Tutorial

This page is intended for folks using HemOnc.org for the first time, although frequent visitors may also learn about new features here. What follows are descriptions of the main features of the wiki.

Table of contents

Almost every page of the wiki has a table of contents, which allows you to jump quickly to the area of the page that you are most interested in. On various longer pages (e.g. the chemotherapy regimen pages) there are also "back to top" buttons that will bring you back to the table of contents.

Main page

This is the landing page of HemOnc.org and is primarily a portal to get to the regimen pages, which are organized in three groups: 1) solid oncology; 2) malignant hematology; and 3) other hematology. There are also many links that appear on the left-hand side navigation bar, which will in fact appear on any page of the wiki.

Chemotherapy regimen pages

Chemotherapy regimens are grouped into individual pages by cancer histology, or sometimes by related histologies (for example, the sarcoma page has several distinctly different sarcoma histologies). On a particular page, regimens are listed alphabetically and by context; for example the melanoma page has two sections: 1) adjuvant therapy and 2) metastatic or unresectable disease.

Chemotherapy regimens

We try to use a consistent style for each chemotherapy regimen, so that you can find the information that you are looking for quickly and easily. Here are the components you will find:

Acronym

For regimens that are known by their acronym(s), the first thing we do is spell out the acronym. Since these acronyms often contain outdated or brand-names, we include the generic names in parentheses as indicated.

Example: CHOP: Cyclophosphamide, Hydroxydaunorubicin (Doxorubicin), Oncovin (Vincristine), Prednisone

Variant

The next thing we do is list each variant of a regimen that we have found, numerically. Right now the order is not really meant to mean anything, although that may change in the future. Generally we consider a variant to be significantly different dosing, significantly different numbers of cycles, or substitution (e.g. prednisolone for prednisone).

Level of evidence

Next, we make an assertion as to the level of evidence of the trial reporting the regimen. Is it a randomized study, or a phase II protocol? Is it a retrospective case series? This section is under active evolution to include links to comparator arms and efficacy; see R-CHOP in follicular lymphoma as one example. For much more information, go to the levels of evidence page.

Antineoplastics

Next, we list the antineoplastic drugs in the same order as the regimen acronym, or alphabetically in the absence of an acronym. Each drug is listed in a particular format:

Generic_name (Brand_name) units per unit measure route frequency on days xyz

Generic_name (Brand_name) is always an active link to the drug page. When a primary reference provides details about infusion time, we include them (this is not common).

Example #1: Cyclophosphamide (Cytoxan) 100 mg/m2 PO once per day on days 1 to 14

Example #2: Mitoxantrone (Novantrone) 8 mg/m2 IV over 30 minutes once on day 1

Supportive medications

Immediately after the antineoplastics, we provide information on supportive medications such as antihistamines, antiemetics, etc. as provided in the original reference. This information is highly variable and sometimes not present in the original reference, in which case it is omitted.

Dose reductions

We occasionally include information on dose reductions, but this has not been a focus of the HemOnc.org project to date. Please consult the original reference if you suspect you are not treating a standard patient (e.g. age > 70 years old, reduced cardiac function, etc.)!

Treatment duration and subsequent disposition

As with the drug information, we try to maintain a very consistent style here:

xx-day or xx-week cycles x yy cycles or xx-day or xx-week course

If a reference reports on a multi-part regimen, we also include a statement linking the parts together. For example, the AIDA 2000 regimen to treat acute promyelocytic leukemia has an induction phase, a consolidation phase, and a maintenance phase. These are all linked together.

References

Finally, we include all of the original references, in chronological order, that we have used to populate the regimen information. These are listed in PubMed style, and include links to the original article (which is usually not free to access) and the PubMed citation. If a contributor has reviewed the original article for accuracy of content, you will see contains verified protocol. If this statement is not present, please be aware that the information present is based on an abstract and may not be wholly accurate or complete. Of course, our standard disclaimer always applies!

Drug index

Beyond the main page and the chemotherapy regimen pages, this is probably where you'll want to go next. This page is pretty self-explanatory but there are a few nuances you may be interested in:

Alphabetical list of drugs

Here, we list drugs alphabetically by their generic name. For all approved drugs, we also include their brand name (if there is more than one brand name we try to choose the most recognizable). Drugs that are under study are labeled in clinical trials. If a drug has been approved in the current or previous calendar year, we list the details right next to the drug, e.g. FDA Approved 7/3/2014. You will probably notice quickly that there are a fair number of red links, which means that the linked page does not yet exist. Help make it happen by contributing!

Drugs by category

Here, we list drugs under a number of different categories. A drug can, of course, be listed under many different categories. For instance, most drugs are categorized by at a minimum their mechanism of action, the diseases for which they are used, and the year that they were approved. See Individual drug pages for more details.

Interesting and helpful links

As the name says, these links are placed here because they have directly relevance to drugs, e.g. the ASCO-ONS Standards for Safe Chemotherapy Administration

Individual drug pages

As with the chemotherapy regimens, we try to use a predictable style across all individual drug pages. They are sectioned as follows:

General information

Here, we provide a description of the mechanism of action (if known), as well as the route(s) and any other important information, such as links to REMS programs. For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information. For most antineoplastics, we provide links to the package insert provided by the manufacturer, as well as a locally-hosted backup.

Diseases for which it is used

These are the specific cancer histologies for which some degree of efficacy has been demonstrated. This is NOT the same as saying that the drug is FDA-approved or even on an approved compendium listing; we are merely stating that there is some evidence to support efficacy. These links will take you to the respective chemotherapy regimen page.

Patient drug information

As indicated, these links are meant to be useful for patients.

History of changes in FDA indication

Here we try to include, at a minimum, the initial date of FDA approval for a cancer-related indication. When the information is available from the FDA, we also include the specific language regarding the approval; this is quite hard to locate for some of the older drugs. We also do our best to update this list with new indications.

Also known as

Here we provide synonyms, which can be only or a few or sometimes hundreds, as is the case for dexamethasone. If you notice that a coded name or other synonym seems to be missing, this is an easy and impactful area for you to contribute to.

References

Self-explanatory

Categories

At the bottom of each drug page, there is a list of any number of categories that the drug has been assigned to. By clicking on one of these categories, you can easily move from a drug page to a list of similar drugs in the class, or a list of drugs approved in the same year, etc. These categories also feed into the drugs by category on the main drug index page.