ABSTRACT
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy OR
Dexamethasone 20 mg PO 6 and 12 hours prior 2. Diphenhydramine 50 mg IV 30 minutes before chemo
therapy 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. Dexamethasone 4 mg PO BID for 6 doses after paclitaxel
(for myalgias) 2. Give cisplatin delayed emesis prophylaxis
Repeat every 21 days CMV cisplatin/ methotrexate/ vinblastine
Cisplatin 100 mg/M2 IV day 2 Methotrexate 30 mg/M2 IV days 1,8 Vinblastine 4 mg/M2 IV days 1,8
REF: Jeffrey et al. Br J Cancer 1992; 66:542-546
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on day 2 2. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on day 2 3. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on days 1 and 8
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
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)
Docetaxel/ cisplatin
Docetaxel 75 mg/M2 IV (over 1 h) day 1 Cisplatin 75 mg/M2 IV (over 1 h) day 1
REF: Dimopoulos et al. Ann Oncol 1999; 10:1385-1388
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy 2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before
chemotherapy 4. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy
OTHER MEDICATIONS 1. Dexamethasone 8 mg PO BID for 8 doses-start day prior
to chemo (decreases lower extremity edema) 2. Give cisplatin delayed-emesis prophylaxis 3. G-CSF is given from day 5 until resolution of neutropenia
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
Gemcitabine/ cisplatin
Gemcitabine 1000 mg/M2 IV days 1,8,15 Cisplatin 70 mg/M2 IV day 2
REF: Moore etal. J Clin Oncol 1999; 17:2876-2881
OR Gemcitabine 1000 mg/M2 IV days 1,8,15 Cisplatin 75 mg/M2 IV day 1
REF: Kaufman et al. J Clin Oncol 2000; 18:1921-1927
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on day 2 2. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on day 2 3. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on days 1,8, and 15 if needed Continued
OTHER MEDICATIONS 1. Give cisplatin delayed-emesis prophylaxis
Repeat every 28 days
Cisplatin-vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine >1.5
MVAC methotrexate/ vinblastine/ doxorubicin/ cisplatin
Methotrexate 30 mg/M2 IV days 1,15,22 Vinblastine 3 mg/M2 IV days 2,15,22 Doxorubicin 30 mg/M2 IV day 2 - reduce dose to 15 mg/M2 if patient has received > 2000 cGy in 5 days to pelvis Cisplatin 70 mg/M2 IV day 2
- vinblastine and methotrexate given on days 15 and 22 only if WBC >2500 and platelet count is > 100,000
REF: Loehrer et al. J Clin Oncol 1992; 10:1066-1073
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on day 2 2. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on day 2 3. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on days 1,15, and 22 if needed
OTHER MEDICATIONS 1. Give cisplatin delayed-emesis prophylaxis
Repeat every 28 days
Cisplatin-vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine >1.5
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
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
Methotrexate - use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)
Paclitaxel/ cisplatin
Paclitaxel 175 mg/M2 IV (over 3 h) day 1 Cisplatin 75 mg/M2 IV day 1
REF: Dreicer et al. J Clin Oncol 2000; 18:1058-1061
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy OR
Dexamethasone 20 mg PO 6 and 12 hours prior 2. Diphenhydramine 50 mg IV 30 minutes before chemo
therapy 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. Dexamethasone 4 mg PO BID for 6 doses after paclitaxel
(for myalgias) 2. Give cisplatin delayed emesis prophylaxis
Repeat every 21 days for a maximum of 6 cycles
Cisplatin-vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine > 1.5
Docetaxel Docetaxel 100 mg/M2 IV(over 1 h) day 1 REF: de Wit et al. Br J Cancer 1998; 78:1342-1345
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy 2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before
chemotherapy
OTHER MEDICATIONS 1. Dexamethasone 8 mg PO BID for 8 doses-start day prior
to chemo (decreases lower extremity edema)
Repeat every 21 days Gemcitabine Gemcitabine 1200 mg/M2 IV days 1,8,15
REF: Moore et al. J Clin Oncol 1997; 15:3441-3445
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on days 1,8, and 15
Repeat every 28 days
Paclitaxel Paclitaxel 250 mg/M2 CIV (over 24 h) day 1
REF: Roth et al. J Clin Oncol 1994; 12:2264-2270
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy OR
Dexamethasone 20 mg P0 6 and 12 hours prior 2. Diphenhydramine 50 mg IV 30 minutes before chemo
therapy 3. Cimetidine 300 mg IV 30 minutes before chemotherapy
OTHER MEDICATIONS 1. Dexamethasone 4 mg P0 BID for 6 doses after (for
