number of cycles: 4 (adjuvant)
6 (palliative)
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
• Following 4 cycles of AC if adjuvant
• Pre-medication (chlorpheniramine, ranitidine, dexamethasone)
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, fluid retention, sensitivity
reaction, peripheral neuropathy, diarrhoea, tiredness, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
After AC, prior to commencing Taxol
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Sledge et al, 2003. J. Clin. Oncol., 21; pages 588-592
3rd Edition
19
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
EC (Epirubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant, Palliative
Schedule:
Drug
Dose
Epirubicin
75mg/m2
Cyclophosphamide 750mg/m2
Cycle frequency:
iv/infusion/oral
iv
iv
Every three weeks
q
Day 1
Day 1
Total number of cycles:
4 (Adjuvant)
6 (Palliative)
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
• Check liver function
• Treatment every 2 weeks if given on a neo-adjuvant or accelerated basis with
pegylated G-CSF on day 2
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, 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, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess every two cycles if palliative
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Lalisang et al, 1997. J. Clin. Oncol., 15; pages 1367-1376
3rd Edition
20
Department of Medical Oncology
Protocol:
ET (Epirubicin/Taxol)
Indications:
Breast Cancer – Metastatic
Schedule:
Drug
Epirubicin
Paclitaxel
Dose
75mg/m2
175mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
iv
500mls 5% dex/3hrs
q
Day 1
Day 1
Total number of cycles:
4-6
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
• Pre-medication (chlorpheniramine, ranitidine, dexamethasone)
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy,
diarrhoea, hypersensitivity reactions, skin rash, fluid retention, hepatic dysfunction,
abdominal pain, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, buscopan
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess after every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Razis and Fountzilas, 2001. Ann. Oncol., 12; pages 593-598
3rd Edition
21
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Canadian FEC (5-Fluorouracil/Epirubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant (high risk)
Schedule:
Drug
5-Fluorouracil
Epirubicin
Cyclophosphamide
Dose
500mg/m2
60mg/m2
500mg/m2
Cycle frequency:
Every four weeks
iv/infusion/oral
iv
iv
iv
q
Days 1 & 8
Days 1 & 8
Days 1 & 8
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
• Check liver function
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, conjunctivitis, diarrhoea,
palmar-plantar syndrome, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, codeine phosphate, encourage oral
fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Review formally after every 2 cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Levine et al, 1998. J. Clin. Oncol., 16; pages 2651-2658
3rd Edition
22
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
FEC100 (5-Fluorouracil/Epirubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant (moderate & high risk – pre-menopausal)
Schedule:
Drug
5-Fluorouracil
Epirubicin
Cyclophosphamide
Dose
500mg/m2
100mg/m2
500mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
iv
iv
iv
q
Day 1
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
• Check liver function
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, conjunctivitis, diarrhoea,
palmar-plantar syndrome, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, codeine phosphate, encourage oral
fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Review formally prior to fourth cycle
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
French Adjuvant Study Group, 2001. J. Clin. Oncol., 19; pages 602611
3rd Edition
23
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
FEC60 (5-Fluorouracil/Epirubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant (moderate risk – post-menopausal)
Schedule:
Drug
5-Fluorouracil
Epirubicin
Cyclophosphamide
Dose
600mg/m2
60mg/m2
600mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
iv
iv
iv
q
Day 1
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
• Check liver function
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, conjunctivitis, diarrhoea,
palmar-plantar syndrome, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, codeine phosphate, encourage oral
fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Review formally prior to fourth cycle
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Levine et al, 1998. J. Clin. Oncol., 16: pages 2651-2658
3rd Edition
24
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
MMM (Methotrexate/Mitozantrone/Mitomycin C)
Indications:
Breast Cancer – Palliative
Schedule:
Drug
Methotrexate
Mitozantrone
Mitomycin C
Dose
30mg/m2
7mg/m2
7mg/m2
Cycle frequency:
Every six weeks
iv/infusion/oral
iv
100mls N. Saline/10mins
iv
q
Days 1 & 21
Days 1 & 21
Day 1
Total number of cycles:
3
Dose modifications: Discuss with Consultant
Administration and safety:
• Mitomycin C once every six weeks only
• Anti-emetic group – Moderate
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Ensure no third space and no renal impairment
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, hair thinning, mucositis, amenorrhoea, diarrhoea, discoloured urine, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess after every each cycle
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Powles et al, 1991. Br. J. Cancer, 64; pages 406-410
3rd Edition
25
