Difference between revisions of "Example orders for CHOEP in lymphoma"
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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. | ||
Revision as of 13:43, 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.
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.
CHOEP, CHOPE
CHOEP: Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Etoposide, Prednisone
Published regimens and references may be found on the Aggressive Non-Hodgkin lymphoma page.
Example regimen #1
- Cyclophosphamide (Cytoxan) 750 mg/m2 IV on day 1
- Doxorubicin (Adriamycin) 50 mg/m2 IV on day 1
- Vincristine (Oncovin) 2 mg IV on day 1
- Etoposide (Vepesid) 100 mg/m2 IV on days days 1-3
- Prednisone (Sterapred) 100 mg PO on days 1 to 5
- Patients with initial bulky disease (mass conglomerate at least 7.5 cm) received 36 Gy radiation therapy and to extranodal sites of disease when possible
21-day cycles x 6 cycles
Supportive medications
- Fosaprepitant (Emend injection) 150 mg IV x1 on day 1 prior to chemotherapy
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
- Allopurinol (Aloprim) as described below
Hydration:
- 500 ml NS and/or D5W KVO rate to be used as running IV for chemotherapy infusion. Give up to 500 ml NS and/or D5W.
Monitoring:
- On days 1, 3, 8, and 17 of cycle 1: CBC with differential, absolute neutrophil count (ANC), comprehensive metabolic panel (chem 10 and LFTs), LDH, uric acid; future labs to be determined based on patient's cycle 1 counts
- Prior to start of therapy, check beta-2 microglobulin, SPEP, IgG, IgA, IgM
- Initial staging with CT torso & bone marrow biopsy
- In anticipation of rituxan use starting cycle 2, check hepatitis B surface antibody (HbsAb), hepatitis B surface antigen (HbsAg), hepatitis B core antibody (HbcAb), hepatitis C antibody (HCV Ab)
Outpatient medications:
- Acyclovir (Zovirax) 400 mg PO TID
- Allopurinol (Aloprim) 300 mg PO daily
- Filgrastim (Neupogen) 300 mcg (patient is 63 kg) SC daily on days 4-13
- Ondansetron (Zofran) 8 mg PO TID
- Pantoprazole (Protonix) 40 mg PO daily
- Prednisone (Sterapred) as described above
- Docusate (Colace) 100 mg PO BID prn constipation
- Sennosides (Senna) 8.6 mg PO Q8H prn constipation
Clinical scenario & comments:
- 44 year-old lady with primary mediastinal lymphoma; 7 cm anterior mediastinal mass, ECOG performance status 0.