myalgias) 2. G-CSF support is required
Repeat every 21 days
Agent Dosage CF cisplatin/ fluorouracil (5-FU)
Cisplatin 100 mg/M2 IV day 1 5-FU 1000 mg/M2/d CIV days 1-5
(X 5 days)
REF: Shammas et al. J Urol 1992; 147:630-632
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 chemo
therapy on day 1
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
MF mitomycin Cl fluorouracil (5-FU)
Mitomycin C 10 mg/M2 IV day 1 5-FU 1000 mg/M2/d CIV days 1-4,29-32 - regimen is given concurrently with XRT
REF: Oberfield et al. Br J Urol 1996; 78:573-578
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 chemo
therapy on day 1
Mitomycin C-myelosuppression occurs late (approximately 4 weeks); limit cumulative dose to 50 mg/M2 (vascular toxicity)
Hormonal Agents LHRH agonists
Agent Dosage Goserelin (Zoladex)
Leuprolide (Lupron)
3.6 mg SQ every 4 weeks REF: Soloway et al. Urology 1991; 37:46-51
10.8 mg SQ every 12 weeks REF: Dijkman et al. Eur Urol 1995; 27:43-46
7.5 mg IM every 4 weeks REF: Leuprolide Study Group: NEJM1984; 311:1281-1286
22.5 mg IM every 12 weeks REF: Sharifi et al. Clin Ther 1996; 18:647-657
Antiandrogens Flutamide (Eulexin)
Bicalutamide (Casodex)
Nilutamide (Nilandron)
250 mg PO TID REF: McLeod et al. Prostate 1999; 40:218-224
50 mg PO QD REF: Schellhammer et al. Urology 1995; 45:745-752
150 mg PO QD REF: Janknegt et al. J Urol 1993; 149:77-82
Other Hormonal Agents Aminoglute thimide/ hydrocortisone
Aminoglutethimide 250 mg PO QID Hydrocortisone 20 mg PO QAM
10 mg PO QPM
REF: Sartor et al. J Natl Cancer Inst 1994; 86:222-227 Ketoconazole/ hydrocortisone
Ketoconazole 400 mg PO TID Hydrocortisone 20 mg PO QAM
10 mg PO QPM
REF: Small et al. Cancer 1997; 80:1755-1759
Chemotherapy Regimens Cyclophos phamide/ etoposide (VP-16)
Cyclophosphamide 100 mg PO days 1-14 VP-16 50 mg PO days 1-14
REF: Maulard-Durdux et al. Cancer 1996; 77:1144-1148 Repeat every 28 days
Estramustine/ docetaxel
Estramustine 280 mg POTID days 1-5 Docetaxel 70 mg/M2 IV day 1
- dose is reduced to 60 mg/M2 in extensively pretreated patients
REF: Petrylak et al. J Clin Oncol 1999; 17:958-967
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on day 1 2. Cimetidine 300 mg IV 30 minutes before chemotherapy on
day 1 3. Diphenhydramine 25-50 mg IV 30 minutes before
chemotherapy on day 1 4. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on day 1
OTHER MEDICATIONS 1. Dexamethasone 8 mg PO BID for 8 doses-start day prior
to chemotherapy (decreases lower extremity edema)
Repeat every 21 days Estramustine/ etoposide (VP-16)
Estramustine 15 mg/kg/d PO (divided QID) days 1-21 VP-16 50 mg/M2 PO (divided BID) days 1-21
REF: Pienta et al. J Clin Oncol 1994; 12:2005-2012
Repeat every 28 days Estramustine/ etoposide (VP-16)/ paclitaxel
Estramustine 280 mg POTID days 1-14 VP-16 100 mg P0 days 1-14 Paclitaxel 135 mg/M2 IV (over 1 h) day 2
REF: Smith et al. J Clin Oncol 1999; 17:1664-1674
PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on day 2 OR Dexamethasone 20 mg PO 6 and 12 hours prior
2. Diphenhydramine 50 mg IV 30 minutes before chemo therapy on day 2
3. Cimetidine 300 mg IV 30 minutes before chemotherapy on day 2
4. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on day 2
OTHER MEDICATIONS 1. Dexamethasone 4 mg PO BID for 6 doses after paclitaxel
(for myalgias)
Repeat every 21 days
Estramustine/ vinblastine
Estramustine 600 mg/M2 PO days 1-42 Vinblastine 4 mg/M2 IV days 1,8,15,22,
29,36
REF: Hudes et al. J Clin Oncol 1999; 17:3160-3166
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy
Repeat every 56 days
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
Mitoxantrone/ prednisone
Mitoxantrone 12 mg/M2 IV dayl Prednisone 5 mg PO BID daily
REF: Tannock et al. J Clin Oncol 1996; 14:756-64
PREMEDICATIONS 1. Compazine 10 mg PO/IV prior to chemotherapy
Repeat every 21 days
| Mitoxantrone-watch cumulative dose-do not exceed 140 mg/M2; possible cardiac toxicity
Cyclophos phamide
; Cyclophosphamide 100 mg/M2 PO days 1-14
REF: Raghavan et al. Br J Urol 1993; 72:625-628
Agent Dosage Vinblastine/ interferonalpha2a (IFN)
Vinblastine 0.1 mg/kg IV day 1 IFN 3 MIU SQTIW week one -then IFN 18 MIU SQTIW
REF: Pyrhonen et al. J Clin Oncol 1999; 17:2859-2867
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy 2. Tylenol 650 mg PO prior to IFN
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
Interferon (IFN)/ interleukin-2 (IL-2)
IL-2 4 MIU SQ days 1-4, weekly X 4 IFN 9 MIU SQ days 1-4, weekly X 4
REF: Vogelzang et al. J Clin Oncol 1993; 11:1809-1816
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before biotherapy 2. Tylenol 650 mg PO before biotherapy
