Dosage

Cladribine (2-chlorode-oxyadenosine, 2-CdA) REF Piro et al. NEJM 1990 322 1117-1121 Single 7 day infusion IFN 2 MIU M2 SQ TIW for 1 year REF Rai et al. Leukemia 1995 9 1116-1120 PREMEDICATIONS 1. Acetaminophen as needed to alleviate fever or flu-like symptoms REF Grever et al. J Clin Oncol 1995 13 974-982 Repeat every 14 days for at least 3 months

Maintenance Phase

Mature B-cell ALL no maintenance B. Ph+ ALL allogeneic transplant if donor available otherwise, IFN and Ara-C as below C. All other patients -therapy is continued for 2 years 6-Mercaptopurine Methotrexate Vincristine Prednisone DS 1 tab PO BID each weekend 2. Valacyclovir 500 mg PO QD or TIW -above medications are continued for first 6 months of maintenance phase REF Kantarjian et al. J Clin Oncol 2000 18 547-561 Methotrexate 25 dose reduction for creatinine 1.5-2 and 50 reduction for...

Treatment protocols

-use monotherapy or combination therapy as indicated by clinical scenario 1. Monotherapy (one of the following) 1-2 gm IV QBH 1-2 gm IV Q12H 500 mg IV Q6H 500 mg IV Q24H 3.375 gm IV Q6H 3.1 gm IV Q6H 2. Combination therapy (one of the following combinations) a. Antipseudomonal beta-lactam (a, b, c, e, or f above) + aminoglycoside 5-6 mg kg d IV Q24H 5-6 mg kg d IV Q24H 15 mg kg d IV Q24H b. Antipseudomonal beta-lactam (a, b, c, e, or f above) + fluoroquinolone -therapy should be broad-based,...

Cns Treatmentprophylaxis

High Risk LDH > 600 and or high proliferative index mature B-cell ALL Known CNS disease IT therapy twice weekly until CNS negative, then per prophylaxis protocol High risk above is repeated for each of the 8 cycles of chemotherapy Low risk above is repeated only during the first 2 cycles of chemotherapy Unknown risk above is repeated during the first 4 cycles of chemotherapy

Vinca Alkaloids

-vinblastine, vincristine, vinorelbine Treatment 1. 150 units hyaluronidase reconstituted in 1-3 cc sterile saline -inject into site using original needle if possible 2. Warm pack apply to site without pressure after above injection -etoposide (VP-16), teniposide (VM-26) 1. treat for large volume extravasations 2. 150 units hyaluronidase reconstituted in 1-3 cc sterile saline -inject into site using original needle if possible 3. Warm pack apply to site without pressure after above injection...

Hematology Oncology Drug Costs

Below is a listing of commonly used drugs in the practice of Hematology and Oncology and their costs. This is not meant to be all-inclusive it is meant to be a guide to the costs of the various drugs used in this field. If more than one dosage formulation is available for a specific agent, only the 1 or 2 most common forms are listed. In addition even though common brand names are listed for recognition purposes, the cost reflects that of the lowest-priced generic (if one is available). Prices...

Gemcitabine cisplatin

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 CrCl < 50 50 dose if CrCl < 25 do not give if patient has an effusion (reservoir effect) IV (over 1 h) day 1 IV (over 1 h) day 1 REF Dimopoulos et al. Ann Oncol 1999 10 1385-1388 1. Dexamethasone 20 mg IV 30 minutes...

Info

Low purity (< 50 factor VIII units mg protein) -Cryoprecipitate Intermediate purity (1-10 factor VIII units mg protein) -Humate-P (also contains high molecular weight multimers of von Willebrand factor) -vials contain average of 500, 1000, or 2000 Ristocetin cofactor units per vial High purity (50-1000 factor VIII units mg protein) -Alphanate -Koate-HP Very high purity (3000 factor VIII units mg protein) -Monoclate-P average of 250, 500, or 1000 factor VIII units vial -Hemofil-M Recombinant...

Cutaneous Tcell Lymphomas

-for use in cutaneous T-cell lymphomas Bexarotene 300 mg M2 d PO REF Duvic et al. Blood 1999 94(Suppl 1) abstract 2927 Bexarotene causes severe hyperlipidemia in majority of patients treated may require concomitant lipid-lowering therapy -for use in refractory CD25 positive cutaneous T-cell lymphomas Ontak 9-18 mg kg IV(over 15 min) days 1-5 1. Diphenhydramine 25-50 mg PO IV 30 minutes before treatment 2. Tylenol 650 mg PO 30 minutes before treatment Repeat every 21 days Ontak watch for high...

Malignant Melanoma

J Clin Oncol 1999 17 2745-2751 1. Kytril 1 mg PO IV 30 minutes before and 12 hours after cisplatin 2. Dexamethasone 20 mg IV 30 minutes before cisplatin 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 Dacarbazine vesicant avoid extravasation Carmustine maximum total dose is 1,440 mg M2 causes delayed myelosuppression dacarbazine (DTIC)...

