Difference between revisions of "Example orders for ABVD in Hodgkin lymphoma"

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

Complete resection

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.

ABVD

ABVD: Adriamycin, Bleomycin, Vinblastine, Dacarbazine

Original references may be found at ABVD

Example regimen #1

Doxorubicin (Adriamycin) 25 mg/m² IV on days 1 & 15
- Given as IV push through running IV.
Bleomycin (Blenoxane) 10 units/m² IV on days 1 & 15
- For cycle 1 only: Bleomycin (Blenoxane) 1 unit test dose infused over 15 minutes. Observe patient for 60 minutes prior to administering the remainder of the full dose.
- Infuse over 30 minutes after premedication with acetaminophen (Tylenol).
Vinblastine (Velban) 6 mg/m² IV on days 1 & 15
- Given as IV push through running IV.
Dacarbazine (DTIC) 375 mg/m² IV on days 1 & 15
- Given over 60 minutes, with rate adjustments as needed based on patient tolerability.

28-day cycles x 6 cycles

Supportive medications

Acetaminophen (Tylenol) 650 mg PO 30 minutes prior to chemotherapy
Diphenhydramine (Benadryl) 25 mg PO 30 minutes prior to chemotherapy
Ondansetron (Zofran) 8 mg PO 30 minutes prior to chemotherapy
Aprepitant (Emend) 125 mg PO on days 1 & 15, 80 mg PO on days 2 to 3, 16-17
Dexamethasone (Decadron) 4 mg PO BID on days 1 to 3, 15-17

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 & 15 of each cycle: CBC with differential, absolute neutrophil count (ANC), comprehensive metabolic panel (including chem 10 & liver function tests (LFTs), LDH, uric acid
Physician to be notified if LFTs/bilirubin are outside normal limits, ANC <1000, platelets <100.
Check pulmonary function test (PFTs) with DLCO (diffusing capacity of the lung for carbon monoxide) prior to starting therapy and after 3-4 cycles of therapy. May perform PFTs as soon as after 2 cycles in high risk patients, such as recent smokers.
Smoking cessation for smokers given risk of bleomycin pulmonary toxicity.
Echocardiogram prior to start of therapy.
Restage with PET/CT after 3 cycles of therapy.

Outpatient medications:

Aprepitant (Emend) & Dexamethasone (Decadron) as described above in Supportive medications.
Trimethoprim/Sulfamethoxazole (Bactrim SS) 80/400 mg PO daily for PCP prophylaxis
Ondansetron (Zofran) 8 mg PO TID prn nausea
Prochlorperazine (Compazine) 10 mg PO Q6H prn nausea

Clinical scenario & comments:

28 year-old gentleman with stage IIIAs Hodgkin lymphoma, treated with 6 cycles of ABVD.

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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.