Difference between revisions of "Example orders for Pemetrexed (Alimta) in non-small cell lung cancer"
Warner-admin (talk | contribs) m (Text replacement - "Just 9 days left" to "Just 8 days left") |
m (Text replacement - "{|style="width: 100%; border-left:solid 20px #dc143c;border-right:solid 20px #dc143c;border-top:solid 20px #dc143c;border-bottom:solid 20px #dc143c;" align="center" | <span style="font-family:Arial; font-size:300%"> Just 8 days left to fill out a survey on how we can make HemOnc.org better and more useful.<br> '''Link:''' http://j.mp/2BlBaoQ </span> |}" to "{{:Editing test page 2}}") |
||
Line 1: | Line 1: | ||
− | { | + | {{:Editing test page 2}}<br>'''Use of this site is subject to you reading and agreeing with the terms set forth in the [[HemOnc.org_-_A_Hematology_Oncology_Wiki:General_disclaimer|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. | 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. |
Revision as of 13:35, 25 January 2018
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
References
- 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 dosing details in manuscript have been reviewed by our editors 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.
Pemetrexed (Alimta)
Original references may be found at Pemetrexed (Alimta)
Example regimen #1
- Pemetrexed (Alimta) 500 mg/m2 IV on day 1
- Administer over 10 minutes.
21-day cycles
Supportive medications
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
- Lorazepam (Ativan) 0.5 mg PO x 1 prn nausea/anxiety
- Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
- Dexamethasone (Decadron) 4 mg PO BID the day before, day of, and day after chemotherapy
- Cyanocobalamin (Vitamin B12) 1000 mcg IM every 9 weeks, the first dose given at least 1 week prior to start of pemetrexed therapy
- Folic acid 1000 mcg PO daily, to start at least 1 week prior to start of pemetrexed therapy, to continue throughout therapy with pemetrexed
Hydration:
- 500 ml NS and/or D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS and/or D5W as needed for IV compatibility.
Monitoring:
- On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, albumin, carcinoembryonic antigen
- Depending on provider preference and patient's tolerance, may simplify to CBC with differential, absolute neutrophil count (ANC), with less frequent BUN/Cr & LFT checks
- On cycle 1 day 10, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
- Assess for response with CT scan every 3+ cycles depending on symptoms
Outpatient medications:
- Dexamethasone (Decadron) as described above
- Lorazepam (Ativan) 0.5 mg PO Q6H prn anxiety, insomnia, nausea
- Ondansetron (Zofran) 4 mg PO Q6H prn nausea
- Prochlorperazine (Compazine) 10 mg PO Q6H prn nausea
- Folic acid 1000 mcg PO daily as described above
Clinical scenario & comments:
- 60 year-old lady with stage IV adenocarcinoma of the lung, s/p treatment with first-line therapy for metastatic disease with Carboplatin (Paraplatin) & Pemetrexed (Alimta), with good response. Pemetrexed (Alimta) was used as a maintenance therapy in this setting.