Revision as of 21:55, 21 August 2016

Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.

Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are invited to contribute to the site.

14 regimens on this page 16 variants on this page

First-line therapy

ADOC

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ADOC: Adriamycin (Doxorubicin), cis-Diamminedichloroplatinum (Cisplatin), Oncovin (Vincristine), Cyclophosphamide

Regimen

Study	Evidence
Fornasiero et al. 1991	Retrospective

Note: The body of Fornasiero et al. 1991 specifies that cycles are given every 3 weeks. However, the abstract says that cycles are given "at monthly intervals," and the NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists the regimen as being given every 4 weeks.

Chemotherapy

Doxorubicin (Adriamycin) 40 mg/m² IV once on day 1
Cisplatin (Platinol) 50 mg/m² IV once on day 1
Vincristine (Oncovin) 0.6 mg/m² IV once on day 3
Cyclophosphamide (Cytoxan) 700 mg/m² IV once on day 4

21 to 28-day cycles--see note above regarding duration of cycles

References

Retrospective: Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30-3. link to original article contains verified protocol PubMed

Carboplatin & Paclitaxel

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Regimen

Study	Evidence
Lemma et al. 2011	Phase II

Chemotherapy

Carboplatin (Paraplatin) AUC 6 IV over 30 minutes once on day 1, given second
Paclitaxel (Taxol) 225 mg/m² IV over 3 hours once on day 1, given first

Supportive medications

Cimetidine (Tagamet) 300 mg IV 1 hour prior to Paclitaxel (Taxol)
Diphenhydramine (Benadryl) 25 mg IV 1 hour prior to Paclitaxel (Taxol)
Dexamethasone (Decadron) 20 mg IV 1 hour prior to Paclitaxel (Taxol)

21-day cycle for up to 6 cycles

References

Lemma GL, Lee JW, Aisner SC, Langer CJ, Tester WJ, Johnson DH, Loehrer PJ Sr. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011 May 20;29(15):2060-5. Epub 2011 Apr 18. link to original article contains verified protocol PubMed

PAC; CAP

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PAC: Platinol (Cisplatin), Adriamycin (Doxorubicin), Cyclophosphamide
CAP: Cyclophosphamide, Adriamycin (Doxorubicin), Platinol (Cisplatin)

Regimen

Study	Evidence
Loehrer et al. 1990	Phase II

Chemotherapy

Cisplatin (Platinol) 50 mg/m² IV over at least 1 hour once on day 1
Doxorubicin (Adriamycin) 50 mg/m² IV by slow injection once on day 1
Cyclophosphamide (Cytoxan) 500 mg/m² IV by slow injection or infusion once on day 1

Supportive medications

1 liter normal saline over 2 hours at least 2 hours before and after Cisplatin (Platinol) therapy
Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis

21-day cycle for up to 8 cycles

References

Loehrer PJ Sr, Perez CA, Roth LM, Greco A, Livingston RB, Einhorn LH. Chemotherapy for advanced thymoma. Preliminary results of an intergroup study. Ann Intern Med. 1990 Oct 1;113(7):520-4. link to original article contains verified protocol PubMed
1. Update: Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994 Jun;12(6):1164-8. link to original article contains verified protocol PubMed

PAC & Prednisone -> RT -> PAC & Prednisone

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PAC: Platinol, Adriamycin, Cyclophosphamide

Regimen

Study	Evidence
Kim et al. 2004	Phase II

Note: The NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists only the induction phase of this regimen under its first-line options. No primary reference could be found for treatment with only the induction phase of therapy.

Induction chemotherapy

Cisplatin (Platinol) 30 mg/m² IV once per day on days 1 to 3
Doxorubicin (Adriamycin) 20 mg/m²/day IV continuous infusion on days 1 to 3 (total dose: 60 mg/m²)
Cyclophosphamide (Cytoxan) 500 mg/m² IV by slow injection or infusion once on day 1
Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

Supportive medications

Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
Diphenhydramine (Benadryl) 25 mg IV prior to chemotherapy

21 to 28-day cycle for 3 cycles

Surgical resection is performed if CT scan 3 to 4 weeks after the third cycle of chemotherapy shows disease amenable resection, and followed by:

Radiotherapy

If tumor is completely resected and has at least 80% necrosis, 50 Gy radiation therapy is administered 3 to 6 weeks after surgery
- If tumor is incompletely resected or has <80% necrosis, 60 Gy radiation therapy is administered

