Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Paclitaxel Carboplatin

Carboplatin/Paclitaxel Ovarian Cancer Adjuvant, Advanced Dose 175mg/m2 AUC 5 Every three weeks iv/infusion/oral 500mls 5% dex/3hrs 500mls 5% dex/1hr q Day 1 Day 1 6

Cycle frequency:

Total number of cycles:

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 & Es, LFTs, creatinine, urate, creatinine clearance LDH, CA125 ECG Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, creatinine LDH, CA125 Mid Treatment: Post Treatment: Reference: Abdominal CT scan prior to fourth cycle if measurable disease present. Ensure CA125 falling. Review in Medical Oncology Clinic 4 weeks after last cycle MRC ICON 3, 2002. Lancet, 360; pages 505-515

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Paclitaxel

Paclitaxel Ovarian Cancer Recurrent Dose 175mg/m2 iv/infusion/oral 500mls 5% dex/3hrs q Day 1 6

Cycle frequency: Every three weeks Dose modifications: Discuss with Consultant

Total number of cycles:

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 & Es, LFTs, creatinine, urate, creatinine clearance LDH, CA125 ECG Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, creatinine LDH, CA125 Mid Treatment: Post Treatment: Reference: Ensure CA125 falling Review in Medical Oncology Clinic 4 weeks after last cycle Gore et al, 1997. J. Clin. Oncol., 15; pages 2183-2193

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Carboplatin

Carboplatin Ovarian Cancer Advanced, Recurrent Dose AUC 6 Every three weeks iv/infusion/oral 500mls 5% dex/1hr q Day 1 6

Cycle frequency:

Total number of cycles:

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 & Es, LFTs, creatinine, urate, creatinine clearance LDH, CA125 ECG Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, creatinine LDH, CA125 Mid Treatment: Post Treatment: Reference: Abdominal CT scan prior to 4th cycle if measurable disease present. Ensure CA125 falling Review in Medical Oncology Clinic 4 weeks after last cycle Taylor et al, 1994. J. Clin. Oncol., 12; pages 2066-2070

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Paclitaxel Cisplatin

Cisplatin/Paclitaxel Ovarian Cancer Adjuvant Dose 175mg/m2 75mg/m2 Every three weeks iv/infusion/oral 500mls 5% dex/3hrs 1L N. Saline/2hrs q Day 1 Day 1 6

Cycle frequency:

Total number of cycles:

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 & Es, 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 & Es, LFTs, Mg2+, Ca2+, creatinine LDH, CA125 Mid Treatment: Post Treatment: Reference: Abdominal CT scan prior to fourth cycle if measurable disease present. Ensure CA125 falling Review in Medical Oncology Clinic 4 weeks after last cycle Neijt et al, 2000. J. Clin. Oncol., 18; pages 3084-3092

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications:

Liposomal Doxorubicin Ovarian Cancer Recurrent iv/infusion/oral 250mls 5% dex/1hr q Day 1 6-12

Schedule: Drug Dose Liposomal Doxorubicin 50mg/m2 Cycle frequency: Every 4 weeks

Total number of cycles:

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 & Es, LFTs, creatinine, urate LDH, CA125 ECG +/- Echocardiogram Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, creatinine LDH, CA125 Mid Treatment: Post Treatment: Reference: Abdominal CT scan prior to 4th cycle if measurable disease present. Ensure CA125 falling Review in Medical Oncology Clinic 4 weeks after last cycle Gordon et al, 2000. J. Clin. Oncol., 18; pages 3093-3100

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Cisplatin Methotrexate Bleomycin

PMB (Cisplatin/Methotrexate/Bleomycin) Cervix Cancer Advanced, Recurrent Dose 60mg/m2 300mg/m2 30,000iu 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 3

Cycle frequency:

Total number of cycles:

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 & Es, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance LDH ECG+/- Audiometry Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, Mg2+, Ca2+, creatinine LDH Mid Treatment: Post Treatment: Reference: Re-assess after 3 cycles Review in Medical Oncology Clinic 4 weeks after last cycle Huskin and Blake, 1991. Int. J. Gynaecol. Oncol., 1; pages 75-80

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications: Schedule: Drug Cisplatin 5-Fluorouracil

CF (Cisplatin/5-Fluorouracil) Cervix Cancer Neoadjuvant, Advanced Dose 75mg/m2 1g/m2/24 hrs Every three weeks iv/infusion/oral 1L N. Saline/2hrs continuous infusion q Day 1 Days 2-5 3

Cycle frequency:

Total number of cycles:

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 & Es, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance LDH ECG Staging investigations as per protocol Prior to each cycle: Performance score, weight FBC U & Es, LFTs, Mg2+, Ca2+, creatinine LDH Post Treatment: Reference: Review in Medical Oncology Clinic 3 weeks after last cycle Morris et al, 1999. N. Engl. J. Med., 340; pages 1137-1143

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