Schedule: Drug Dose iv/infusion/oral q Carboplatin AUC 5 500mls 5% dex/1hr Day 1 Gemcitabine 1200mg/m 2 200mls N. Saline/30mins Days 1 & 8

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1 Carboplatin/Gemcitabine Lung Cancer (non-small cell) - Advanced Carboplatin AUC 5 500mls 5% dex/1hr Day 1 Gemcitabine 1200mg/m 2 200mls N. Saline/30mins Days 1 & 8 Cycle frequency: Every three weeks Total number of cycles: 4 Anti-emetic group Moderately high Carboplatin dose by EDTA or creatinine clearance. If calculated using formula then AUC 6 vomiting, mucositis, alopecia (uncommon), amenorrhoea, peripheral neuropathy, diarrhoea, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, CXR U & E s, LFTs, creatinine, urate, creatinine clearance U & E s, LFTs, creatinine After two cycles Reference: Rudd et al, J. Clin. Oncol., 23; pages rd Edition 1

2 Cisplatin/Gemcitabine Lung Cancer (non-small cell) Adjuvant, Neoadjuvant Cisplatin 50mg/m 2 1L N. Saline/2hrs Day 1, 2 Gemcitabine 1250mg/m 2 200mls N. Saline/30mins Days 1 & 8 Cycle frequency: Every three weeks Total number of cycles: 4 Anti-emetic group High Pre & post hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility, CXR After two cycles Reference: Cardenal et al, J. Clin. Oncol., 17; pages rd Edition 2

3 Carboplatin/Vinorelbine Advanced Lung, Breast and Ovarian cancer Vinorelbine 25mg/m 2 20mls N. Saline/10mins Days 1 & 8 Carboplatin AUC 5 500mls 5% dex/1hr Day 1 Cycle frequency: Every three weeks Total number of cycles: 4-6 Anti-emetic group Moderately high Carboplatin dose by EDTA or creatinine clearance. If calculated using formula then AUC 6 vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, fluid retention, hypersensitivity reaction, abdominal discomfort, infertility Symptomatic treatment of side effects: Mouth care, diuretics U & E s, LFTs, creatinine, urate, creatinine clearance U & E s, LFTs, creatinine Abdominal CT scan prior to fourth cycle if measurable disease present (ovarian) Reference: Cremonesi et al, Oncology, 64; pages rd Edition 3

4 MVP Lung Cancer (non-small cell) - Advanced, Palliative Mitomycin C 8mg/m 2 iv Day 1 Vinblastine 6mg/m 2 (max 10mg) iv Day 1 Cisplatin 50mg/m 2 1L N. Saline/2hrs Day 1 Cycle frequency: Every three weeks Total number of cycles: 3 Anti-emetic group High Ensure serum creatinine is within normal levels Pre & post hydration, mannitol, potassium & magnesium Blood film is normal i.e. no red cell fragmentation vomiting, mucositis, alopecia, cardiotoxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, infertility, CXR Reference: Smith et al, J. Clin. Oncol., 19; pages rd Edition 4

5 MIC Lung Cancer (non-small cell) - Advanced, Palliative Mitomycin C 6mg/m 2 iv Day 1 Ifosfamide 3000mg/m 2 1L N. Saline/4hrs Day 1 Cisplatin 50mg/m 2 1L N. Saline/2hrs Day 1 Cycle frequency: Every three weeks Total number of cycles: 4 Anti-emetic group High Pre & post hydration, mannitol, potassium & magnesium Mesna dose guidelines vomiting, mucositis, alopecia, peripheral neuropathy, diarrhoea, constipation, nephrotoxicity, ototoxicity, encephalopathy, carcinogenesis, infertility, CXR Re-assess after 2 cycles Reference: Cullen et al, Br. J. Cancer, 58; pages rd Edition 5

6 NP (Vinorelbine/Cisplatin) Lung Cancer (non-small cell) Adjuvant Vinorelbine 30mg/m 2 20mls N. Saline/10mins Days 1, 8, 15 & 22 Cisplatin 50mg/m 2 1L N. Saline/4hrs Days 1 & 2 Cycle frequency: Every four weeks Total number of cycles: 4 Anti-emetic group High Pre & post hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility, CXR Re-assess after 2 cycles Reference: Winton et al, N. Engl. J. Med., 352; pages rd Edition 6