One course, followed by consolidation:

Consolidation chemotherapy

Cisplatin (Platinol) 24 mg/m² IV once per day on days 1 to 3
Doxorubicin (Adriamycin) 16 mg/m²/day IV continuous infusion on days 1 to 3 (total dose: 48 mg/m²)
Cyclophosphamide (Cytoxan) 400 mg/m² IV by slow injection or infusion once on day 1
Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5

21 to 28-day cycle for 3 cycles

References

Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, Truong M, Moon H, Swisher SG, Fossella FV, Khuri FR, Hong WK, Shin DM. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004 Jun;44(3):369-79. link to original article contains verified protocol PubMed

PE

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PE: Platinol (Cisplatin), Etoposide

Regimen

Study	Evidence
Giaccone et al. 1996	Phase II

Chemotherapy

Cisplatin (Platinol) 60 mg/m² IV over 1 hour once on day 1
Etoposide (Vepesid) 120 mg/m² IV over at least 30 minutes once per day on days 1 to 3

Supportive medications

"A program of forced hydration"

21-day cycle for up to 8 cycles

References

Giaccone G, Ardizzoni A, Kirkpatrick A, Clerico M, Sahmoud T, van Zandwijk N. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma. A phase II study of the European Organization for Research and Treatment of Cancer Lung Cancer Cooperative Group. J Clin Oncol. 1996 Mar;14(3):814-20. link to original article contains verified protocol PubMed

VIP

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VIP: Vepesid (Etoposide), Ifosfamide, Platinol (Cisplatin)

Regimen

Study	Evidence
Loehrer et al. 2001	Phase II

Chemotherapy

Etoposide (Vepesid) 75 mg/m² IV once per day on days 1 to 4
Ifosfamide (Ifex) 1200 mg/m² IV once per day on days 1 to 4
Cisplatin (Platinol) 20 mg/m² IV once per day on days 1 to 4

Supportive medications

Mesna (Mesnex) 240 mg/m² IV push before, 4 hours after, and 8 hours after Ifosfamide (Ifex) once per day on days 1 to 4
1 liter normal saline prior to Cisplatin (Platinol)
Filgrastim (Neupogen) 5 mcg/kg SC once per day on days 5 to 15, until WBC at least 10,000 postnadir

21-day cycle for 4 cycles

References

Loehrer PJ Sr, Jiroutek M, Aisner S, Aisner J, Green M, Thomas CR Jr, Livingston R, Johnson DH. Combined etoposide, ifosfamide, and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial. Cancer. 2001 Jun 1;91(11):2010-5. link to original article contains verified protocol PubMed

Second-line therapy

Ifosfamide (Ifex)

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Regimen #1

Study	Evidence
[Highley et al. 1999]	Pilot, <20 pts

Chemotherapy

Ifosfamide (Ifex) 1500 mg/m² IV over 30 minutes once per day on days 1 to 5

Supportive medications

Mesna (Mesnex) 400 mg IV bolus before ifosfamide, then 1000 mg/m² in 1 liter NS IV over 7.5 hours after ifosfamide once per day on days 1 to 5

21-day cycles

Regimen #2

Study	Evidence
[Highley et al. 1999]	Pilot, <20 pts

Chemotherapy

- Ifosfamide (Ifex) 1500 mg/m²/day IV continuous infusion on days 1 to 5

Supportive medications

Mesna (Mesnex) as follows:
- Day 1: 2000 mg IV bolus on day 1, given first
- Days 1 to 5: 1500 mg/m²/day in 3 liters of D5NS IV continuous infusion
- Days 6 to 8: 1500 mg/m²/day in 3 liters of D5NS IV continuous infusion

21-day cycles

References

Highley MS, Underhill CR, Parnis FX, Karapetis C, Rankin E, Dussek J, Bryant B, Rowland C, Hodson N, Hughes J, Harper PG. Treatment of invasive thymoma with single-agent ifosfamide. J Clin Oncol. 1999 Sep;17(9):2737-44. link to original article contains verified protocol PubMed content property of HemOnc.org

Octreotide (Sandostatin)

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Regimen

Study	Evidence	Comparator
Loehrer et al. 2004	Randomized Phase II	Octreotide & Prednisone

Endocrine therapy

Octreotide (Sandostatin) 0.5 mg SC TID

1-month cycle for up to 12 cycles

References

Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group Phase II Trial. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. link to original article contains verified protocol PubMed

