Cycle length: Every 21 days for a maximum of six cycles, followed by maintenance therapy with bevacizumab every three weeks. | |||
Drug | Dose and route | Administration | Given on days |
Paclitaxel | 200 mg/m2 IV | Dilute in 250 mL NS* (final concentration of 0.3 to 1.2 mg/mL) and administer over three hours.¶ | Day 1 |
Carboplatin | AUCΔ = 6 mg/mL per min IV | Dilute in 250 mL NS* and administer over 30 minutes (administer 60 minutes after the completion of the paclitaxel infusion). | Day 1 |
Bevacizumab | 15 mg/kg IV | Dilute into a total volume of 100 mL of NS.* The first dose should be administered over 90 minutes one hour after carboplatin. If well tolerated, the second infusion may be administered over 60 minutes. If well tolerated, all subsequent infusions may be administered over 10 to 30 minutes.[2] | Day 1 |
Pretreatment considerations: | |||
Emesis risk |
| ||
Prophylaxis for infusion reactions |
| ||
Vesicant/irritant properties |
| ||
Infection prophylaxis |
| ||
Dose adjustment for baseline liver or kidney dysfunction |
| ||
Monitoring parameters: | |||
| |||
| |||
| |||
Suggested dose modifications for toxicity: | |||
Myelotoxicity |
| ||
Kidney/hepatic toxicity |
| ||
Neurotoxicity |
| ||
Other toxicity |
| ||
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. |
ANC: absolute neutrophil count; AUC: area under the concentration × time curve; CBC: complete blood count; GFR: glomerular filtration rate; IV: intravenous; NCCN: National Comprehensive Cancer Network; NS: normal saline; RPLS: reversible posterior leukoencephalopathy syndrome.
* 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 renal 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 and treatment of chemotherapy-induced nausea and vomiting in adults.
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