Schedule: Drug Dose iv/infusion/oral q Doxorubicin 25mg/m 2 iv bolus Days 1, 2 & 3 Cisplatin 50mg/m 2 1L N. Saline/2hrs Days 1 & 2

Transcription

1 Doxorubicin/Cisplatin Osteosarcoma - neoadjuvant Doxorubicin 25mg/m 2 iv bolus Days 1, 2 & 3 Cisplatin 50mg/m 2 1L N. Saline/2hrs Days 1 & 2 (3 before surgery) Ensure adequate renal function Pre & post-hydration, mannitol, potassium & magnesium vomiting, mucositis, alopecia, amenorrhoea, cardiac toxicity, peripheral neuropathy, nephrotoxicity, ototoxicity, diarrhoea, carcinogenesis, infertility, encourage oral fluids, CXR U & E s, LFTs, Mg 2+, Ca 2+, creatinine, urate, creatinine clearance U & E s, LFTs, Mg 2+, Ca 2+, creatinine CXR After three cycles Reference: Bramwell et al, J. Clin. Oncol., 10; pages rd Edition 78

2 Ifosfamide Soft tissue sarcomas - Palliative Ifosfamide 3g/m 2 1L N. Saline/4hrs Days 1-3 Mesna dose guidelines vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, haemorrhagic cystitis, nephrotoxicity, encephalopathy, diarrhoea, carcinogenesis, infertility, urate After every two cycles Reference: van Oosterom et al, Eur. J. Cancer, 18; pages rd Edition 79

3 Adjuvant DI (Doxorubicin/Ifosfamide) Soft tissue sarcomas adjuvant (high risk) Doxorubicin 60mg/m 2 iv Day 1 Ifosfamide 3g/m 2 1L N. Saline/4hrs Days 1-3 Mesna dose guidelines Give prophylactic pegylated G-CSF on day 4 vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, haemorrhagic cystitis, nephrotoxicity, encephalopathy, diarrhoea, carcinogenesis, infertility, urate Creatinine clearance Reference: Frustaci et al, Oncology, 65 (Suppl 2); pages rd Edition 80

4 CYVADIC Soft tissue sarcomas Metastatic, Recurrent Cyclophosphamide 500mg/m 2 iv Day 1 Vincristine 1.5mg/m 2 iv (max 2 mg) Day 1 Doxorubicin 50mg/m 2 iv Day 1 Dacarbazine 850mg/m 2 500mls N. Saline/1hr Day 1 Ensure adequate renal function vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, peripheral neuropathy, constipation, encephalopathy, haemorrhagic cystitis, nephrotoxicity, diarrhoea, carcinogenesis, infertility, encourage oral fluids, urate, creatinine clearance After every two cycles Reference: Santoro et al, J. Clin. Oncol., 13; pages rd Edition 81

5 High dose Ifosfamide/Etoposide Sarcomas - adjuvant, recurrent Etoposide 100mg/m 2 500mls N. Saline/1hr Days 1-5 Ifosfamide 3g/m 2 1L N. Saline/4hrs Days 1-5 Cycle frequency: Every three weeks Total number of cycles: 2 With mesna (equivalent dose to ifosfamide over 24 hours) Continuous hydration with total 3 litres fluid/m 2 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, urate, creatinine clearance Reference: Goorin et al, J. Clin. Oncol., 20; pages rd Edition 82

6 Doxorubicin (Sarcoma) Sarcoma - palliative Doxorubicin 75mg/m 2 iv Day 1 Cycle frequency: Every three weeks Total number of cycles: 4-6 Anti-emetic group - Moderately High Check liver function vomiting, mucositis, alopecia, cardiotoxicity, amenorrhoea, carcinogenesis, infertility, urate Post treatment: After every two cycles, if palliative Review in Medical Oncology Clinic 3 weeks after the last cycle or at the start CMF as per protocol 13 Reference: Nielsen et al, Br. J. Cancer, 78; pages rd Edition 83