Octreotide & Prednisone

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Regimen

Study	Evidence	Comparator
Loehrer et al. 2004	Randomized Phase II	Octreotide

Endocrine therapy

Octreotide (Sandostatin) 0.5 mg SC TID

1-month cycle for 2 cycles

If stable disease after 2 cycles, patients would then receive:

Octreotide (Sandostatin) 0.5 mg SC TID
Prednisone (Sterapred) 0.6 mg/kg PO once per day

1-month cycle for up to 10 additional cycles

References

Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group Phase II Trial. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. link to original article contains verified protocol PubMed

@@ Line 1: / Line 1: @@
 '''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]].'''
-Is there a regimen missing from this list?  Would you like to share a different dosage/schedule or an additional reference for a regimen?  Have you noticed an error?  Do you have an idea that will help the site grow to better meet your needs and the needs of many others?  You are [[How_to_contribute|invited to contribute to the site]].
+Is there a regimen missing from this list? Would you like to share a different dosage/schedule or an additional reference for a regimen? Have you noticed an error? Do you have an idea that will help the site grow to better meet your needs and the needs of many others? You are [[How_to_contribute|invited to contribute to the site]].
 {| class="wikitable" style="float:right; margin-right: 5px;"
 |-
-|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
+|<div style="background-color: #66FF66; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}" align="right"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |limit=10000|format=sum}} regimens on this page</b></font></div>
-<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]]  |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
+<div style="background-color: #66CCFF; border: 1px solid #808000; padding: 5px; {{border-radius|16px}}"><font size="4"><b>{{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |limit=10000|format=sum}} variants on this page</b></font></div>
 |}
 {{TOC limit|limit=3}}
@@ Line 18: / Line 18: @@
 ADOC: '''<u>A</u>'''driamycin (Doxorubicin), cis-'''<u>D</u>'''iamminedichloroplatinum (Cisplatin), '''<u>O</u>'''ncovin (Vincristine), '''<u>C</u>'''yclophosphamide
 ===Regimen {{#subobject:ee5c1b|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2819910701%2968:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4/abstract Fornasiero et al. 1991]
+|<span
 style="background:#ff0000;
 padding:3px 6px 3px 6px;
@@ Line 25: / Line 29: @@
 border-width:2px;
 border-style:solid;">Retrospective</span>
+|-
-''Note: The body of Fornasiero et al. 1991 specifies that cycles are given every 3 weeks.  However, the abstract says that cycles are given "at monthly intervals," and the NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists the regimen as being given every 4 weeks.''
+|}
-*[[Doxorubicin (Adriamycin)]] 40 mg/m2 IV on day 1
+''Note: The body of Fornasiero et al. 1991 specifies that cycles are given every 3 weeks. However, the abstract says that cycles are given "at monthly intervals," and the NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists the regimen as being given every 4 weeks.''
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV on day 1
+====Chemotherapy====
-*[[Vincristine (Oncovin)]] 0.6 mg/m2 IV on day 3
+*[[Doxorubicin (Adriamycin)]] 40 mg/m<sup>2</sup> IV once on day 1
-*[[Cyclophosphamide (Cytoxan)]] 700 mg/m2 IV on day 4
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV once on day 1
+*[[Vincristine (Oncovin)]] 0.6 mg/m<sup>2</sup> IV once on day 3
+*[[Cyclophosphamide (Cytoxan)]] 700 mg/m<sup>2</sup> IV once on day 4
 '''21 to 28-day cycles'''--see note above regarding duration of cycles
 ===References===
-# Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30-3. [http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2819910701%2968:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/2049749 PubMed]
+# '''Retrospective:''' Fornasiero A, Daniele O, Ghiotto C, Piazza M, Fiore-Donati L, Calabró F, Rea F, Fiorentino MV. Chemotherapy for invasive thymoma. A 13-year experience. Cancer. 1991 Jul 1;68(1):30-3. [http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2819910701%2968:1%3C30::AID-CNCR2820680106%3E3.0.CO;2-4/abstract link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/2049749 PubMed]
 ==Carboplatin & Paclitaxel {{#subobject:410ff6|Regimen=1}}==
@@ Line 43: / Line 49: @@
 |}
 ===Regimen {{#subobject:34b20a|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/29/15/2060.long Lemma et al. 2011]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 50: / Line 60: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Carboplatin (Paraplatin)]] AUC 6 IV over 30 minutes once on day 1, '''given second'''
+*[[Paclitaxel (Taxol)]] 225 mg/m<sup>2</sup> IV over 3 hours once on day 1, '''given first'''
-*[[Carboplatin (Paraplatin)]] AUC 6 IV over 30 minutes on day 1, given second
+====Supportive medications====
-*[[Paclitaxel (Taxol)]] 225 mg/m2 IV over 3 hours on day 1, given first
+*[[Cimetidine (Tagamet)]] 300 mg IV 1 hour prior to [[Paclitaxel (Taxol)]]
+*[[Diphenhydramine (Benadryl)]] 25 mg IV 1 hour prior to [[Paclitaxel (Taxol)]]
-'''21-day cycles x up to 6 cycles'''
+*[[Dexamethasone (Decadron)]] 20 mg IV 1 hour prior to [[Paclitaxel (Taxol)]]
-Supportive medications:
+'''21-day cycle for up to 6 cycles'''
-*Cimetidine (Tagamet) 300 mg IV 1 hour prior to paclitaxel
-*Diphenhydramine (Benadryl) 25 mg IV 1 hour prior to paclitaxel
-*[[Dexamethasone (Decadron)]] 20 mg IV 1 hour prior to paclitaxel
 ===References===
 # Lemma GL, Lee JW, Aisner SC, Langer CJ, Tester WJ, Johnson DH, Loehrer PJ Sr. Phase II study of carboplatin and paclitaxel in advanced thymoma and thymic carcinoma. J Clin Oncol. 2011 May 20;29(15):2060-5. Epub 2011 Apr 18. [http://jco.ascopubs.org/content/29/15/2060.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/21502559 PubMed]
-==PAC, CAP {{#subobject:ce7f87|Regimen=1}}==
+==PAC; CAP {{#subobject:ce7f87|Regimen=1}}==
 {| class="wikitable" style="float:right; margin-left: 5px;"
 |-
@@ Line 72: / Line 84: @@
 CAP: '''<u>C</u>'''yclophosphamide, '''<u>A</u>'''driamycin (Doxorubicin), '''<u>P</u>'''latinol (Cisplatin)
 ===Regimen {{#subobject:f15804|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://annals.org/article.aspx?articleid=704151 Loehrer et al. 1990]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 79: / Line 95: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 50 mg/m<sup>2</sup> IV over at least 1 hour once on day 1
+*[[Doxorubicin (Adriamycin)]] 50 mg/m<sup>2</sup> IV by slow injection once on day 1
+*[[Cyclophosphamide (Cytoxan)]] 500 mg/m<sup>2</sup> IV by slow injection or infusion once on day 1
-*[[Cisplatin (Platinol)]] 50 mg/m2 IV over at least 1 hour on day 1
+====Supportive medications====
-*[[Doxorubicin (Adriamycin)]] 50 mg/m2 IV by slow injection on day 1
+*1 liter normal saline over 2 hours at least 2 hours before and after [[Cisplatin (Platinol)]] therapy
-*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV by slow injection or infusion on day 1
+*Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis
-'''21-day cycles x up to 8 cycles'''
-Supportive medications:
+'''21-day cycle for up to 8 cycles'''
-*1 liter normal saline over 2 hours at least 2 hours before and after cisplatin therapy
-*Corticosteroids use for antiemesis was specifically discouraged unless the indication was for myasthenia gravis
 ===References===
