Gemcitabine

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Etoposide Etoposide

100 mg 100 mg

PO QOD

days 1-7 days 8-14

REF: Kakolyris et al. Am J Clin Oncol 1998; 21:505-508 Repeat every 28 days

Gemcitabine 1000 mg/M2 IV days 1,8,15

REF: Crino et al. J Clin Oncol 1999; 17:2081-2085 PREMEDICATIONS

1. Compazine 10 mg PO/IV 30 minutes before chemotherapy Repeat every 28 days

Topotecan Topotecan 1.5 mg/M2/d IV (over 30 min) days 1-5

REF: Perez-Soler et al. J Clin Oncol 1996; 14:503-13 PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 1-5

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on days 1-5

Repeat every 21 days

Topotecan—hold for ANC < 1500 or platelets < 100,000; decrease dose by 0.25 mg/M2/d for prior episode of severe neutropenia or administer G-CSF starting on day 6

Vinorelbine Vinorelbine 30 mg/M2 IV every 7 days

-decrease dose to 15 mg/M2 when ANC 1000-1499 REF: Crawford et al. J Clin Oncol 1996; 14:2774-2784 PREMEDICATIONS

1. Compazine 10 mg PO/IV 30 minutes before chemotherapy Repeat every 7 days

Vinorelbine—vesicant; avoid extravasation; can cause peripheral neuropathy re

tu o

to re

su n

Small-Cell Lung Cancer

Agent

Carboplatin/ paclitaxel

CAE (ACE) cyclophosphamide/ doxorubicin/ etoposide

Dosage

REF: Groen et al. J Clin Oncol 1999; 17:927-932

Paclitaxel -followed by Carboplatin

PREMEDICATIONS

1. Dexamethasone 20 mg IV 30 minutes before chemotherapy

Dexamethasone 20 mg PO 6 and 12 hours prior

2. Diphenhydramine 50 mg IV 30 minutes before chemotherapy

3. Cimetidine 300 mg IV 30 minutes before chemotherapy

4. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy

OTHER MEDICATIONS

1. Give non-cisplatin delayed-emesis prophylaxis

2. Dexamethasone 4 mg PO BID for 6 doses after paclitaxel (for myalgias)

Repeat every 21 days

Cyclophosphamide Doxorubicin Etoposide (VP-16)

1000 mg/M2 45 mg/M2 50 mg/M2

IV IV IV

day 1 day 1 days 1-5

REF: Aisner et al. Semin Oncol 1986; 13:54-62

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on day 1

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on day 1

3. Compazine 10 mg PO/IV 30 minutes before chemotherapy on days 2-5

OTHER MEDICATIONS

1. May need to give non-cisplatin delayed-emesis prophylaxis

Repeat every 21 days

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant—avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.

cyclophosphamide/ doxorubicin/ vincristine

etoposide/ carboplatin

cisplatin/ etoposide

Cyclophosphamide

Doxorubicin

Vincristine

1000 mg/M2 40 mg/M2 1 mg/M2

IV IV IV

day 1 day 1 day 1

day 1 day 1 day 1

REF: Roth et al. J Clin Oncol 1992; 10:282-291

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy

OTHER MEDICATIONS

1. May need to give non-cisplatin delayed-emesis prophylaxis

Repeat every 21 days

Doxorubicin—monitor cumulative dose for cardiac toxicity (not to exceed 550 mg/M2 or 450 mg/M2 with prior chest radiotherapy); vesicant—avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Vincristine—vesicant-avoid extravasation; cumulative neurotoxicity—may produce severe constipation; maximum 2 mg per administration

Etoposide Carboplatin

120 mg/M2 AUC 6

IV IV

days 1-3 day 1

REF: Birch et al. Semln Oncol 1997; 24(4 Suppl 12):135-137

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on day 1

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on day 1

3. Compazine 10 mg PO/IV 30 minutes before chemotherapy on days 2 and 3

OTHER MEDICATIONS

1. Give cisplatin delayed-emesis prophylaxis

Repeat every 28-35 days

Etoposide Cisplatin

100 mg/M2 25 mg/M2

IV IV

days 1-3 days 1-3

REF: Loehrer et al. Semin Oncol 1988; 15:2-8 -multiple variants of this regimen have been published l ÇJ