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
TAC (Taxotere/Doxorubicin/Cyclophosphamide)
Indications:
Breast Cancer – Adjuvant (high risk), Palliative
Schedule:
Drug
Docetaxel
Doxorubicin
Cyclophosphamide
Dose
75mg/m2
50mg/m2
500mg/m2
Cycle frequency:
Every three weeks
Dose modification:
Discuss with Consultant
iv/infusion/oral
250mls N. Saline/1hr
iv
iv
q
Day 1
Day 1
Day 1
Total number of cycles:
6
Administration and safety:
• Anti-emetic group – Moderately high
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Pre-medication dexamethasone 8mg bd oral, for three days, starting 1 day prior
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nauseas &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, conjunctivitis, hyper-sensitivity
reaction, skin rash, fluid retention, diarrhoea, constipation, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, codeine phosphate, encourage oral
fluids
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Review formally after 3 cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Martin et al, 2005, N. Engl. J. Med., 352; pages 2302-2313
3rd Edition
26
Department of Medical Oncology
Protocol:
XT (Xeloda/Docetaxel)
Indications:
Breast Cancer – Metastatic
Schedule:
Drug
Docetaxel
Capecitabine
Dose
75mg/m2
1250mg/m2 bd
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
250mls N. Saline/1hr
oral
q
Day 1
Days 1-14
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 dexamethasone 8 mg bd oral, for three days, starting 1 day prior
• Ensure patient education regarding palmar-plantar syndrome
• Round Capecitabine tablets to the nearest 150mg or 500mg
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, diarrhoea,
hypersensitivity reactions, skin rash, palmar-plantar syndrome, fluid retention, hepatic
dysfunction, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess after every two cycles
Post Treatment:
Review in Medical Oncology outpatients 4 weeks after last cycle
Reference:
O’Shaughnessy et al, 2002. J. Clin. Oncol., 20; pages 2812 -2823
3rd Edition
27
Department of Medical Oncology
Protocol:
Docetaxel
Indications:
Breast Cancer – Metastatic
Schedule:
Drug
Docetaxel
Dose
100mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
250mls N. Saline/1hr
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 dexamethasone 8 mg bd oral, for three days, starting 1 day prior
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, diarrhoea,
hypersensitivity reactions, skin rash, fluid retention, hepatic dysfunction, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess after every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Chan et al, 1999. J. Clin. Oncol., 17; pages 2341-2354
3rd Edition
28
Department of Medical Oncology
Protocol:
Vinorelbine
Indications:
Breast Cancer – Palliative
Schedule:
Drug
Vinorelbine
Dose
30mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
20mls N. Saline/10mins
q
Days 1, 8 &15
Total number of cycles:
6
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
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, amenorrhoea, peripheral neuropathy, diarrhoea, constipation, hair thinning,
allergic reaction, 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, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
Re-assess after every 2 cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Weber et al, 1995, J. Clin. Oncol., 13; pages 2722-2730
3rd Edition
29
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Trastuzumab/Paclitaxel
Indications:
Breast Cancer – Metastatic (Her2/neu – positive)
Schedule:
Drug
Trastuzumab
Trastuzumab
Dose
4mg/kg
2mg/kg
Paclitaxel
175mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
q
500mls N. Saline/90mins Day -1
250mls N. Saline/90mins Days 1, 8 &15
(↓ 30 min. if infusions are well tolerated)
500mls 5% dex/3hrs
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
• First dose – administer Trastuzumab on day 1 and Paclitaxel on day 2
• Subsequent doses – administer both on day 1
Administration and safety:
• Anti-emetic group – Low
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Loading dose of Trastuzumab once.
• Chlorpheniramine 10 mg iv pre-Trastuzumab if required
• Paclitaxel pre-med – ranitidine, dexamethasone
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, cardiotoxicity, peripheral neuropathy, hair thinning, fluid retention,
sensitivity reaction, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG, Echocardiogram
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
After every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Slamon et al, 2001. N. Engl. J. Med., 344; pages 783-792
3rd Edition
30
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Trastuzumab/Docetaxel
Indications:
Breast Cancer – Metastatic (Her2/neu – positive)
Schedule:
Drug
Trastuzumab
Trastuzumab
Dose
4mg/kg
2mg/kg
Docetaxel
100mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
q
500mls N. Saline/90min
Day -1
250mls N. Saline/90min
Days 1, 8 &15
(↓ 30 min. if infusions are well tolerated)
250mls N. Saline/1hr
Day 1
Total number of cycles:
6
Dose modifications: Discuss with Consultant
• First dose – administer Trastuzumab day 1 and Docetaxel on day 2
• Subsequent doses – administer both on same day
Administration and safety:
• Anti-emetic group – Low
• Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
• Loading dose of Trastuzumab once
• Chlorpheniramine 10 mg iv pre-Trastuzumab if required
• Pre-medication dexamethasone 8mg bd oral, for three days, starting 1 day prior
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, cardiotoxicity, peripheral neuropathy, hair thinning, fluid retention,
