Cycle length: Every 21 days, for a maximum of six cycles. | |||
Drug | Dose and route | Administration | Given on days |
Paclitaxel | 200 mg/m2 IV | Dilute in 250 mL NS* and administer over one hour; special tubing needed.¶ | Day 1 |
Carboplatin | AUCΔ = 6 mg/mL per min IV | Dilute in 250 mL NS* and administer over 30 minutes. | Day 1 |
Pretreatment considerations: | |||
Emesis risk |
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Prophylaxis for infusion reactions |
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Vesicant/irritant properties |
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Infection prophylaxis |
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Dose adjustment for baseline liver or kidney dysfunction |
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Monitoring parameters: | |||
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Suggested dose modifications for toxicity: | |||
Myelotoxicity |
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Kidney/hepatic toxicity |
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Neurotoxicity |
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If there is a change in body weight of at least 10%, doses should be recalculated. | |||
Dose reductions may also be indicated if there are other grade 2 or higher nonhematologic toxicities. The dose reduction is at the discretion of the clinician, as formal guidelines are not available. |
AUC: area under the concentration × time curve; CBC: complete blood count; D5W: 5% dextrose in water; GFR: glomerular filtration rate; IV: intravenous; NCCN: National Comprehensive Cancer Network; NS: normal saline.
* Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibility(ies).
¶ Paclitaxel can be administered in NS, D5W, or NS/D5W* at varying concentrations between 0.3 to 1.2 mg/mL. Use glass or polypropylene bottles or polypropylene or polyolefin plastic bags, and administer through polyethylene-lined administration sets with a microporous membrane 0.22 microns or less.
Δ AUC is converted to a patient-specific carboplatin dose (in mg) according to kidney function by using the Calvert formula. The Calvert formula is total dose (mg) = (target AUC) × (GFR + 25). If using measured serum creatinine, limit the maximal GFR for the calculation to 125 mL/min. Refer to UpToDate topics on dosing of anticancer agents in adults.
◊ Consensus-based guidelines from the NCCN classify higher carboplatin doses (AUC ≥4) as highly emetogenic; by contrast, the American Society of Clinical Oncology and the Multinational Association for Supportive Care in Cancer guidelines consider all carboplatin doses to be moderately emetogenic. Although many institutions classify carboplatin-containing regimens as moderately emetogenic, a benefit for adding a neurokinin 1 receptor antagonist on day 1 has been shown in many studies; additional prophylaxis beyond day 1 for delayed emesis is not needed for most patients. Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
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