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 1-3

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on days 1-3

OTHER MEDICATIONS

1. Give cisplatin delayed-emesis prophylaxis Repeat every 21 days

Cisplatin—vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine > 1.5

Irinotecan/ cisplatin

cyclophosphamide/ doxorubicin/ etoposide (VP-16)

Irinotecan Cisplatin

60 mg/M2 60 mg/M2

IV IV

REF: Kudoh et al. J Clin Oncol 1998; 1068-1074

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 1, 8, 15

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on days 1, 8, 15

OTHER MEDICATIONS

1. Give cisplatin delayed-emesis prophylaxis

2. Lomotil 4 mg PO at first sign of any loose stool and 2 mg every 2 hours until formed stool

Repeat every 28 days for 4 (with XRT in limited disease) or 6 (extensive disease) cycles

Cisplatin—vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine > 1.5

Paclitaxel

Carboplatin

VP-16

-alternating with VP-16

50 mg PO QOD days 1-10

100 mg PO QOD days 1-10

-if limited stage, concurrent XRT to 45 Gy is given with cycles 3 and 4

REF: Hainsworth et al. J Clin Oncol 1997; 15:3464-3470 PREMEDICATIONS

1. Dexamethasone 20 mg IV 30 minutes before chemotherapy OR

Dexamethasone 20 mg PO 6 and 12 hours prior

2. Diphenhydramine 50 mg IV 30 minutes before chemotherapy

3. Cimetidine 300 mg IV 30 minutes before chemotherapy I

4. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy

OTHER MEDICATIONS

1. Give cisplatin delayed-emesis prophylaxis

2. Dexamethasone 4 mg PO BID for 6 doses after chemotherapy (for myalgias)

Repeat every 21 days

PE/XRT Cisplatin 60 mg/M2 ¡V day 1

cisplatin/ VP-16 120 mg/M2 IV days 1-3

etoposide -radiotherapy to 45 Gy is given, starting concurrently with

(VP-16)/ cycle 1 of chemotherapy concurrent -a total of 4 cycles of chemotherapy are given, 2 during radiotherapy radiotherapy and 2 after

REF: Turrisi et al. NEJM 1999; 340:265-271

PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after cisplatin

2. Dexamethasone 20 mg IV 30 minutes before cisplatin

3. Compazine 10 mg PO/IV 30 minutes before etoposide

OTHER MEDICATIONS

1. Give cisplatin delayed-emesis prophylaxis

Repeat every 21 days

Cisplatin—vigorous hydration is required; can be nephrotoxic and-ototoxic; Can cause peripheral neuropathy; hold or reduce for creatinine > 1.5

Etoposide (VP-16)-oral

Etoposide

100 mg PO days 1-21

REF: Sessa et al. Ann Oncol 1993; 4:553-558 Repeat every 28 days

Gemcitabine Gemcitabine 1000-1250 mg/M2 IV days 1,8,15

REF: Cormier et al. Ann Oncol 1994; 5:283-285

PREMEDICATIONS

1. Compazine 10 mg PO/IV 30 minutes before chemotherapy

Repeat every 28 days

u

Agent

n r

Topotecan

Topotecan 1.5 mg/M2/d IV (over 30 min) days 1-5 REF: Ardizonni et al. J Clin Oncol 1997; 15:2090-2096 PREMEDICATIONS

1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on day 1

2. Dexamethasone 20 mg IV 30 minutes before chemotherapy on day 1

Malignant Melanoma

Sarcoma

Topotecan—hold for ANC < 1500 or platelets < 100,000; decrease dose by 0.25 mg/M2/d for prior episode of severe neutropenia or administer G-CSF starting on day 6

Supportive Care

Hematology Basics

Chemo-therapeutic Drug Toxicities

Drug Costs

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