Penile cancer

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Neoadjuvant chemotherapy

TIP

TIP: Taxol, Ifosfamide, Platinol

Regimen, Pagliaro et al. 2010

• Paclitaxel (Taxol) 175 mg/m2 IV over 3 hours on day 1
• Ifosfamide (Ifex) 1,200 mg/m2 IV over 2 hours days 1, 2, 3
• Cisplatin (Platinol) 25 mg/m2 IV over 2 hours days 1, 2, 3
  • Administered intravenously in 250 mL of normal saline containing 12.5 g of mannitol
  • Following administration, infused 3 L of a solution of 5% dextrose, sodium chloride, potassium chloride, magnesium sulfate, and mannitol
• Mesna (Mesnex) 400 mg/m2 IV before each dose of ifosfamide
• Mesna (Mesnex) 200 mg/m2 IV at both 4 and 8 hours after each dose of ifosfamide

21 to 28 day cycles for a total of 4 cycles; Cycle was repeated on day 22 if the patient's ANC was at least 1,400/μL and platelet count was at least 100,000/μL

Supportive medications:

• Dexamethasone (Decadron) 8 mg IV 1 hour before, or 20 mg PO at both 12 and 6 hours before the paclitaxel dose
• Diphenhydramine (Benadryl) 50 mg IV prior to paclitaxel
• Any of the following prior to paclitaxel
  • Cimetidine (Tagamet) 300 mg IV
  • Ranitidine (Zantac) 50 mg IV
  • Famotidine (Pepcid) 20 mg IV
• "The use of prophylactic granulocyte colony-stimulating factor was allowed but not required"

References

1. Pagliaro LC, Williams DL, Daliani D, Williams MB, Osai W, Kincaid M, Wen S, Thall PF, Pettaway CA. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. J Clin Oncol. 2010 Aug 20;28(24):3851-7. doi: 10.1200/JCO.2010.29.5477. Epub 2010 Jul 12. link to original article contains verified protocol PubMed