Procarbazine alkylating agent cell cycle Independent bone marrow suppressionprolonged

-nausea and vomiting severe tolerance often develops with repeated dosing -mucocutaneous effects (mucositis, stomatitis, diarrhea) -rash, hives, photosensitivity -interstitial pneumonitis -CNS toxicity seizures, lethargy, headache, ataxia -flu-like syndrome _-azoospermia and amenorrhea almost universal_ Rituximab -monoclonal antibody to CD20 (B-cell surface antigen) -fever, chills, malaise -nausea, vomiting -flushing -bronchospasm, angioedema, urticaria -rhinitis -tumor lysis syndrome may occur...

Hematology Drugs

Coagulation Factor Replacement Therapy Hematopoietic Growth Factors Immune Thrombocytopenic Purpura Warfarin -adjust dosage to maintain INR of 2-3 (3-4.5 for prosthetic valves) Supportive Sarcoma Malignant Care Melanoma Unfractionated -loading dose of 80 mg kg, followed by 18 mg kg hr adjust Heparin dose to maintain a therapeutic PTT REF Raschke et al. Ann Intern Med 1993 119 874-881 Prophylaxis Enoxaparin 30-60 mg SQ BID (Lovenox) Dalteparin 2500-5000 units SQ QD (Fragmin) Ardeparin 50 units...

Acute Promyelocytic Leukemia

-continued to complete 2 years of therapy ATRA 45 mg M2 PO -continued to complete 2 years of therapy ATRA 45 mg M2 PO REF Fenaux et al. Blood 1999 94 1192-1200 1. Kytril 1 mg PO IV 30m minutes before and Q12 hours during daunorubicin and ara-c 2. Dexamethasone 20 mg IV 30 minutes before chemotherapy during daunorubicin and ara-c 6-Mercaptopurine reduce dose by 75 when used in conjunction with allopurinol Daunorubicin monitor cumulative dose for possible cardiac toxicity vesicant avoid...

Cns Prophylaxis

-initiate within 1 week of achieving complete remission Cranial XRT 1800 cGy in 10 fractions Methotrexate 12 mg IT weekly X 6 -if CNS is positive at time of diagnosis -begin weekly intrathecal MTX during induction -continued for 30 months of CR Methotrexate 20 mg M2 PO REF Linker et al. Blood 1991 78 2814-2822 1. Kytril 1 mg PO IV 30 minutes before and 12 hours after daunorubicin 2. Compazine 10 mg PO IV 30 minutes before Ara-C, L-asparaginase, and teniposide Daunorubicin monitor cumulative...

Interleukin2 IL2lowdose

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 REF Pyrh nen et al. J Clin Oncol 1999 17 2859-2867 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

Streptozocin alkylating agent cell cycle independent nephrotoxicitycan be doselimiting

-nausea and vomiting may get progressively worse with continued administration -mucocutaneous effects (mucositis, stomatitis, diarrhea) -bone marrow suppression -irritant if extravasated (not vesicant) -delirium or depression -risk of secondary leukemias Tamoxifen -nonsteroidal antiestrogen -nausea and vomiting -bowel changes (diarrhea or constipation) -headache -peripheral edema -hot flashes -endometrial carcinoma -vaginal bleeding -venous thrombosis -nausea and vomiting mild to moderate...

Formula to calculate amount of IV iron

Iron dose (mg) (Normal Hb - Patient Hb) X weight (lbs) + 1000 mg (males) or 600 mg (females) Iron dextran (InFed) comes as 50 mg ml Premedicate with Diphenhydramine 50 mg PO IV 30 minutes before iron Premedicate with Tylenol 650 mg PO 30 minutes before iron Administer test dose of iron 25 mg IV wait at least 30 minutes if no reaction Administer remainder of total iron dose in 1 liter normal saline over 4-5 hours Tylenol 650 mg PO Q6H for 2 doses after conclusion of iron infusion

Cisplatin

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 REF Hitt et al. Semin Oncol 1995 22 50-54 1. Dexamethasone 20 mg IV 30 minutes before chemotherapy 2. Diphenhydramine 50 mg IV 30 minutes before chemotherapy 3. Cimetidine 300 mg IV 30 minutes before chemotherapy 4. Kytril 1 mg PO IV 30 minutes before and 12 hours after chemotherapy 1....

Course I Induction 4 Week

-for patients > age 60, modify doses as follows COURSE II EARLY INTENSIFICATION (4 WEEK REPEAT ONCE) COURSE III CNS PROPHYLAXIS AND INTERIM MAINTENANCE (12 WEEK) COURSE IV LATE INTENSIFICATION (8 WEEK) REF Larson et al. Blood 1995 85 2025-2037 REF Larson et al. Blood 1995 85 2025-2037 1. Kytril 1 mg PO IV 30 minutes before and 12 hours after daunorubicin, doxorubicin, and cyclophosphamide 2. Compazine 10 mg PO IV 30 minutes before cytarabine and L-asparaginase Anthracyclines monitor...

