Example orders for adjuvant Interferon alfa-2b (Intron-A) in melanoma

Carboplatin & Paclitaxel (CP)

CP: Carboplatin & Paclitaxel

Regimen

Study	Dates of enrollment	Evidence	Comparator	Comparative Efficacy
Forde et al. 2022 (CheckMate 816)	2017-2019	Phase 3 (C)	1a. CP & Nivolumab 1b. CVb & Nivolumab 1c. DC & Nivolumab	Inferior EFS

Note: there were additional comparator options depending on histology; see the respective histology-specific pages for more details. This study was conducted in the United States. The reason for the study was that an unanswered question at the time was whether adding an immune checkpoint inhibitor would improve outcomes.

Biomarker eligibility criteria

• CheckMate 816: No sensitizing EGFR or ALK mutations

Chemotherapy

• Carboplatin (Paraplatin) AUC 5 or 6 IV once on day 1
• Paclitaxel (Taxol) 175 or 200 mg/m² IV once on day 1

21-day cycle for 3 cycles

Subsequent treatment

• Complete resection

References

1. CheckMate 816: Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, Felip E, Broderick SR, Brahmer JR, Swanson SJ, Kerr K, Wang C, Ciuleanu TE, Saylors GB, Tanaka F, Ito H, Chen KN, Liberman M, Vokes EE, Taube JM, Dorange C, Cai J, Fiore J, Jarkowski A, Balli D, Sausen M, Pandya D, Calvet CY, Girard N; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985. Epub 2022 Apr 11. link to original article contains dosing details in manuscript PubMed NCT02998528

Start of hidden/commented information for virtual editor End of hidden/commented information for virtual editor

Start of comment inserted by visual editor(edited again by visual editor)

(edited again by visual editor end)End of comment inserted by visual editor
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer. If this is your first time visiting, we suggest you read the tutorial.

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.

Interferon alfa-2b (Intron-A)

Published regimens and references can be found on the melanoma page.

Example order set #1 (5 days per week)

Induction phase

• Interferon alfa-2b (Intron-A) 20,000,000 units/m² IV once per day on days 1, 2, 3, 6, 7

7-day cycles x 4 cycles, then proceed to maintenance phase

Supportive medications

• Acetaminophen (Tylenol) 1000 mg PO once 30 minutes prior to interferon
• Naproxen (Naprosyn) 375 mg PO Q12H prn fevers, chills, myalgias, headache if acetaminophen not effective
• Lorazepam (Ativan) 0.5 to 1 mg PO once prn nausea/anxiety 30 minutes prior to chemotherapy

Hydration:

• Normal saline 500 mL IV bolus over 20 minutes prior to interferon
• Normal saline IV continuous infusion at 5 mL/H during administration of interferon
• Normal saline 25 to 50 mL IV prn flush before and after chemotherapy

Nursing:

• Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete.
• Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.

Maintenance phase

Frequency and dose may need to be adjusted based on patient's tolerance of induction phase.

• Interferon alfa-2b (Intron-A) 10,000,000 units/m² SC three times per week

48-week course

Example order set #2 (3 days per week)

Induction phase

• Interferon alfa-2b (Intron-A) 20,000,000 units/m² IV once per day on days 3, 6, 7

7-day cycles x 4 cycles, then proceed to maintenance phase

Supportive medications

• Acetaminophen (Tylenol) 1000 mg PO once 30 minutes prior to interferon
• Naproxen (Naprosyn) 375 mg PO Q12H prn fevers, chills, myalgias, headache if acetaminophen not effective
• Lorazepam (Ativan) 0.5 to 1 mg PO once prn nausea/anxiety 30 minutes prior to chemotherapy

Hydration:

• Normal saline 500 mL IV bolus over 20 minutes prior to interferon
• Normal saline IV continuous infusion at 5 mL/H during administration of interferon
• Normal saline 25 to 50 mL IV prn flush before and after chemotherapy

Nursing:

• Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete.
• Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.

Maintenance phase

Frequency and dose may need to be adjusted based on patient's tolerance of induction phase.

• Interferon alfa-2b (Intron-A) 10,000,000 units/m² SC three times per week

48-week course

Example order set #3 (2 days per week)

Induction phase

• Interferon alfa-2b (Intron-A) 20,000,000 units/m² IV once per day on days 6 & 7

7-day cycles x 4 cycles, then proceed to maintenance phase

Supportive medications

• Acetaminophen (Tylenol) 1000 mg PO once 30 minutes prior to interferon
• Naproxen (Naprosyn) 375 mg PO Q12H prn fevers, chills, myalgias, headache if acetaminophen not effective
• Lorazepam (Ativan) 0.5 to 1 mg PO once prn nausea/anxiety 30 minutes prior to chemotherapy

Hydration:

• Normal saline 500 mL IV bolus over 20 minutes prior to interferon
• Normal saline IV continuous infusion at 5 mL/H during administration of interferon
• Normal saline 25 to 50 mL IV prn flush before and after chemotherapy

Nursing:

• Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete.
• Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.

Maintenance phase

Frequency and dose may need to be adjusted based on patient's tolerance of induction phase.

• Interferon alfa-2b (Intron-A) 10,000,000 units/m² SC three times per week

48-week course