Difference between revisions of "Example orders for Carboplatin (Paraplatin) and Pemetrexed (Alimta) in non-small cell lung cancer"
Jump to navigation
Jump to search
m (table of contents limit) |
m |
||
Line 8: | Line 8: | ||
*[[Carboplatin (Paraplatin)]] AUC 5 IV on day 1 | *[[Carboplatin (Paraplatin)]] AUC 5 IV on day 1 | ||
**Infuse over 30-60 minutes. | **Infuse over 30-60 minutes. | ||
− | *[[Pemetrexed (Alimta)]] 500 mg/m2 IV day 1 | + | *[[Pemetrexed (Alimta)]] 500 mg/m2 IV on day 1 |
**Administer over 10 minutes. Administer after carboplatin. | **Administer over 10 minutes. Administer after carboplatin. | ||
Line 35: | Line 35: | ||
*Ondansetron (Zofran) 4 mg PO Q6H prn nausea | *Ondansetron (Zofran) 4 mg PO Q6H prn nausea | ||
*Prochlorperazine (Compazine) 10 mg PO x Q6H prn nausea | *Prochlorperazine (Compazine) 10 mg PO x Q6H prn nausea | ||
+ | *Folic acid 1000 mcg PO daily as described above | ||
*Due to refractory nausea, in later cycles, we eventually added Aprepitant (Emend) 125 mg PO on day 1, 80 mg PO on days 2-3, and [[Dexamethasone (Decadron)]] use was extended to include day -1 through day 4 | *Due to refractory nausea, in later cycles, we eventually added Aprepitant (Emend) 125 mg PO on day 1, 80 mg PO on days 2-3, and [[Dexamethasone (Decadron)]] use was extended to include day -1 through day 4 | ||
'''Clinical scenario & comments:''' | '''Clinical scenario & comments:''' | ||
*60 year-old lady with stage IV adenocarcinoma of the lung, treated with first-line therapy for metastatic disease. Our institution's standard order set uses Carboplatin (Paraplatin) at AUC 5. This is reasonable in my view; the patient also had a history of pelvic radiation and chemotherapy for an unrelated malignancy many years ago. This was subsequently followed by [[Non-small cell lung cancer#Pemetrexed_.28Alimta.29|Pemetrexed (Alimta) maintenance therapy]]. | *60 year-old lady with stage IV adenocarcinoma of the lung, treated with first-line therapy for metastatic disease. Our institution's standard order set uses Carboplatin (Paraplatin) at AUC 5. This is reasonable in my view; the patient also had a history of pelvic radiation and chemotherapy for an unrelated malignancy many years ago. This was subsequently followed by [[Non-small cell lung cancer#Pemetrexed_.28Alimta.29|Pemetrexed (Alimta) maintenance therapy]]. |
Revision as of 04:31, 21 May 2012
Use of this site is subject to you reading and agreeing with the terms set forth in the disclaimer.
Carboplatin (Paraplatin) & Pemetrexed (Alimta)
Original reference may be found at Carboplatin (Paraplatin) & Pemetrexed (Alimta)
Example regimen #1
- Carboplatin (Paraplatin) AUC 5 IV on day 1
- Infuse over 30-60 minutes.
- Pemetrexed (Alimta) 500 mg/m2 IV on day 1
- Administer over 10 minutes. Administer after carboplatin.
21-day cycles x 6 cycles
Supportive medications:
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
- Lorazepam (Ativan) 0.5-1 mg PO/IV x 1 prn nausea/anxiety
- Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
- Dexamethasone (Decadron) 4 mg PO BID 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 as part of a basic metabolic panel, 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), BUN/Cr
- 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 after cycle 3
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
- Prochlorperazine (Compazine) 10 mg PO x Q6H prn nausea
- Folic acid 1000 mcg PO daily as described above
- Due to refractory nausea, in later cycles, we eventually added Aprepitant (Emend) 125 mg PO on day 1, 80 mg PO on days 2-3, and Dexamethasone (Decadron) use was extended to include day -1 through day 4
Clinical scenario & comments:
- 60 year-old lady with stage IV adenocarcinoma of the lung, treated with first-line therapy for metastatic disease. Our institution's standard order set uses Carboplatin (Paraplatin) at AUC 5. This is reasonable in my view; the patient also had a history of pelvic radiation and chemotherapy for an unrelated malignancy many years ago. This was subsequently followed by Pemetrexed (Alimta) maintenance therapy.