Sarcoma | 16 | Chemotherapy Regimens and Cancer Care

ABSTRACT

Q12H for 3 additional doses 2. Dexamethasone 20 mg IV on days 1 and 2 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

Ifosfamide-adequate hydration is necessary to prevent nephrotoxicity____________________________________

Mesna Doxorubicin Ifosfamide Dacarbazine

2500 mg/M2/d 20 mg/M2/d

2500 mg/M2/d 300 mg/M2/d

CIV (X 96 h) days 1-4 CIV <x 72 h) days 1-3 CIV (X 72 h) days 1-3 CIV (X 72 h) days 1-3

REF: Elias et al. J Clin Oncol 1989; 7:1208-1216 PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before chemotherapy on day

1 then Q12H for 6 additional doses 2. Dexamethasone 20 mg IV days 1-3 Repeat every 21-28 days Doxorubicin-monitor cumulative dose for cardiac toxicity;

vesicant-avoid extravasation; can give larger cumulative doses than “standard” because less cardiotoxic by continuous infusion; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin >3.0

Dacarbazine-vesicant-avoid extravasation Ifosfamide-adequate hydration is necessary to prevent

nephrotoxicity

Agent Dosage Doxorubicin Doxorubicin 75 mg/M2 IV dayl

REF: Santoro, et al. J Clin Oncol 1995; 13:1537-1545 PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before 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 radio therapy); vesicant-avoid extravasation; use 50% for bilirubin 1.5-3.0; use 25% for bilirubin > 3.0

Ifosfamide/ mesna

Ifosfamide 5000 mg/M2 CIV (X 24 h) dayl Mesna 400 mg/M2 IV Q4H X 9 doses REF: Bramwell et al. Eur J Cancer Clin Oncol 1987; 23:311-321 PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before chemotherapy 2. Dexamethasone 20 mg IV 30 minutes before chemo

therapy Repeat every 21 days Ifosfamide-adequate hydration is necessary to prevent

nephrotoxicity M

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Kaposi’s Sarcoma Agent Dosage ABV Doxorubicin 10 mg/M2 IV day 1 doxorubicin/ bleomycin/ vincristine

Bleomycin 15 units IV day 1 Vincristine 1 mg IV day 1

REF: Gill et al. J Clin Oncol 1996; 14:2353-2364 PREMEDICATIONS 1. Compazine 10 mg PO/IV 30 minutes before chemotherapy 2. Dexamethasone 10 mg IV 30 minutes before chemo

therapy Repeat every 14 days Vincristine-vesicant-avoid extravasation; cumulative neurotoxic

ity-may produce severe constipation; maximum 2 mg per administration

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

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

Liposomal daunorubicin (DaunoXome)

DaunoXome 40 mg/M2 IV (over 1 h) day 1

REF: Gill et al. J Clin Oncol 1996; 14:2353-2364 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 Daunorubicin-monitor cumulative dose for possible cardiac

toxicity; vesicant-avoid extravasation Liposomal doxorubicin (Doxil)

Doxil 20 mg/M2 IV day 1

REF: Northfelt et al. J Clin Oncol 1997; 15:653-659

Lung Cancer

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Dosage 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

Paclitaxel Paclitaxel 100 mg/M2 IV (over 3 h) dayl REF: Gill etal. J Clin Oncol 1999; 17:1876-1883 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 8 doses after chemo therapy

Repeat every 14 days

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