 # Loehrer PJ Sr, Perez CA, Roth LM, Greco A, Livingston RB, Einhorn LH. Chemotherapy for advanced thymoma. Preliminary results of an intergroup study. Ann Intern Med. 1990 Oct 1;113(7):520-4. [http://annals.org/article.aspx?articleid=704151 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/2203292 PubMed]
-# '''Update:''' Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994 Jun;12(6):1164-8. [http://jco.ascopubs.org/content/12/6/1164.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8201378 PubMed]
+## '''Update:''' Loehrer PJ Sr, Kim K, Aisner SC, Livingston R, Einhorn LH, Johnson D, Blum R. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial. The Eastern Cooperative Oncology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clin Oncol. 1994 Jun;12(6):1164-8. [http://jco.ascopubs.org/content/12/6/1164.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8201378 PubMed]
-==PAC, Prednisone (Sterapred), surgery, RT, chemo {{#subobject:96fd1b|Regimen=1}}==
+==PAC & Prednisone -> RT -> PAC & Prednisone {{#subobject:96fd1b|Regimen=1}}==
 {| class="wikitable" style="float:right; margin-left: 5px;"
 |-
@@ Line 101: / Line 119: @@
 PAC: '''<u>P</u>'''latinol, '''<u>A</u>'''driamycin, '''<u>C</u>'''yclophosphamide
 ===Regimen {{#subobject:dcf948|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://www.lungcancerjournal.info/article/S0169-5002%2803%2900626-3/abstract Kim et al. 2004]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 108: / Line 130: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
-''Note: The NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists only the induction phase of this regimen under its first-line options.  No primary reference could be found for treatment with only the induction phase of therapy.''<br>
+''Note: The NCCN, Thymomas and Thymic Carcinomas version 2.2012, lists only the induction phase of this regimen under its first-line options. No primary reference could be found for treatment with only the induction phase of therapy.''<br>
-Induction phase:
+====Induction chemotherapy====
-*[[Cisplatin (Platinol)]] 30 mg/m2 IV once per day on days 1 to 3
+*[[Cisplatin (Platinol)]] 30 mg/m<sup>2</sup> IV once per day on days 1 to 3
-*[[Doxorubicin (Adriamycin)]] 20 mg/m2/day (60 mg/m2 total dose) IV continuous infusion once per day on days 1 to 3
+*[[Doxorubicin (Adriamycin)]] 20 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 3 (total dose: 60 mg/m<sup>2</sup>)
-*[[Cyclophosphamide (Cytoxan)]] 500 mg/m2 IV by slow injection or infusion on day 1
+*[[Cyclophosphamide (Cytoxan)]] 500 mg/m<sup>2</sup> IV by slow injection or infusion once on day 1
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
-'''21 to 28-day cycles x 3 cycles'''
+====Supportive medications====
+*[[Metoclopramide (Reglan)]] 1 mg/kg IV prior to chemotherapy
+*[[Diphenhydramine (Benadryl)]] 25 mg IV prior to chemotherapy
+'''21 to 28-day cycle for 3 cycles'''
-Supportive medications:
+''Surgical resection is performed if CT scan 3 to 4 weeks after the third cycle of chemotherapy shows disease amenable resection, and followed by:''
-*Metoclopramide (Reglan) 1 mg/kg IV prior to chemotherapy
-*Diphenhydramine (Benadryl) 25 mg IV prior to chemotherapy
-*Surgical resection is performed if CT scan 3-4 weeks after the third cycle of chemotherapy shows disease amenable resection
+====Radiotherapy====
-*If tumor is completely resected and has at least 80% necrosis, 50 Gy radiation therapy is  administered 3-6 weeks after surgery
+*If tumor is completely resected and has at least 80% necrosis, 50 Gy radiation therapy is administered 3 to 6 weeks after surgery
 **If tumor is incompletely resected or has <80% necrosis, 60 Gy radiation therapy is administered
-Consolidation phase (at 80% of the induction doses of cisplatin, doxorubicin, and cyclophosphamide; 100% dose of prednisone):
+'''One course, followed by consolidation:'''
-*[[Cisplatin (Platinol)]] 24 mg/m2 IV once per day on days 1 to 3