Repeat every 42 days Alphainterferon (IFN)
IFN 18 MIU IM TIW
REF: Fossa et al. Ann Oncol 1992; 3:301-305
PREMEDICATIONS 1. Tylenol 650 mg PO prior to IFN
lnterleukin-2 (IL-2) high-dose
IL-2 600,000-720,000 lU/kg IV Q8h X 14 doses (over 15 min)
Repeat above in 6-9 days
REF: Fyfe et al. J Clin Oncol 1995; 13:688-696
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before therapy and Q12H
during therapy 2. Tylenol 650 mg PO 30 minutes before each dose of IL-2,
and Q4H pm 3. Cimetidine 800 mg PO/IV daily during IL-2 therapy (given
in single or divided doses)
Repeat every 6-12 weeks IL-2 may cause capillary leak syndrome with profound hypoten sion and patients may require vasopressor support and aggres sive fluid management. Patients should be cared for in an inten sive care setting
lnterleukin-2 (IL-2)-iow-dose
IL-2 3 MIU SQ BID days 1-5 weekly for 6 wks
REF: Stadler et al. Semin Oncol 1995; 22:67-73
PREMEDICATIONS 1. Tylenol 650 mg PO 30 minutes before IL-2 daily 2. Compazine 10 mg PO 30 minutes before IL-2
Vinblastine Vinblastine 0.1 mg/kg IV day 1 REF: Pyrhonen et al. J Clin Oncol 1999; 17:2859-2867
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy
Repeat every 7 days
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
Agent Dosage BEP bleomycin/ etoposide (VP-16)/ cisplatin
Cisplatin 20 mg/M2 IV days 1-5 VP-16 100 mg/M2 IV days 1-5 Bleomycin 30 units IV days 2,9,16
REF: Einhorn et al. J Clin Oncol 1989; 7:387-391
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1-5 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5
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
Bleomycin-give test dose of 1 -2 units because of possible acute pulmonary, anaphylactoid, or severe febrile reactions; must dose adjust for renal insufficiency; total lifetime dose should not exceed 400 units; avoid high Fi02 as it can exacerbate pulmo nary toxicity
EP etoposide (VP-16)/ cisplatin
VP-16 100 mg/M2 IV days 1-5 Cisplatin 20 mg/M2 IV days 1-5
REF: Motzer et al. J Clin Oncol 1995; 13:2700-2704
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1-5 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5
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
PVB cisplatin/ vinblastine/ bleomycin
Cisplatin 20.00 mg/M2 IV days 1-5 Vinblastine 0.15 mg/kg IV days 1,2 -reduce dose by 20% for prior radiotherapy Bleomycin 30 units IV days 2,9,16
REF: Einhorn et al. Ann Intern Med 1977; 87:293-298 PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1-5 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5
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
I Bleomycin-give test dose of 1 -2 units because of possible acute pulmonary, anaphylactoid, or severe febrile reactions; must dose adjust for renal insufficiency; total lifetime dose should not exceed 400 units; avoid high Fi02 as it can exacerbate pulmo nary toxicity
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity
VelP vinblastine/ ifosfamide/ cisplatin (salvage)
Vinblastine 0.11 mg/kg IV days 1,2 | Ifosfamide 1200mg/M2/d CIV (120 hr) days 1-5 | Cisplatin 20 mg/M2 IV days 1-5 ! Mesna 400 mg/M2 IV day 1 I -give bolus 15 minutes prior to Ifosfamide | Mesna 1200mg/M2/d CIV (120 hr) days 1-5
I -start immediately after Mesna bolus
j REF: Loehrer et al. Ann Intern Med 1988; 109:540-546
| PREMEDICATIONS I 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1 -5 I 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5
j OTHER MEDICATIONS I 1. Give cisplatin delayed-emesis prophylaxis
i 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
Ifosfamide-adequate hydration is necessary to prevent nephrotoxicity
Vinblastine-use 50% of dose for bilirubin > 3.0; vesicantavoid extravasation; watch for neurotoxicity
VIP etoposide (VP-16)/ ifosfamide/ cisplatin (salvage)
VP-16 75 mg/M2 IV days 1-5 Ifosfamide 1200mg/M2/d CIV (120 hr) days 1-5 Cisplatin 20 mg/M2 IV days 1-5 Mesna 400 mg/M2 IV day 1 -give bolus 15 minutes prior to Ifosfamide Mesna 1200mg/M2/d CIV (120 hr) days 1-5 -start immediately after Mesna bolus
REF: Loehrer et al. Ann Intern Med 1988; 109:540-546
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1-5 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5
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
Ifosfamide-adequate hydration is necessary to prevent nephrotoxicity
Gemcitabine -for use in refractory, heavily pretreated patients Gemcitabine 1200 mg/M2 IV days 1,8,15
REF: Einhorn et al. J Clin Oncol 1999; 17:509-511
PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy
on days 1,8, and 15
Repeat every 28 days
