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Download Protocol: Carboplatin/Gemcitabine Indications: Lung Cancer (non
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Department of Medical Oncology Chemotherapy Protocols Protocol: Carboplatin/Gemcitabine Indications: Lung Cancer (non-small cell) - Advanced Schedule: Drug Carboplatin Gemcitabine Dose AUC 5 1200mg/m2 Cycle frequency: Every three weeks iv/infusion/oral 500mls 5% dex/1hr 200mls N. Saline/30mins q Day 1 Days 1 & 8 Total number of cycles: 4 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 6 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia (uncommon), amenorrhoea, peripheral neuropathy, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • FBC • U & E’s, LFTs, creatinine, urate, creatinine clearance • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, creatinine • LDH • CXR Mid Treatment: After two cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Rudd et al, 2005. J. Clin. Oncol., 23; pages 6269-6270 3rd Edition 1 Department of Medical Oncology Chemotherapy Protocols Protocol: Cisplatin/Gemcitabine Indications: Lung Cancer (non-small cell) – Adjuvant, Neoadjuvant Schedule: Drug Cisplatin Gemcitabine Dose 50mg/m2 1250mg/m2 Cycle frequency: Every three weeks iv/infusion/oral 1L N. Saline/2hrs 200mls N. Saline/30mins q Day 1, 2 Days 1 & 8 Total number of cycles: 4 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 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: After two cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Cardenal et al, 1999. J. Clin. Oncol., 17; pages 12-18 3rd Edition 2 Department of Medical Oncology Chemotherapy Protocols Protocol: Carboplatin/Vinorelbine Indications: Advanced – Lung, Breast and Ovarian cancer Schedule: Drug Vinorelbine Carboplatin Dose 25mg/m2 AUC 5 Cycle frequency: Every three weeks iv/infusion/oral 20mls N. Saline/10mins 500mls 5% dex/1hr q Days 1 & 8 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 • 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 • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, creatinine • LDH Mid Treatment: Abdominal CT scan prior to fourth cycle if measurable disease present (ovarian) Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Cremonesi et al, 2003. Oncology, 64; pages 97-101 3rd Edition 3 Department of Medical Oncology Chemotherapy Protocols Protocol: MVP Indications: Lung Cancer (non-small cell) - Advanced, Palliative Schedule: Drug Mitomycin C Vinblastine Cisplatin Dose 8mg/m2 6mg/m2 (max 10mg) 50mg/m2 Cycle frequency: Every three weeks iv/infusion/oral iv iv 1L N. Saline/2hrs q Day 1 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 adequate renal function • Ensure serum creatinine is within normal levels • Pre & post hydration, mannitol, potassium & magnesium • Blood film is normal i.e. no red cell fragmentation Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Smith et al, 2002. J. Clin. Oncol., 19; pages 1336-1343 3rd Edition 4 Department of Medical Oncology Chemotherapy Protocols Protocol: MIC Indications: Lung Cancer (non-small cell) - Advanced, Palliative Schedule: Drug Mitomycin C Ifosfamide Cisplatin Dose 6mg/m2 3000mg/m2 50mg/m2 Cycle frequency: Every three weeks iv/infusion/oral iv 1L N. Saline/4hrs 1L N. Saline/2hrs q Day 1 Day 1 Day 1 Total number of cycles: 4 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 • Mesna dose guidelines Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, peripheral neuropathy, diarrhoea, constipation, nephrotoxicity, ototoxicity, encephalopathy, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: Re-assess after 2 cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Cullen et al, 1988. Br. J. Cancer, 58; pages 359-361 3rd Edition 5 Department of Medical Oncology Chemotherapy Protocols Protocol: NP (Vinorelbine/Cisplatin) Indications: Lung Cancer (non-small cell) – Adjuvant Schedule: Drug Vinorelbine Cisplatin Dose 30mg/m2 50mg/m2 Cycle frequency: Every four weeks iv/infusion/oral 20mls N. Saline/10mins 1L N. Saline/4hrs q Days 1, 8, 15 & 22 Days 1 & 2 Total number of cycles: 4 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 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: Re-assess after 2 cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Winton et al, 2005. N. Engl. J. Med., 352; pages 2589-2597 3rd Edition 6 Department of Medical Oncology Chemotherapy Protocols Protocol: Docetaxel Indications: Lung Cancer (non-small cell) - Recurrent Schedule: Drug Docetaxel Dose 75mg/m2 Cycle frequency: Every three weeks 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 one day prior Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, fluid retention, hypersensitivity reaction, skin rash, infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: Re-assess after 2 cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Shephard et al, 2000. J. Clin. Oncol., 18; pages 2095-2103 3rd Edition 7 Department of Medical Oncology Chemotherapy Protocols Protocol: Docetaxel/Cisplatin Indications: Lung Cancer (non-small cell) – Advanced, Palliative Schedule: Drug Docetaxel Cisplatin Dose 75mg/m2 75mg/m2 Cycle frequency: Every three weeks iv/infusion/oral 250ml N. Saline/1hr 1L N. Saline/4hrs q Day 1 Day 1 Total number of cycles: 