-*[[Doxorubicin (Adriamycin)]] 16 mg/m2/day (48 mg/m2 total dose) IV continuous infusion once per day on days 1 to 3
+====Consolidation chemotherapy====
-*[[Cyclophosphamide (Cytoxan)]] 400 mg/m2 IV by slow injection or infusion on day 1
+*[[Cisplatin (Platinol)]] 24 mg/m<sup>2</sup> IV once per day on days 1 to 3
+*[[Doxorubicin (Adriamycin)]] 16 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 3 (total dose: 48 mg/m<sup>2</sup>)
+*[[Cyclophosphamide (Cytoxan)]] 400 mg/m<sup>2</sup> IV by slow injection or infusion once on day 1
 *[[Prednisone (Sterapred)]] 100 mg PO once per day on days 1 to 5
-'''21 to 28-day cycles x 3 cycles'''
+'''21 to 28-day cycle for 3 cycles'''
 ===References===
@@ Line 142: / Line 170: @@
 |[[#toc|back to top]]
 |}
-PE: '''<u>P</u>'''latinol, '''<u>E</u>'''toposide
+PE: '''<u>P</u>'''latinol (Cisplatin), '''<u>E</u>'''toposide
 ===Regimen {{#subobject:906dfc|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://jco.ascopubs.org/content/14/3/814.long Giaccone et al. 1996]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 151: / Line 183: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Cisplatin (Platinol)]] 60 mg/m<sup>2</sup> IV over 1 hour once on day 1
+*[[Etoposide (Vepesid)]] 120 mg/m<sup>2</sup> IV over at least 30 minutes once per day on days 1 to 3
-*[[Cisplatin (Platinol)]] 60 mg/m2 IV over 1 hour on day 1
+====Supportive medications====
-*[[Etoposide (Vepesid)]] 120 mg/m2 IV over at least 30 minutes once per day on days 1 to 3
+*"A program of forced hydration"
-'''21-day cycles x up to 8 cycles'''
-Supportive medications:
+'''21-day cycle for up to 8 cycles'''
-*"A program of forced hydration"
 ===References===
@@ Line 168: / Line 202: @@
 |[[#toc|back to top]]
 |}
-VIP: '''<u>V</u>'''epesid, '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol
+VIP: '''<u>V</u>'''epesid (Etoposide), '''<u>I</u>'''fosfamide, '''<u>P</u>'''latinol (Cisplatin)
 ===Regimen {{#subobject:2235f2|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2820010601%2991:11%3C2010::AID-CNCR1226%3E3.0.CO;2-2/full Loehrer et al. 2001]
+|<span
 style="background:#EEEE00;
 padding:3px 6px 3px 6px;
@@ Line 177: / Line 215: @@
 border-width:2px;
 border-style:solid;">Phase II</span>
+|-
+|}
+====Chemotherapy====
+*[[Etoposide (Vepesid)]] 75 mg/m<sup>2</sup> IV once per day on days 1 to 4
+*[[Ifosfamide (Ifex)]] 1200 mg/m<sup>2</sup> IV once per day on days 1 to 4
+*[[Cisplatin (Platinol)]] 20 mg/m<sup>2</sup> IV once per day on days 1 to 4
-*[[Etoposide (Vepesid)]] 75 mg/m2 IV once per day on days 1 to 4
+====Supportive medications====
-*[[Ifosfamide (Ifex)]] 1200 mg/m2 IV once per day on days 1 to 4
+*[[Mesna (Mesnex)]] 240 mg/m<sup>2</sup> IV push before, 4 hours after, and 8 hours after [[Ifosfamide (Ifex)]] once per day on days 1 to 4
-*[[Mesna (Mesnex)]] 240 mg/m2 IV push before, 4 hours after, and 8 hours after ifosfamide once per day on days 1 to 4
+*1 liter normal saline prior to [[Cisplatin (Platinol)]]
-*[[Cisplatin (Platinol)]] 20 mg/m2 IV once per day on days 1 to 4
+*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day on days 5 to 15, until WBC at least 10,000 postnadir
-'''21-day cycles x 4 cycles'''
+'''21-day cycle for 4 cycles'''
-Supportive medications:
-*1 liter normal saline prior to cisplatin
-*[[Filgrastim (Neupogen)]] 5 mcg/kg SC once per day on days 5 to 15, until WBC at least 10,000 postnadir
 ===References===
@@ Line 198: / Line 238: @@
 |[[#toc|back to top]]
 |}
-===Regimen #1, Highley et al. 1999 {{#subobject:d0877e|Variant=1}}===
+===Regimen #1 {{#subobject:d0877e|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[Highley et al. 1999]
+|<span
 style="background:#ff0000;
 padding:3px 6px 3px 6px;
 border-color:black;
 border-width:2px;
-border-style:solid;">Pilot, <20 patients reported</span>
+border-style:solid;">Pilot, <20 pts</span>
+|-
+|}
+====Chemotherapy====
