Difference between revisions of "Example orders for Pemetrexed (Alimta) in non-small cell lung cancer"
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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. | 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. | ||
| Line 20: | Line 13: | ||
'''21-day cycles''' | '''21-day cycles''' | ||
| − | ====Supportive | + | ====Supportive therapy==== |
| − | *Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy | + | *Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy |
| − | *Lorazepam (Ativan) 0.5 mg PO x 1 prn nausea/anxiety | + | *Lorazepam (Ativan) 0.5 mg PO x 1 prn nausea/anxiety |
| − | *Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea | + | *Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea |
| − | *[[Dexamethasone (Decadron)]] 4 mg PO | + | *[[Dexamethasone (Decadron)]] 4 mg PO twice per day 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 | *[[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 | *Folic acid 1000 mcg PO daily, to start at least 1 week prior to start of pemetrexed therapy, to continue throughout therapy with pemetrexed | ||
| Line 34: | Line 27: | ||
*On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, albumin, carcinoembryonic antigen | *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 | **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). | + | *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 | *Assess for response with CT scan every 3+ cycles depending on symptoms | ||
Outpatient medications: | Outpatient medications: | ||
*[[Dexamethasone (Decadron)]] as described above | *[[Dexamethasone (Decadron)]] as described above | ||
| − | *Lorazepam (Ativan) 0.5 mg PO | + | *Lorazepam (Ativan) 0.5 mg PO every 6 hours prn anxiety, insomnia, nausea |
| − | *Ondansetron (Zofran) 4 mg PO | + | *Ondansetron (Zofran) 4 mg PO every 6 hours prn nausea |
| − | *Prochlorperazine (Compazine) 10 mg PO | + | *Prochlorperazine (Compazine) 10 mg PO every 6 hours prn nausea |
*Folic acid 1000 mcg PO daily as described above | *Folic acid 1000 mcg PO daily as described above | ||
'''Clinical scenario & comments:''' | '''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 [[Non-small cell lung cancer#Carboplatin_monotherapy_.26_Pemetrexed_.28Alimta.29|Carboplatin (Paraplatin) & Pemetrexed (Alimta)]], with good response. | + | *60 year-old lady with stage IV adenocarcinoma of the lung, s/p treatment with first-line therapy for metastatic disease with [[Non-small cell lung cancer#Carboplatin_monotherapy_.26_Pemetrexed_.28Alimta.29|Carboplatin (Paraplatin) & Pemetrexed (Alimta)]], with good response. Pemetrexed (Alimta) was used as a maintenance therapy in this setting. |
[[Category:Example chemotherapy order sets]] | [[Category:Example chemotherapy order sets]] | ||
Latest revision as of 01:59, 1 June 2023
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 therapy
- 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 twice per day 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 every 6 hours prn anxiety, insomnia, nausea
- Ondansetron (Zofran) 4 mg PO every 6 hours prn nausea
- Prochlorperazine (Compazine) 10 mg PO every 6 hours 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.