Department of Medical Oncology Chemotherapy Protocols

Protocol: AC (Doxorubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant, Palliative

Schedule:
Drug Dose iv/infusion/oral q
Doxorubicin 60mg/m2 iv Day 1
Cyclophosphamide 600mg/m2 iv Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Paclitaxel

Indications: Breast Cancer – Adjuvant (high risk), Palliative

Schedule:
Drug Dose iv/infusion/oral q
Paclitaxel 175mg/m2 500mls 5% dex/3hrs Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: EC (Epirubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant, Palliative

Schedule:
Drug Dose iv/infusion/oral q
Epirubicin 75mg/m2 iv Day 1
Cyclophosphamide 750mg/m2 iv Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: ET (Epirubicin/Taxol)

Indications: Breast Cancer – Metastatic

Schedule:
Drug Dose iv/infusion/oral q
Epirubicin 75mg/m2 iv Day 1
Paclitaxel 175mg/m2 500mls 5% dex/3hrs Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Canadian FEC (5-Fluorouracil/Epirubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant (high risk)

Schedule:
Drug Dose iv/infusion/oral q
5-Fluorouracil 500mg/m2 iv Days 1 & 8
Epirubicin 60mg/m2 iv Days 1 & 8
Cyclophosphamide 500mg/m2 iv Days 1 & 8

Cycle frequency: Every four weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: FEC100 (5-Fluorouracil/Epirubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant (moderate & high risk – pre-menopausal)

Schedule:
Drug Dose iv/infusion/oral q
5-Fluorouracil 500mg/m2 iv Day 1
Epirubicin 100mg/m2 iv Day 1
Cyclophosphamide 500mg/m2 iv Day 1

Cycle frequency: Every three weeks 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 602-
611

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Department of Medical Oncology Chemotherapy Protocols

Protocol: FEC60 (5-Fluorouracil/Epirubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant (moderate risk – post-menopausal)

Schedule:
Drug Dose iv/infusion/oral q
5-Fluorouracil 600mg/m2 iv Day 1
Epirubicin 60mg/m2 iv Day 1
Cyclophosphamide 600mg/m2 iv Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: MMM (Methotrexate/Mitozantrone/Mitomycin C)

Indications: Breast Cancer – Palliative

Schedule:
Drug Dose iv/infusion/oral q
Methotrexate 30mg/m2 iv Days 1 & 21
Mitozantrone 7mg/m2 100mls N. Saline/10mins Days 1 & 21
Mitomycin C 7mg/m2 iv Day 1

Cycle frequency: Every six weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: TAC (Taxotere/Doxorubicin/Cyclophosphamide)

Indications: Breast Cancer – Adjuvant (high risk), Palliative

Schedule:
Drug Dose iv/infusion/oral q
Docetaxel 75mg/m2 250mls N. Saline/1hr Day 1
Doxorubicin 50mg/m2 iv Day 1
Cyclophosphamide 500mg/m2 iv Day 1

Cycle frequency: Every three weeks Total number of cycles: 6

Dose modification: 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 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: XT (Xeloda/Docetaxel)

Indications: Breast Cancer – Metastatic

Schedule:
Drug Dose iv/infusion/oral q
Docetaxel 75mg/m2 250mls N. Saline/1hr Day 1
Capecitabine 1250mg/m2 bd oral Days 1-14

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Docetaxel

Indications: Breast Cancer – Metastatic

Schedule:
Drug Dose iv/infusion/oral q
Docetaxel 100mg/m2 250mls N. Saline/1hr Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Vinorelbine

Indications: Breast Cancer – Palliative

Schedule:
Drug Dose iv/infusion/oral q
Vinorelbine 30mg/m2 20mls N. Saline/10mins Days 1, 8 &15

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Trastuzumab/Paclitaxel

Indications: Breast Cancer – Metastatic (Her2/neu – positive)

Schedule:
Drug Dose iv/infusion/oral q
Trastuzumab 4mg/kg 500mls N. Saline/90mins Day -1
Trastuzumab 2mg/kg 250mls N. Saline/90mins Days 1, 8 &15
(↓ 30 min. if infusions are well tolerated)
Paclitaxel 175mg/m2 500mls 5% dex/3hrs Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Trastuzumab/Docetaxel

Indications: Breast Cancer – Metastatic (Her2/neu – positive)

Schedule:
Drug Dose iv/infusion/oral q
Trastuzumab 4mg/kg 500mls N. Saline/90min Day -1
Trastuzumab 2mg/kg 250mls N. Saline/90min Days 1, 8 &15
(↓ 30 min. if infusions are well tolerated)
Docetaxel 100mg/m2 250mls N. Saline/1hr Day 1

Cycle frequency: Every three weeks 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Trastuzumab (Weekly)

Indications: Breast Cancer – Metastatic (Her2/neu – positive)

Schedule:
Drug Dose iv/infusion/oral q
Trastuzumab 4mg/kg 500mls N. Saline/90mins once
Trastuzumab 2mg/kg 250mls N. Saline/90mins weekly
(↓ 30 min. if infusions are well tolerated)

Cycle frequency: Weekly Total number of cycles: Indefinite

Dose modification: Discuss with Consultant

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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: Trastuzumab (3-weekly)

Indications: Breast Cancer – Metastatic or Adjuvant (Her2/neu – positive)

Schedule:
Drug Dose iv/infusion/oral q
Trastuzumab 8mg/kg 500mls N. Saline/90min once
Trastuzumab 6mg/kg 500mls N. Saline/90min 3 weekly
(↓ 30 min. if infusions are well tolerated)

Cycle frequency: Every three weeks Total number of cycles: Indefinite

(1 year if adjuvant)

Dose modification: Discuss with Consultant

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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: AC/T (Accelerated)

Indications: Breast Cancer - Adjuvant (high risk)

Schedule:
Drug Dose iv/infusion/oral q
Doxorubicin 60mg/m2 IV Day 1, cycles 1-4
Cyclophosphamide 600mg/m2 IV Day 1, cycles 1-4
Then
Paclitaxel 175mg/m2 IV 500mls 5% dex/3hrs Day 1, cycles 5-8

Cycle frequency: Every two weeks (14 days) 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

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Department of Medical Oncology Chemotherapy Protocols

Protocol: AC/T

Indications: Breast Cancer - Adjuvant (high risk)

Schedule:
Drug Dose iv/infusion/oral q
Doxorubicin 60mg/m2 IV Day 1, cycles 1-4
Cyclophosphamide 600mg/m2 IV Day 1, cycles 1-4
Then
Paclitaxel 175mg/m2 IV 500mls 5% dex/3hrs Day 1, cycles 5-8

Cycle frequency: Every three weeks (21days) 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

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