7 Docetaxel Lung Cancer (non-small cell) - Recurrent Docetaxel 75mg/m 2 250mls N. Saline/1hr Day 1 Cycle frequency: Every three weeks Total number of cycles: 6 Anti-emetic group Low Pre-medication dexamethasone 8 mg bd oral, for three days, starting one day prior vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, fluid retention, hypersensitivity reaction, skin rash, infertility Symptomatic treatment of side effects: Mouth care, CXR U & E s, LFTs, creatinine, urate U & E s, LFTs, creatinine Re-assess after 2 cycles Reference: Shephard et al, J. Clin. Oncol., 18; pages rd Edition 7

8 Docetaxel/Cisplatin Lung Cancer (non-small cell) Advanced, Palliative Docetaxel 75mg/m 2 250ml N. Saline/1hr Day 1 Cisplatin 75mg/m 2 1L N. Saline/4hrs Day 1 Cycle frequency: Every three weeks Total number of cycles: 4 Anti-emetic group High Pre-medication dexamethasone 8mg bd oral, for three days, starting one day prior Pre & post hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility, fluid retention, hypersensitivity reaction History and examination, CXR Mid-treatment: Post-treatment: Re-assess after 2 cycles Reference: Schiller et al, N. Engl. J. Med., 346; pages rd Edition 8

9 PE (Cisplatin/Etoposide) - long Lung Cancer (small cell) - Limited Cisplatin 60mg/m 2 1L N. Saline/2hrs Day 1 Etoposide 120mg/m 2 1L N. Saline/2hrs Days 1-3 Cycle frequency: Every three weeks Total number of cycles: 4 ( Anti-emetic group High Pre & post hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility Re-assess prior to third cycle Reference: Turrisis et al, N. Engl. J. Med., 340; pages rd Edition 9

10 PE (Cisplatin/Etoposide) - short Lung Cancer (small cell) - Limited Cisplatin 60mg/m 2 1L N. Saline/2hrs Day 1 Etoposide 120mg/m 2 1L N. Saline/2hrs Day 1 Etoposide 100mg bd oral Days 2 & 3 Cycle frequency: Every three weeks Total number of cycles: 4 Anti-emetic group High Pre & post hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility Re-assess prior to third cycle Reference: Evans et al, Ann. Intern. Med., 107; pages rd Edition 10

11 Carboplatin/Etoposide - long Lung Cancer - Advanced Carboplatin AUC 5 500mls 5% dex/1hr Day 1 Etoposide 100mg/m 2 500mls N. Saline/2hrs Days 1-3 Cycle frequency: Every three weeks Total number of cycles: 4-6 Anti-emetic group Moderately high Etoposide 100mg bd oral may be substituted on days 2 & 3 Carboplatin dose by EDTA or creatinine clearance. If calculated using formula then AUC 6 vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, diarrhoea, carcinogenesis, infertility Re-assess prior to third cycle Reference: Skarlos et al, Ann. Oncol., 5; pages rd Edition 11

12 Carboplatin/Etoposide - short Lung Cancer - Advanced Carboplatin AUC 5 500mls 5% dex/1hr Day 1 Etoposide 100mg/m 2 500mls N. Saline/2hrs Day 1 Etoposide 100mg bd oral Days 2 & 3 Cycle frequency: Every three weeks Total number of cycles: 4-6 Anti-emetic group Moderately high Carboplatin dose by EDTA or creatinine clearance. If calculated using formula then AUC 6 vomiting, mucositis, alopecia, amenorrhoea, peripheral neuropathy, nephrotoxicity, diarrhoea, carcinogenesis, infertility Re-assess prior to third cycle Reference: Skarlos et al, Ann. Oncol., 5; pages rd Edition 12

13 CAV (Cyclophosphamide/Doxorubicin/Vincristine) Lung Cancer (small cell) Palliative Cyclophosphamide 1,000mg/m 2 iv Day 1 Doxorubicin 50mg/m 2 iv Day 1 Vincristine 1.4mg/m 2 (max 2mg) iv Day 1 Cycle frequency: Every three weeks Total number of cycles: 6 Anti-emetic group Moderately high vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, haemorrhagic cystitis, constipation, carcinogenesis, infertility, CXR U & E s, LFTs, creatinine, urate U & E s, LFTs, creatinine Re-assess prior to fourth cycle Reference: Evans et al, Ann. Intern. Med., 107; pages rd Edition 13

14 Oral Etoposide Lung Cancer (small cell) - Palliative Etoposide 100mg od oral Days 1-10 (14) Cycle frequency: Every three weeks Total number of cycles: 6 Anti-emetic group Mild Start with 10 day course (total dose 1000 mg) Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, alopecia, carcinogenesis, infertility Symptomatic treatment of side effects: Mouth care, CXR U & E s, LFTs, creatinine, urate U & E s, LFTs, creatinine Re-assess after every two cycles Reference: Slevin, J. Clin. Oncol., 8; pages rd Edition 14