Example orders for Docetaxel (Taxotere) in non-small cell lung cancer

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

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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.

Docetaxel (Taxotere)

Original references may be found at Docetaxel (Taxotere)

Example regimen #1

• Docetaxel (Taxotere) 75 mg/m² IV on day 1
  • Administer over 30-60 minutes. Use non-DEHP tubing/paclitaxel tubing.

21-day cycles

Supportive medications

• Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
• Dexamethasone (Decadron) 8 mg PO BID the day before, day of, and day after chemotherapy

Hydration:

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, carcinoembryonic antigen
• 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

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. Progressed after maintenance therapy with Pemetrexed (Alimta).

Example regimen #2 - dose reduction & neulasta for pancytopenia

• Docetaxel (Taxotere) 60 mg/m² IV on day 1
  • Administer over 30-60 minutes. Use non-DEHP tubing/paclitaxel tubing.

21-day cycles

Supportive medications

• Pegfilgrastim (Neulasta) 6 mg SC x1 on day 2, 24 hours after completion of day 1 chemotherapy
• Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
• Dexamethasone (Decadron) 8 mg PO BID the day before, day of, and day after chemotherapy

Hydration:

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, carcinoembryonic antigen
• Once on day 10-14, check nadir CBC with differential, absolute neutrophil count (ANC). Transfuse RBCs as needed.
• 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

Clinical scenario & comments:

• 72 year-old lady with stage IV adenocarcinoma of the lung with bony metastases and history of pathologic fracture, s/p treatment with first-line therapy for metastatic disease with Carboplatin (Paraplatin) & Pemetrexed (Alimta), who initially responded but them progressed on CT imaging after cycle 5 of therapy. Cycle 1 of therapy was given as above in example #1, but due to significant neutropenia, anemia, and thrombocytopenia (50-60) at nadir blood count, Docetaxel (Taxotere) was dose reduced as above, and Pegfilgrastim (Neulasta) added. In later cycles, neutropenia was not an issue, RBC transfusion need was minimal, and platelet counts were adequate for treatment.