Difference between revisions of "Polycythemia"
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==Initial evaluation== | ==Initial evaluation== | ||
Revision as of 13:56, 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
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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.
Initial evaluation
May consist of:
- CBC with differential
- Pulse oximetry
- Serum erythropoetin
- JAK2 (V617F, exon 12 mutation)
- Comprehensive metabolic panel (CMP)
- Reticulocyte count
- Iron, total iron binding capacity (TIBC), ferritin
- Clinical history of arterial or venous thromboembolism (VTE), stroke, post-bathing pruritis, facial plethora, headache, fatigue, visual changes
Secondary polycythemia?
- Smoking
- Chronic lung disease
- Obstructive sleep apnea (OSA)
- Carbon monoxide (CO) exposure
- Home heating: natural gas or oil?
- Carbon monoxide detectors?
- Carboxyhemoglobin
- High altitude environments
- Testosterone use
- Erythropoetin use
- Athletic blood doping/transfusions
- Right to left cardiac shunt
- Dehydration/diuretic use
Additional considerations
- Renal ultrasound or other imaging to evaluate for erythropoetin-secreting renal tumor, pheochromocytoma
- Chest x-ray
- Urinalysis
- Family history of high oxygen affinity hemoglobinopathies?
- Cushing's syndrome?
- Congenital polycythemia?