Contents

Department of Medical Oncology
Chemotherapy Protocols
Fludarabine
Indications: “Low Grade” non-Hodgkin’s Lymphoma and CLL Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Prophylactic co-trimoxazole and valaciclovir • Round Fludarabine to the nearest 10mg Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, amenorrhoea, pneumonitis, carcinogenesis, infertility, hair thinning, fluid retention Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment • U &E’s, LFTs, creatinine, urate • Staging investigations as per protocol Review in the Medical Oncology Clinic 4 weeks after last cycle et al, 1999. J. Clin. Oncol., 17; pages 546-553 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
“Low Grade” non-Hodgkin’s lymphoma and CLL Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle Rosenberg SA, 1985. J. Clin. Oncol., 3; pages 299-310 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
“Low Grade” non-Hodgkin’s lymphoma and CLL Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2005. Blood, 105; pages 1417-1423 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: “Low Grade” non-Hodgkin’s Lymphoma Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils - < 1.0 x 109/L or platelets < 100 x 109/L • Prophylactic co-trimoxazole and valaciclovir Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, encephalopathy, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2000. Ann. Oncol., 11; pages 861-865 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 1991. J. Clin. Oncol., 9; pages 211-219 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: Non-Hodgkin’s Lymphoma (B-cell) Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately High • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Rituximab should be given pre-CHOP on cycle 1, subsequent cycles the order • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab Symptomatic treatment of side effects: Mouth care encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2002. N. Engl. J. Med., 346; pages 235-242 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
CHOP-R (with Intrathecal Methotrexate)
Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately High • Delay if neutrophils <1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Intrathecal methotrexate to be given in accordance with local policy • Rituximab should be given pre-CHOP on cycle 1, subsequent cycles the order • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility, sensitivity reaction to rituximab, post-lumbar puncture headache, meningeal irritation Symptomatic treatment of side effects: Mouth care encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 2002. N. Engl. J. Med., 346; pages 235-242 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
PIE (Cisplatin/Ifosfamide/Etoposide)
Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre & post hydration, mannitol, potassium & magnesium • Mesna dose guidelines Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
R-ICE (Carboplatin/Ifosfamide/Etoposide)
Ifosfamide 5,000mg/m2 1L N. Saline/24 hrs Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function, hydration • Prophylactic pegylated G-CSF on day 5 • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Kewalramani et al, 2004. Blood, 103; pages 3684-3688
3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Dose modification: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high on days 1 and 15 • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function and liver function • Round Etoposide dose to the nearest 50mg Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, haemorrhagic cystitis, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate, creatinine clearance • Staging investigations as per protocol Review in the Medical Oncology Clinic 4 weeks after last cycle et al, 1994. Ann. Oncol., 5; pages 147-155 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Rituximab (Mabthera)
Dose modification: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.0 x 109/L or platelets < 100 x 109/L • Pre-med Rituximab – paracetamol, chlorpheniramine, dexamethasone • Rituximab Rapid Infusion guidelines apply Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, hyper-sensitivity reaction, carcinogenesis, infertility, allergic-like reaction, bronchospasm, hypotension, cardiotoxicity, chills/fevers, rigors Symptomatic treatment of side effects: Supportive therapy Investigations Pre-treatment: • U & E’s, LFTs, creatinine, urate • Staging investigations as per protocol Review in Medical Oncology Clinic 4 weeks after last cycle et al, 1999. J. Clin. Oncol., 17; pages 1851-1857 3rd Edition
Department of Medical Oncology
Chemotherapy Protocols
Indications: Recurrent lymphoma and Hodgkin’s disease Schedule: Drug Dose iv/infusion/oral Dose modifications: Discuss with Consultant Administration and safety: • Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L • Pre & post hydration, mannitol, potassium & magnesium • Double/triple lumen Hickman line required Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea & vomiting, mucositis, conjunctivitis, alopecia, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, red skin, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, encourage oral fluids Investigations Pre-treatment: • U & E’s, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance • Staging investigations as per protocol inc. CT scans • U & E’s, LFTs, Mg2+, Ca2+, creatinine Post Treatment: Review in Medical Oncology Clinic 4 weeks after last cycle Reference: Velasquez et al, 1994. J. Clin. Oncol., 12; pages 1169-1176
3rd Edition

Source: http://www.midwesterncancercentre.ie/protocols/NonHodkinsChemoProtocols.pdf