. Gynecologic Cancer | 11 | Chemotherapy Regimens and Cancer Care

ABSTRACT

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

Ifosfamide-adequate hydration is necessary to prevent nephrotoxicity

BIP #2 bleomycin/ ifosfamide/ cisplatin

Bleomycin 30 units CIV (over 24 h) day 1 Ifosfamide 5000 mg/M2 CIV (over 24 h) day 2 Mesna 8000 mg/M2 CIV (over 36 h) day 2 -starting with ifosfamide Cisplatin 50 mg/M2 IV day 2

REF: Buxton et al. J Natl Cancer Inst 1989; 81:359-361

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

chemotherapy on days 1 and 2 2. Dexamethasone 10 mg IV 30 minutes before chemo

therapy on days 1 and 2

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

Cisplatin/XRT (neoadjuvant)

Cisplatin 40 mg/M2 IV weekly X 6 -given concurrently with XRT

REF: Keys et al. NEJM 1999; 340:1154-1161

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

chemotherapy 2. Dexamethasone 10 mg IV 30 minutes before chemotherapy

OTHER MEDICATIONS 1. Give cisplatin delayed-emesis prophylaxis

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

Gemcitabine/ cisplatin

Gemcitabine 1250 mg/M2 IV days 1,8 Cisplatin 50 mg/M2 IV day 1

REF: Burnett et al. Gynecol Oncol 2000; 76:63-66

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

chemotherapy on day 1 2. Dexamethasone 10 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

Paclitaxel/ cisplatin

Paclitaxel 175 mg/M2 IV (over 3 h) dayl Cisplatin 75 mg/M2 IV day 1

REF: Papadimitriou et al. J Clin Oncol 1999; 17:761-766

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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 28 days

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: Kudelka et al. Anticancer Drugs 1996; 7:398-401

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 chemotherapy (decreases lower extremity edema)

Repeat every 21 days Irinotecan Irinotecan 125 mg/M2 IV days 1,8,

REF: Look et al. Gynecol Oncol 1998; 70:334-338

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

chemotherapy

OTHER MEDICATIONS 1. Lomotil 4 mg PO at first sign of any loose stool and 2 mg

every 2 hours until formed stool

Repeat every 42 days Paclitaxel Paclitaxel 250 mg/M2 IV (over 3 hr) dayl

REF: Kudelka et al. Anticancer Drugs 1997; 8:657-661

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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 PO BID for 6 doses after (for

myalgias) 2. Requires G-CSF support

Repeat every 21 days

Endometrial Carcinoma Agent Dosage CAP cyclophos phamide/ doxorubicin/ cisplatin

Cyclophosphamide 500 mg/M2 IV day 1 Doxorubicin 50 mg/M2 IV day 1 Cisplatin 50 mg/M2 IV day 1

REF: Burke et al. Gynecol Oncol 1991; 40:264-267

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

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

CP carboplatin/ paclitaxel

Paclitaxel 175 mg/M2 IV (over 3 h) day 1 followed by Carboplatin AUC 5 IV (over 1 h) day 1 REF: Price et al. Semin Oncol 1997; 24(5suppl15):S78-S82 PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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 28 days

Doxorubicin/ cisplatin

Doxorubicin 50 mg/M2 IV day 1 Cisplatin 50 mg/M2 IV dayl

REF: Deppe et al. Eur J Gynaecol Oncol 1994; 15:263-266

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

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

Doxorubicin/ cyclophos phamide

Doxorubicin 60 mg/M2 IV day 1 Cyclophosphamide 500 mg/M2 IV day 1

REF: Thigpen et al. J Clin Oncol 1994; 12:1408-1414

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

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

Medroxy progesterone

Medroxyprogesterone 200 mg PO daily

REF: Thigpen et al. J Clin Oncol 1999; 17:1736-1744

Paclitaxel Paclitaxel 175 mg/M2IV over 3 hours day 1 REF: Lissoni et al. Ann Oncol 1996; 7:861-863

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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 PO BID for 6 doses after (for

myalgias)

Repeat every 21 days

Ovarian Cancer Agent Dosage CC carboplatin/ cyclophos phamide

Carboplatin 300 mg/M2 IV day 1 Cyclophosphamide 600 mg/M2 IV day 1

REF: Alberts et al. J Clin Oncol 1992; 10:706-717

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

OTHER MEDICATIONS 1. Give cisplatin delayed emesis prophylaxis

Repeat every 28 days CP cyclophos phamide/ cisplatin

Cyclophosphamide 600 mg/M2 IV day 1 Cisplatin 100 mg/M2 IV dayl

REF: Alberts et al. J Clin Oncol 1992; 10:706-717

OR Cyclophosphamide 750 mg/M2 IV day 1 Cisplatin 75 mg/M2 IV day 1

REF: McGuire et al. NEJM1996; 334:1-6

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

chemotherapy ! 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

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

CT paclitaxel/ cisplatin

I Paclitaxel 135 mg/M2 CIV (over 24 h) day 1 Cisplatin 75 mg/M2 IV day 1

REF: McGuire et al. NEJM 1996; 334:1-6

O n |QJ (T) 3 Q n o 3 oera

OR Paclitaxel 175 mg/M2 IV (over 3 h) dayl Cisplatin 75 mg/M2 IV day 1

REF: Piccant et al. Proc ASC0 1997; 16:abstract 1258

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR

Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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. Give cisplatin delayed-emesis prophylaxis 2. Dexamethasone 4 mg PO BID for 6 doses after paclitaxel

