Download CE (4 weekly) - CARBOPLATIN &amp

CE (4 weekly) - CARBOPLATIN &
Cumbria, Northumberland, Tyne & Wear Area Team
DRUG ADMINISTRATION SCHEDULE
Day
Drug
Sodium Chloride 0.9%
Dose
250/500ml
Route
Infusion
Diluent & Rate
Fast Running
Dexamethasone
8mg
IV bolus
Via saline drip
Ondansetron
8mg
Carboplatin*
AUC 5 or 6
IV Infusion
Etoposide
120mg/m2
IV Infusion
Day
1
Days
2&3
Etoposide
Oral /Slow bolus/15 min infusion
240 mg/m2
Oral
500/250ml 5% Glucose over
30 to 60 Minutes
1000ml 0.9% Sodium
Chloride over 90 minutes
Given as Divided doses
(twice daily) rounded to
nearest 50mg
*Ondansetron IV must be infused over 15 minutes in patients over 65 years of age.
DOSE FORM
Oral Etoposide given as a divided dose (twice daily) rounded to nearest 50mg,
Available as 50mg and 100mg capsules.
CARBOPLATIN DOSAGE *
Dose (mg) = AUC x (GFR + 25)
Where the GFR is the non-corrected EDTA clearance. If Cockcroft & Gault calculation
is used the AUC should be increased to 6, however, the Wright formula can also be
used with AUC 5.
CYCLE LENGTH AND NUMBER OF DAYS
Administered on a 28 day cycle.
APPROVED INDICATIONS
First line treatment for SCLC
ELIGIABILITY CRITERIA
There are two versions of CE for SCLC this 4 weekly schedule should be used for
patients with for poorer performance status and/or extensive stage disease.
EXCLUSION CRITERIA
Patients not fitting the above criteria
PREMEDICATION
As above
RECOMMENDED TAKE HOME MEDICATION
Ondansetron 8mgs twice daily for 2 to 3 days
Dexamethsone 4mgs x twice daily for 1 to 3 days
Metoclopramide 10mg three times daily as required
Carboplatin etoposide 4 weekly CRP14 L007 v1.2
Issue Date 29/05/2014
Page 1 of 3
Expiry Date May 2016
CE (4 weekly) - CARBOPLATIN &
Cumbria, Northumberland, Tyne & Wear Area Team
INVESTIGATIONS / MONITORING REQUIRED
Pre treatment
Full blood count, urea and electrolytes, liver function tests, baseline radiology (CXR/
CT). Repeat radiology after 2 cycles
Prior to each cycle - FBC, U/E’s, LFT’s as required
Check renal function before commencing platinum. Use EDTA or C&G/Wright
formulae to calculate GFR
ASSESSMENT OF RESPONSE
Metastatic: Tumour size and patient symptomatic response
REVIEW BY CLINICIAN
To be reviewed by either a Nurse, Pharmacist or Clinician before every cycle.
NURSE / PHARMACIST LED REVIEW
On cycles where not seen by clinician.
ADMINISTRATION NOTES
May give prophylactic Ciprofloxacin 250 mgs TWICE daily for SEVEN days starting
on day 10
EXTRAVASATION See NECN/Local Policy
TOXICITIES
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Risk of hypersensitivity and anaphylaxis with platinum, starting within a few
minutes of administration
Nausea and vomiting
Myelosuppression, particularly, thrombocytopenia, anaemia & neutropenia
Nephrotoxicity
Peripheral neuropathy
Dizziness during infusion
Oedema/peripheral oedema
Lethargy
Mild Alopecia
Constipation
Electrolyte disturbance
Otological symptoms; 8000 Hz conduction deafness
Alteration in LFT’s (infrequent and transient)
DOSE MODIFICATION / TREATMENT DELAYS
Haematological Toxicity:
Proceed On Day 1 If:WCC ≥ 3.0
PLT ≥ 100
ANC ≥ 1.5
Delay 1 week on DAY 1 if:WCC < 3.0
PLT <100
ANC <1.5
Carboplatin etoposide 4 weekly CRP14 L007 v1.2
Issue Date 29/05/2014
Page 2 of 3
Expiry Date May 2016
CE (4 weekly) - CARBOPLATIN &
Cumbria, Northumberland, Tyne & Wear Area Team

If WCC, Platelets or ANC still below required levels for treatment at week 2 , delay
treatment again and patient will need assessed and chemotherapy dose reduction by
Oncologist

If Hb < 10 & patient symptomatic will need blood transfusion, but may proceed with
chemotherapy as planned if performance status (PS) stable.

If pre-treatment ( Day 1) U&E’s & LFT’s abnormal, delay treatment 1 week and
discuss with Oncologist as may need dose reduction.
Non-Haematological Toxicity:-

If PS deteriorates to 3 or 4 and on assessment patient is more symptomatic
withhold treatment and discuss with Oncologist
TREATMENT LOCATION
Can be given at Cancer Centre or Cancer Unit
REFERENCES:
Smith IE, Evans BD, Gore ME, et al. Carboplatin (Paraplatin; JM8) and etoposide
(VP-16) as first-line combination therapy for small-cell lung cancer. J Clin Oncol.
1987 Feb; 5(2): 185-9.
Document Control
Document Title:
CE Q4W NECN protocol CRP14 L007
Document No:
CRP09 L007
Author:
Approved by:
Current
Version:
Steve Williamson, Consultant
Pharmacist NECN
Calum Polwart, Cancer Pharmacist
1.2
Approval
Signature*
Date
Approved:
29.05.14
Due for Review:
May 2016
Summary of
Changes
1.1
Reformatted from old NCN/CCA version
1.2
Protocol reviewed and reissued, Antiemetic advice updated
Carboplatin etoposide 4 weekly CRP14 L007 v1.2
Issue Date 29/05/2014
Page 3 of 3
Expiry Date May 2016