ABSTRACT
Cisplatin-vigorous hydration is required; can be nephrotoxic and ototoxic; can cause peripheral neuropathy; hold or reduce for creatinine >1.5
Mitotane-if well-tolerated, dose may be doubled on day 3; then,
from day 5 onwards, may increase dose by 500 mg every 2-3 days until maximum tolerated dose (8-12 grams daily) has been reached; glucocorticoid and mineralocorticoid replacement necessary to prevent adrenal insufficiency; increased steroid doses may be needed at times of physiologic stress
MS mitotane/ streptozocin
Mitotane 2000-4000 mg PO QD (in 4 divided doses)
Streptozocin 1000 mg IV days 1-5
-followed by 1500 to 2000 mg monthly maintenance
REF: Eriksson et al. Cancer 1987; 59:1398-1403
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 non-cisplatin delayed emesis prophylaxis
Streptozocin-vesicant-avoid extravasation; have 50% dextrose available in case of sudden hypoglycemia; monitor closely for renal impairment
I Mitotane-if well-tolerated, dose may be doubled on day 3; then, from day 5 onwards, may increase dose by 500 mg every 2-3 days until maximum tolerated dose (8-12 grams daily) has been reached; glucocorticoid and mineralocorticoid replacement necessary to prevent adrenal insufficiency; increased steroid doses may be needed at times of physiologic stress
Mitotane (o.p.-DDD)
Mitotane 6-15 mg/kg PO QD (in 3-4 divided doses)
REF: Wooten et al. Cancer 1993; 72:3145-3155
Mitotane-if well-tolerated, dose may be doubled on day 3; then, from day 5 onwards, may increase dose by 500 mg every 2-3 days until maximum tolerated dose (8-12 grams daily) has been reached; glucocorticoid and mineralocorticoid replacement necessary to prevent adrenal insufficiency; increased steroid doses may be needed at times of physiologic stress
Carcinoid and Islet Cell Carcinoma Agent Dosage CE cisplatin/ etoposide
Cisplatin 100 mg/M2 IV day 1 Etoposide 120 mg/M2 IV day 1
REF: Davis et al. Proc Am Soc Clin Oncol 1987; 6:73
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/ cisplatin
I Doxorubicin 50 mg/M2 IV day 1 ! Cisplatin 50 mg/M2 IV day 1
REF: Sridhar et al. Cancer 1985; 55:2634-2637
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 -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
Streptozocin/ doxorubicin
Streptozocin 500 mg/M2 IV days 1-5 Doxorubicin 50 mg/M2 IV days 1,22
REF: Moertel et al. NEJM 1992; 326:519-523
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1-5 and 22 2. Dexamethasone 10 mg IV 30 minutes before chemo
therapy on days 1-5 and 22
OTHER MEDICATIONS 1. Give non-cisplatin delayed emesis prophylaxis
Repeat every 42 days
Streptozocin-vesicant-avoid extravasation; have 50% dextrose available in case of sudden hypoglycemia; monitor closely for renal impairment
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
Streptozocin/ fluorouracil (5-FU)
Streptozocin 500 mg/M2 IV days 1-5 5-FU 400 mg/M2 IV days 1-5
REF: Moertel et al. NEJM 1980; 303:1189-1194
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 non-cisplatin delayed emesis prophylaxis
Repeat every 42 days Streptozocin-vesicant-avoid extravasation; have 50% dextrose
available in case of sudden hypoglycemia; monitor closely for renal impairment
Agent Dosage CVD cyclophos phamide/ vincristine/ dacarbazine (DTIC)
Cyclophosphamide 750 mg/M2 IV day 1 Vincristine 1.4 mg/M2 IV day 1 DTIC 600 mg/M2 IV days 1,2
REF: Wu et al. Cancer 1994; 73:432-436
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1 and 2 2. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on days 1 and 2
Repeat every 21-28 days
Dacarbazine-vesicant-avoid extravasation
Vincristine-vesicant-avoid extravasation; cumulative neurotox icity-may produce severe constipation; maximum 2 mg per administration
Dacarbazine (DTIC)/ fluorouracil (5-FU)
DTIC 250 mg/M2 IV days 1-5 (over 15-30 min)
5-FU 450 mg/M2 IV days 1-5 (over 12 hours)
REF: Orlandi et al. Ann Oncol 1994; 5:763-765
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
Repeat every 28 days (maximum of 6 cycles)
Agent Dosage CVD cyclophospha mide/ vincristine/ dacarbazine (DTIC)
Cyclophosphamide Vincristine DTIC
750 mg/M2 1.4 mg/M2
600 mg/M2
IV IV IV
day 1 day 1
days 1,2
REF: Averbuch et al. Ann Intern Med 1988; 109:267-273
PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after
chemotherapy on days 1 and 2 2. Dexamethasone 20 mg IV 30 minutes before chemo
therapy on days 1 and 2
Repeat every 21-28 days
Dacarbazine-vesicant-avoid extravasation
Vincristine-vesicant-avoid extravasation; cumulative neurotoxicity-may produce severe constipation; maximum 2 mg per administration