(for myalgias) 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

PC paclitaxel/ carboplatin

Paclitaxel 175 mg/M2 IV (over 3 h) dayl followed by Carboplatin AUC 7-7.5 IV (over 1 h) day 1 REF: Coleman et al. Cancer J Sci Am 1997; 3:246-253

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

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

Docetaxel Docetaxel 100 mg/M2 IV (over 1 h) day 1

REF: Kaye et al. Eur J Cancer 1997; 33:2167-2170

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. Compazine 10 mg PO/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 Etoposide (VP-16)

VP-16 50 mg PO BID days 1-7

REF: de Jong et al. Gynecol Oncol 1997; 66:197-201

Repeat every 21 days Gemcitabine Gemcitabine 1250 mg/M2 IV days 1,8,15

REF: von Minckwitz et al. Ann Oncol 1999; 10:853-855

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

Repeat every 28 days Hexamethylmelamine

Hexamethylmelamine 260mg/M2/d PO days 1-14

REF: Markman et al. Gynecol Oncol 1998: 69:226-229

Repeat every 28 days

Hexamethylmelamine-can have dose-limiting nausea and vomiting

Liposomal doxorubicin (Doxil)

Doxil 50 mg/M2 IV day 1

REF: Muggia et al. J Clin Oncol 1997; 15:987-993

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 21-28 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

Paclitaxel Paclitaxel 175 mg/M2 IV (over 3 h) day 1 REF: Eisenhauer et al. J Clin Oncol 1994; 2654-2666

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy 4. Compazine 10 mg PO/IV 30 minutes before chemotherapy

! OTHER MEDICATIONS I 1. Dexamethasone 4 mg PO BID for 6 doses after (for

myalgias)

Repeat every 21 days Topotecan Topotecan 1.5 mg/M2 IV (over 30 min) days 1 -5

REF: McGuire et al. J Clin Oncol 2000; 18:1062-1067

PREMEDICATIONS 1. Kytril 1 mg IV/PO 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

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

LOW RISK DISEASE

Agent Dosage Dactinomycin Dactinomycin 1.25 mg/M2 IV day 1

REF: Osathanondh et al. Cancer 1975; 36:863-866

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

chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy

Repeat every 14 days; treat for 1 to 2 cycles beyond negative HCG titers

Dactinomycin-vesicant-watch for extravasation Methotrexate Methotrexate 40 mg/M2 IM weekly

REF: Gleeson et al. Eur J Gynaecol Oncol 1993; 14:461-465

Treat for 2 courses beyond negative HCG titers

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

INTERMEDIATE/HIGH RISK DISEASE EMA-CO etoposide (VP-16)/ dactinomycin/ methotrexate/ vincristine/ cyclophos phamide

Etoposide 100 mg/M2 IV days 1,2 j Dactinomycin 0.5 mg IV days 1,2 | Methotrexate 100 mg/M2 IV day 1

— f^ollowed by Methotrexate 200 mg/M2 CIV (over 12 h) day 1

I Folic Acid 15 mg PO/IM BID for 4 doses, starting 24 h after first methotrexate dose

: Vincristine 0.8 mg/M2 IV day 8 Cyclophosphamide 600 mg/M2 IV day 8

i -patients with pulmonary metastases receive intrathecal methotrexate every 2 weeks with cycles of CO

REF: Bower et al. J Clin Oncol 1997; 15:2636-2643

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

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

on days 1, 2, and 8

Repeat every 14 days Continued

Agent Dosage Dactinomycin-vesicant-watch for extravasation

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

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

EP/EMA etoposide (VP-16)/ cispiatin/ dactinomycin/ methotrexate

Etoposide 150 mg/M2 IV day 1 Cisplatin 75 mg/M2 IV (over 12 h) dayl Etoposide 100 mg/M2 IV day 8 Methotrexate 300 mg/M2 IV (over 12 h) day 8 Dactinomycin 0.5 mg IV day 8 FolinicAcid 15 mg PO/IM BID days 9,10

-for 4 doses, starting 24 h after MTX

REF: Newlands et al. J Clin Oncol 2000; 18:854-859

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

chemotherapy on days 1 and 8 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy on days 1 and 8

OTHER MEDICATIONS 1. Give cisplatin delayed-emesis prophylaxis

Repeat every 14 days

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

Dactinomycin-vesicant-watch for extravasation

Methotrexate-use 75% dose for CrCI < 50; 50% dose if CrCI < 25; do not give if patient has an effusion (“reservoir effect”)

PVB cisplatin/ vinblastine/ bleomycin

Cisplatin 20 mg/M2 IV days 1-5 Vinblastine 0.15 mg/kg IV days 1,2 Bleomycin 30 units IV days 2,9,16

REF: Hainsworth et al. Cancer Treat Rep 1983; 67:393-395

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

Vinblastine-use 50% of dose for bilirubin > 3.0; vesicant-avoid extravasation; watch for neurotoxicity

Paclitaxel Paclitaxel 250 mg/M2 CIV (over 24 h) day 1 REF: Termrungruanglert et al. Anticancer Drugs 1996; 7:503-506

PREMEDICATIONS 1. Dexamethasone 20 mg IV 30 minutes before chemo

therapy OR

Dexamethasone 20 mg PO 6 and 12 hours prior to chemotherapy

2. Cimetidine 300 mg IV 30 minutes before chemotherapy 3. Diphenhydramine 25-50 mg IV 30 minutes before

chemotherapy 4. Compazine 10 mg PO/IV 30 minutes before chemotherapy

OTHER MEDICATIONS 1. Dexamethasone 4 mg PO BID for 6 doses after (for

myalgias) 2. Requires G-CSF support

Repeat every 21 days