Factor IX

-Factor VIII Inhibitor dose 75 factor IX units kg Factor IX (desired concentration - current level) X wt (kg) -multiply this value by 1.2 when using recombinant factor IX Low purity (< 50 factor IX units mg protein) -Proplex T (Factor IX Complex) used for factor VIII inhibitors, and factor VII or IX deficiency -Factor IX replacement dose desired increase X wt (kg) -Factor VII replacement dose desired increase in factor VII level X wt (kg) X 0.5 High purity (> 160 factor IX units mg protein)...

Nitrogen Mustard And Mitomycin C

4 mg PO after first loose BM, then 2 mg PO after each loose BM Treatment 1. Mix 4 cc 10 sodium thiosulfate with 6 cc of sterile H20 -inject 2 cc into site for each mg of drug extavasated 2. Topical DMSO - 1.5 cc topically Q6H for 7-14 days allow to air dry * cisplatin large extravasations can also be treated in the above manner

Thrombolytics

Streptokinase 1.5 million units IV over 1 hour Alteplase 100 mg IV give 60 mg IV during first hour (6-10 mg IV bolus over 1-2 minutes), followed by 20 mg IV during 2nd hour and 20 mg IV during 3rd hour Anistreplase 30 units IV over 2-5 minutes Reteplase 10 unit IV bolus, followed by 10 units 5 gram bolus, followed by 1-2 grams PO Q1-2HPRN

Bleomycin

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 chemotherapy on days 1 and 8 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...

Chemotherapy Regimens and Cancer Care

VADEMECUM Chemotherapy Regimens and Cancer Care LANDES BIOSCIENCE Georgetown, Texas U.S.A. Copyright 2001 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Please address all inquiries to the Publisher Landes Bioscience, 810 S. Church Street, Georgetown, Texas, U.S.A....

Hematologic Malignancies

Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia Vincristine 2 mg IV days 1,8,15,22 Daunorubicin 25 mg M2 IV days 1,8,15,22 Prednisone 60 mg M2 PO days 1-28 L-asparaginase 5,000 units M2 IV days 1-14 Cyclophosphamide 650 mg M2 IV days 29,43,57 -maximum dose 1000 mg 6-Mercaptopurine 60 mg M2 PO days 29-57 Methotrexate 10 mg M2 IT days 31,38,45,52 -maximum dose is 15 mg Cranial 1800-2400 cGy given with phase II radiotherapy induction CONSOLIDATION PHASE I-begins week 20 Vincristine 2 mg...

Cervical Cancer

BIP 1 bleomycin ifosfamide cisplatin Bleomycin Ifosfamide Cisplatin Mesna 15 mg 1QQQ mg M2 5Q mg M2 1QQQ mg M2 REF Kumar et al. Gynecol Oncol 1991 4Q 1Q7-111 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 chemotherapy on days 1-5 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 gt 1.5...

Dose administration malaise myalgias fatigueDLT for lowdose administration

-bone marrow suppression -nausea and vomiting -mucocutaneous effects stomatitis, mucositis -cardiovascular effects arrhythmias, hypotension -anorexia -mental status changes confusion, lethargy, psychosis -renal impairment Altretamine -alkylating agent hexamethyl- -nausea and vomiting melamine -bone marrow suppression -diarrhea, abdominal cramps -mucocutaneous effects stomatitis, mucositis -neuropathies -mental status changes -cytoprotectant free radical scavenger -nausea and vomiting...

Mesna

Eur J Cancer 1990 26 558-561 -there are multiple variations of this regimen 1. Kytril 1 mg PO IV 30 minutes before chemotherapy and Q12H for 3 additional doses 2. Dexamethasone 20 mg IV on days 1 and 2 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 gt 3.0 Ifosfamide adequate hydration is necessary to prevent nephrotoxicity...

Gemcitabine

Am J Clin Oncol 1998 21 505-508 Repeat every 28 days Gemcitabine 1000 mg M2 IV days 1,8,15 REF Crino et al. J Clin Oncol 1999 17 2081-2085 PREMEDICATIONS 1. Compazine 10 mg PO IV 30 minutes before chemotherapy Repeat every 28 days Topotecan Topotecan 1.5 mg M2 d IV over 30 min days 1-5 REF Perez-Soler et al. J Clin Oncol 1996 14 503-13 PREMEDICATIONS 1. Kytril 1 mg PO IV 30 minutes before and 12 hours after chemotherapy on days 1-5 2. Dexamethasone 20 mg IV 30 minutes...

Cisplatin gemcitabine

J Clin Oncol 1999 17 25-30 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 chemotherapy on day 1 3. Compazine 10 mg PO IV 30 minutes before chemotherapy on days 8 and 15 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 gt 1.5 REF Chahinian et al. J Clin Oncol 1993 11...