+*[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 to 5
-*[[Ifosfamide (Ifex)]] 1500 mg/m2 IV over 30 minutes once per day on days 1 to 5
+====Supportive medications====
-*[[Mesna (Mesnex)]] 400 mg IV bolus before ifosfamide, then Mesna (Mesnex) 1000 mg/m2 in 1 liter NS IV over 7.5 hours after ifosfamide once per day on days 1 to 5
+*[[Mesna (Mesnex)]] 400 mg IV bolus '''before ifosfamide''', then 1000 mg/m<sup>2</sup> in 1 liter NS IV over 7.5 hours after ifosfamide once per day on days 1 to 5
 '''21-day cycles'''
-===Regimen #2, Highley et al. 1999 {{#subobject:1d5654|Variant=1}}===
+===Regimen #2 {{#subobject:1d5654|Variant=1}}===
-Level of Evidence:
+{| border="1" style="text-align:center;" !align="left"
-<span
+|'''Study'''
+|[[Levels_of_Evidence#Evidence|'''Evidence''']]
+|-
+|[Highley et al. 1999]
+|<span
 style="background:#ff0000;
 padding:3px 6px 3px 6px;
 border-color:black;
 border-width:2px;
-border-style:solid;">Pilot, <20 patients reported</span>
+border-style:solid;">Pilot, <20 pts</span>
+|-
+|}
+====Chemotherapy====
+**[[Ifosfamide (Ifex)]] 1500 mg/m<sup>2</sup>/day IV continuous infusion on days 1 to 5
-*[[Mesna (Mesnex)]] 2000 mg IV bolus on day 1, given first
+====Supportive medications====
-*A 3 liter solution of D5NS containing the following is then given IV continuous 24-hour infusion once per day on days 1 to 5
+*[[Mesna (Mesnex)]] as follows:
-**[[Ifosfamide (Ifex)]] 1500 mg/m2/day IV continuous 24-hour infusion once per day on days 1 to 5
+**Day 1: 2000 mg IV bolus on day 1, '''given first'''
-**[[Mesna (Mesnex)]] 1500 mg/m2/day IV continuous 24-hour infusion once per day on days 1 to 5
+**Days 1 to 5: 1500 mg/m<sup>2</sup>/day in 3 liters of D5NS IV continuous infusion
-*[[Mesna (Mesnex)]] 1500 mg/m2/day in 3 liters of D5NS IV continuous 24-hour infusion once per day on days 6 to 8
+**Days 6 to 8: 1500 mg/m<sup>2</sup>/day in 3 liters of D5NS IV continuous infusion
 '''21-day cycles'''
@@ Line 253: / Line 309: @@
 |-
 |}
+====Endocrine therapy====
 *[[Octreotide (Sandostatin)]] 0.5 mg SC TID
-'''1-month cycle x up to 12 cycles'''
+'''1-month cycle for up to 12 cycles'''
 ===References===
@@ Line 282: / Line 338: @@
 |-
 |}
+====Endocrine therapy====
 *[[Octreotide (Sandostatin)]] 0.5 mg SC TID
-'''1-month cycle x 2 cycles'''
+'''1-month cycle for 2 cycles'''
 ''If stable disease after 2 cycles, patients would then receive:''
@@ Line 291: / Line 348: @@
 *[[Prednisone (Sterapred)]] 0.6 mg/kg PO once per day
-'''1-month cycle x up to 10 additional cycles'''
+'''1-month cycle for up to 10 additional cycles'''
 ===References===
 # Loehrer PJ Sr, Wang W, Johnson DH, Aisner SC, Ettinger DS; Eastern Cooperative Oncology Group Phase II Trial. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004 Jan 15;22(2):293-9. [http://jco.ascopubs.org/content/22/2/293.long link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/14722038 PubMed]
+[[Category:Chemotherapy regimens]]
+[[Category:Solid oncology regimens]]

Difference between revisions of "Thymoma"

Revision as of 21:55, 21 August 2016

First-line therapy

ADOC

Regimen

Chemotherapy

References

Carboplatin & Paclitaxel

Regimen

Chemotherapy

Supportive medications

References

PAC; CAP

Regimen

Chemotherapy

Supportive medications

References

PAC & Prednisone -> RT -> PAC & Prednisone

Regimen

Induction chemotherapy

Supportive medications

Radiotherapy

Consolidation chemotherapy

References

PE

Regimen

Chemotherapy

Supportive medications

References

VIP

Regimen

Chemotherapy

Supportive medications

References

Second-line therapy

Ifosfamide (Ifex)

Regimen #1

Chemotherapy

Supportive medications

Regimen #2

Chemotherapy

Supportive medications

References

Octreotide (Sandostatin)

Regimen

Endocrine therapy

References

Octreotide & Prednisone

Regimen

Endocrine therapy

References

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