Department of Medical Oncology
Protocol:
Doxorubicin/Cisplatin
Indications:
Osteosarcoma - neoadjuvant
Schedule:
Drug
Doxorubicin
Cisplatin
Dose
25mg/m2
50mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
iv bolus
1L N. Saline/2hrs
q
Days 1, 2 & 3
Days 1 & 2
Total number of cycles: 6
(3 before surgery)
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
Ensure adequate renal function
Pre & post-hydration, mannitol, potassium & magnesium
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, amenorrhoea, cardiac toxicity, peripheral neuropathy,
nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care, encourage oral fluids
Investigations
Pre-treatment:
History and Examination
Performance score, weight, CXR
FBC
U & Es, LFTs, Mg2+, Ca2+, creatinine, urate, creatinine clearance
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, Mg2+, Ca2+, creatinine
LDH
CXR
Mid Treatment:
After three cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Bramwell et al, 1992. J. Clin. Oncol., 10; pages 1579-1591
3rd Edition
78
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Ifosfamide
Indications:
Soft tissue sarcomas - Palliative
Schedule:
Drug
Ifosfamide
Dose
3g/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
1L N. Saline/4hrs
q
Days 1-3
Total number of cycles:
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
Mesna dose guidelines
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy,
haemorrhagic cystitis, nephrotoxicity, encephalopathy, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
History and Examination
Performance score, weight
FBC
U & Es, LFTs, creatinine, urate
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, creatinine
LDH
Mid Treatment:
After every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
van Oosterom et al, 2002. Eur. J. Cancer, 18; pages 2397-2406
3rd Edition
79
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
Adjuvant DI (Doxorubicin/Ifosfamide)
Indications:
Soft tissue sarcomas adjuvant (high risk)
Schedule:
Drug
Doxorubicin
Ifosfamide
Dose
60mg/m2
3g/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
iv
1L N. Saline/4hrs
q
Day 1
Days 1-3
Total number of cycles:
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
Mesna dose guidelines
Give prophylactic pegylated G-CSF on day 4
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy,
haemorrhagic cystitis, nephrotoxicity, encephalopathy, diarrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
History and Examination
Performance score, weight
FBC
U & Es, LFTs, creatinine, urate
Creatinine clearance
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, creatinine
LDH
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Frustaci et al, 2003. Oncology, 65 (Suppl 2); pages 80-84
3rd Edition
80
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
CYVADIC
Indications:
Soft tissue sarcomas Metastatic, Recurrent
Schedule:
Drug
Cyclophosphamide
Vincristine
Doxorubicin
Dacarbazine
Dose
500mg/m2
1.5mg/m2
50mg/m2
850mg/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
iv
iv (max 2 mg)
iv
500mls N. Saline/1hr
q
Day 1
Day 1
Day 1
Day 1
Total number of cycles:
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
Ensure adequate renal function
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:
History and Examination
Performance score, weight
FBC
U & Es, LFTs, creatinine, urate, creatinine clearance
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, creatinine
LDH
Mid Treatment:
After every two cycles
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Santoro et al, 1995. J. Clin. Oncol., 13; pages 1537-1545
3rd Edition
81
Department of Medical Oncology
Chemotherapy Protocols
Protocol:
High dose Ifosfamide/Etoposide
Indications:
Sarcomas - adjuvant, recurrent
Schedule:
Drug
Etoposide
Ifosfamide
Dose
100mg/m2
3g/m2
Cycle frequency:
Every three weeks
iv/infusion/oral
500mls N. Saline/1hr
1L N. Saline/4hrs
q
Days 1-5
Days 1-5
Total number of cycles:
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
With mesna (equivalent dose to ifosfamide over 24 hours)
Continuous hydration with total 3 litres fluid/m2 per day
Pegylated G-CSF on day 6
Toxicities:
Severe myelosuppression and risk of neutropenic sepsis or haemorrhage,
nausea & vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral
neuropathy, haemorrhagic cystitis, nephrotoxicity, encephalopathy, diarrhoea,
carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
History and Examination
Performance score, weight
FBC
U & Es, LFTs, creatinine, urate, creatinine clearance
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, creatinine
LDH
Post Treatment:
Review in Medical Oncology Clinic 4 weeks after last cycle
Reference:
Goorin et al, 2002. J. Clin. Oncol., 20; pages 426-433
3rd Edition
82
Department of Medical Oncology
Protocol:
Doxorubicin (Sarcoma)
Indications:
Sarcoma - palliative
Schedule:
Drug
Doxorubicin
Dose
75mg/m2
Cycle frequency:
Every three weeks
Chemotherapy Protocols
iv/infusion/oral
iv
q
Day 1
Total number of cycles:
4-6
Dose modifications: Discuss with Consultant
Administration and safety:
Anti-emetic group - Moderately High
Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L
Check liver function
Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea &
vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, carcinogenesis, infertility
Symptomatic treatment of side effects: Mouth care
Investigations
Pre-treatment:
History and Examination
Performance score, weight
FBC
U & Es, LFTs, creatinine, urate
LDH
ECG
Staging investigations as per protocol
Prior to each cycle:
Performance score, weight
FBC
U & Es, LFTs, creatinine
LDH
Mid Treatment:
After every two cycles, if palliative
Post treatment:
Review in Medical Oncology Clinic 3 weeks after the last cycle or at
the start CMF as per protocol 13
Reference:
Nielsen et al, 1998. Br. J. Cancer, 78; pages 1634-1639
3rd Edition
83