sensitivity reaction, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine, urate
• LDH
• ECG, Echocradiogram
• Staging investigations as per protocol
Prior to each cycle:
• Performance score, weight
• FBC
• U & E’s, LFTs, creatinine
• LDH
Mid Treatment:
After every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Marty et al, 2005. J. Clin. Oncol., 23; pages 4265-4274
3rd Edition
31
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Trastuzumab (Weekly)
Indications:
Breast Cancer – Metastatic (Her2/neu – positive)
Schedule:
Drug
Trastuzumab
Trastuzumab
Dose
4mg/kg
2mg/kg
iv/infusion/oral
q
500mls N. Saline/90mins once
250mls N. Saline/90mins weekly
(↓ 30 min. if infusions are well tolerated)
Cycle frequency:
Weekly
Total number of cycles:
Dose modification:
Discuss with Consultant
Indefinite
Administration and safety:
•
Anti-emetic group – Low
•
Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L
•
Loading dose of Trastuzumab once
•
Chlorpheniramine 10mg iv pre-Trastuzumab, if required
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea,
cardiotoxicity, hyper-sensitivity reaction, carcinogenesis, infertility, allergic-like reaction,
bronchospasm
Symptomatic treatment of side effects: Supportive therapy
Investigations
Pre-treatment
•
History and Examination
•
Performance score, weight
•
FBC
•
U & E’s, LFTs, creatinine, urate
•
LDH
•
ECG, Echocardiogram
•
Staging investigations as per protocol
Prior to each cycle:
•
Performance score, weight
•
FBC
•
U & E’s, LFTs, creatinine
•
LDH
Mid Treatment:
After every four weeks
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Baselga et al, 1999. Semin. Oncol., 26 (suppl 12); pages 78-83
3rd Edition
32
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Trastuzumab (3-weekly)
Indications:
Breast Cancer – Metastatic or Adjuvant (Her2/neu – positive)
Schedule:
Drug
Trastuzumab
Trastuzumab
Dose
8mg/kg
6mg/kg
Cycle frequency:
Every three weeks
Dose modification:
Discuss with Consultant
iv/infusion/oral
q
500mls N. Saline/90min
once
500mls N. Saline/90min
3 weekly
(↓ 30 min. if infusions are well tolerated)
Total number of cycles: Indefinite
(1 year if adjuvant)
Administration and safety:
•
Anti-emetic group – Low
•
Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L
•
Loading dose of Trastuzumab once
•
Chlorpheniramine 10mg iv pre-Trastuzumab if required
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea,
cardiotoxicity, hyper-sensitivity reaction, carcinogenesis, infertility, allergic-like reaction,
bronchospasm
Symptomatic treatment of side effects: Supportive therapy
Investigations
Pre-treatment
•
History and Examination
•
Performance score, weight
•
FBC
•
U & E’s, LFTs, creatinine, urate
•
LDH
•
ECG, Echocardiogram
•
Staging investigations as per protocol
Prior to each cycle:
•
Performance score, weight
•
FBC
•
U & E’s, LFTs, creatinine
•
LDH
Mid Treatment:
After every nine weeks and Echocrdiogram
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Piccart-Gebhart et al, 2005. N. Engl. J. Med., 353; pages 1659-1672
3rd Edition
33
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
AC/T (Accelerated)
Indications:
Breast Cancer - Adjuvant (high risk)
Schedule:
Drug
Doxorubicin
Cyclophosphamide
Then
Paclitaxel
Cycle frequency:
Dose
60mg/m2
600mg/m2
175mg/m2
iv/infusion/oral
IV
IV
q
Day 1, cycles 1-4
Day 1, cycles 1-4
IV 500mls 5% dex/3hrs
Every two weeks (14 days)
Day 1, cycles 5-8
Total number of cycles: 8
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group - Moderately High
• Delay if neutrophils < 1.5 x 10^9/L or platelets < 100 x 10^9/L
• Pre-medication required for Paclitaxel (chlorpheniramine, ranitidine,
dexamethasone)
• Pegylated G-CSF on day 2 of each cycle
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea and
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, fluid retention, sensitivity
reaction, peripheral neuropathy, diarrhoea, tiredness, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & Es, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol:
Prior to each cycle:
• Performance score, weight
• FBC
• U & Es, LFTs, creatinine
• LDH
Consultant Review:
After AC, prior to commencing Paclitaxel
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference;
Citron et al, 2003. J. Clin. Oncol; 21, pp1431-1439
3rd Edition
109
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
AC/T
Indications:
Breast Cancer - Adjuvant (high risk)
Schedule:
Drug
Doxorubicin
Cyclophosphamide
Then
Paclitaxel
Cycle frequency:
Dose
60mg/m2
600mg/m2
175mg/m2
iv/infusion/oral
IV
IV
IV 500mls 5% dex/3hrs
Every three weeks (21days)
q
Day 1, cycles 1-4
Day 1, cycles 1-4
Day 1, cycles 5-8
Total number of cycles: 8
Dose modifications: Discuss with Consultant
Administration and safety:
• Anti-emetic group - Moderately High
• Delay if neutrophils < 1.5 x 10^9/L or platelets < 100 x 10^9/L
• Pre-medication required for Paclitaxel (chlorpheniramine, ranitidine,
dexamethasone)
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea and
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, fluid retention, sensitivity
reaction, peripheral neuropathy, diarrhoea, tiredness, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
• History and Examination
• Performance score, weight
• FBC
• U & Es, LFTs, creatinine, urate
• LDH
• ECG
• Staging investigations as per protocol:
Prior to each cycle:
• Performance score, weight
• FBC
• U & Es, LFTs, creatinine
• LDH
Consultant Review:
After AC, prior to commencing Paclitaxel
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference;
Citron et al, 2003. J. Clin. Oncol; 21, pp1431-1439
3rd Edition
110