4 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 • Pre-medication dexamethasone 8mg bd oral, for three days, starting one day prior • Ensure adequate renal function • Pre & post hydration, mannitol, potassium & magnesium Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility, fluid retention, hypersensitivity reaction Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and examination • Performance score, weight, CXR • 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 • CXR Mid-treatment: Re-assess after 2 cycles Post-treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Schiller et al, 2002. N. Engl. J. Med., 346; pages 92-98 3rd Edition 8 Department of Medical Oncology Chemotherapy Protocols Protocol: PE (Cisplatin/Etoposide) - long Indications: Lung Cancer (small cell) - Limited Schedule: Drug Cisplatin Etoposide Dose 60mg/m2 120mg/m2 Cycle frequency: Every three weeks iv/infusion/oral 1L N. Saline/2hrs 1L N. Saline/2hrs q Day 1 Days 1-3 Total number of cycles: ( 4 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 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, 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 • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, Mg2+, Ca2+, creatinine • LDH • CXR Mid Treatment: Re-assess prior to third cycle Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Turrisis et al, 1999. N. Engl. J. Med., 340; pages 265-271 3rd Edition 9 Department of Medical Oncology Chemotherapy Protocols Protocol: PE (Cisplatin/Etoposide) - short Indications: Lung Cancer (small cell) - Limited Schedule: Drug Cisplatin Etoposide Etoposide Dose 60mg/m2 120mg/m2 100mg bd Cycle frequency: Every three weeks iv/infusion/oral 1L N. Saline/2hrs 1L N. Saline/2hrs oral q Day 1 Day 1 Days 2 & 3 Total number of cycles: 4 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 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, 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 • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, Mg2+, Ca2+, creatinine • LDH • CXR Mid Treatment: Re-assess prior to third cycle Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Evans et al, 1987. Ann. Intern. Med., 107; pages 451-458 3rd Edition 10 Department of Medical Oncology Chemotherapy Protocols Protocol: Carboplatin/Etoposide - long Indications: Lung Cancer - Advanced Schedule: Drug Carboplatin Etoposide Dose AUC 5 100mg/m2 Cycle frequency: Every three weeks iv/infusion/oral 500mls 5% dex/1hr 500mls N. Saline/2hrs q Day 1 Days 1-3 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 • Ensure adequate renal function • Etoposide 100mg bd oral may be substituted on days 2 & 3 • 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, nephrotoxicity, diarrhoea, 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 • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, Mg2+, Ca2+, creatinine • LDH • CXR Mid Treatment: Re-assess prior to third cycle Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Skarlos et al, 1994. Ann. Oncol., 5; pages 601-607 3rd Edition 11 Department of Medical Oncology Chemotherapy Protocols Protocol: Carboplatin/Etoposide - short Indications: Lung Cancer - Advanced Schedule: Drug Carboplatin Etoposide Etoposide Dose AUC 5 100mg/m2 100mg bd Cycle frequency: Every three weeks iv/infusion/oral 500mls 5% dex/1hr 500mls N. Saline/2hrs oral q Day 1 Day 1 Days 2 & 3 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 • Ensure adequate renal function • 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, nephrotoxicity, diarrhoea, 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 • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, Mg2+, Ca2+, creatinine • LDH • CXR Mid Treatment: Re-assess prior to third cycle Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Skarlos et al, 1994. Ann. Oncol., 5; pages 601-607 3rd Edition 12 Department of Medical Oncology Chemotherapy Protocols Protocol: CAV (Cyclophosphamide/Doxorubicin/Vincristine) Indications: Lung Cancer (small cell) – Palliative Schedule: Drug Cyclophosphamide Doxorubicin Vincristine Dose 1,000mg/m2 50mg/m2 1.4mg/m2 (max 2mg) 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 Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, haemorrhagic cystitis, constipation, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: Re-assess prior to fourth cycle Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Evans et al, 1987. Ann. Intern. Med., 107; pages 451-458 3rd Edition 13 Department of Medical Oncology Chemotherapy Protocols Protocol: Oral Etoposide Indications: Lung Cancer (small cell) - Palliative Schedule: Drug Etoposide Dose 100mg od Cycle frequency: Every three weeks iv/infusion/oral oral q Days 1-10 (14) Total number of cycles: 6 Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Mild • Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L • Start with 10 day course (total dose 1000 mg) Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, alopecia, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score, weight, CXR • 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 • CXR Mid Treatment: Re-assess after every two cycles Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Slevin, 1990. J. Clin. Oncol., 8; pages 1607-1609 3rd Edition 14
