The purpose of this page is to document a "manual of style" that should be used for all entries on HemOnc.org. If you're looking for more general information on how to make edits in Mediawiki, visit this page. If you're looking for a general overview of the site, visit this page. As outlined in the HemOnc.org philosophy, it is important for the overall user experience to adhere to a consistent format for pages and entries because it makes it easier for people to find information. It also contributes to safety by communicating information about treatment regimens in a standard and unambiguous way. It's understood that, due to the ever-evolving nature of this website, some pages will have older formatting, but it is expected that existing pages will gradually be transitioned to the standard format, and all pages moving forward will be created following these guidelines.

HemOnc.org is collaborative, and suggestions for revisions to the style guide are welcome. The style guide is currently still a work in progress.

Introduction

If you've found this page, chances are you're considering making edits to HemOnc.org. Thank you in advance! The goal of this page is to provide guidance on a uniform style across the site. As with many knowledge base endeavors, HemOnc.org has grown organically and the style has evolved over time. In fact, parts of this style guide are/will be outdated, although we do our best to keep the recommendations here concordant with our current best practice. Future work will include adding more templates here, to make it easier to create your own content on the site.

If you're looking for templates for treatment regimens, click this link.

Drug index

Alphabetical list of medications

The primary organization of this page is alphabetical, by (preferred) generic name. There is a separate heading for each letter A-Z for which there is at least one medication.

Examples

Acyclovir (Zovirax)
Ado-trastuzumab emtansine (Kadcyla) FDA approved 2/22/2013
Afatinib (BIBW 2992) in clinical trials

Standard format for this page is as follows:

*[[Generic name (Brand name)]] '''FDA approved mm/dd/yyyy''' or '''in clinical trials''' (see notes)

Medications are listed alphabetically in the drug index by their generic name, with--preferentially--the most common brand name in parentheses, which is usually the predominant United States brand name. Medications which are not yet FDA approved should have a bold in clinical trials after it. Medications which do not yet have generic or brand names can have placeholder entries based on their pharmaceutical company code name, with updates based on generic names and brand names when they become available. So, for example, a preliminary entry may be:

*[[MDV3100]] '''in clinical trials'''

When a generic name is available, the entry on the drug index and the medication's information page--if it exists--will be updated:

*[[Enzalutamide (MDV3100)]] '''in clinical trials'''

The older "MDV3100" page should be redirected to "Enzalutamide (MDV3100)" via the Move function, which is in the downward pointing triangle menu to the right of "view history" at the top of the page. When the medication gets approved by the FDA, its drug index entry and name of the medication page should again be updated:

*[[Enzalutamide (Xtandi)]] '''FDA approved 8/31/2012'''

The FDA approved label remains in place for medications that have been FDA approved since the beginning of the prior year. Specifically, if the current year is 2018, all medications that have been FDA approved since 1/1/2017 will be labeled with the approval date. This choice was made rather than, say, within the last year, to facilitate these updates being made in batches rather than continuously year-round. The labels are also removed so as not to clutter up the page too much. For example, imatinib, which was FDA approved in 2001, simply appears as:

*[[Imatinib (Gleevec)]]

Drugs in preclinical or early phase clinical trials

Given that most early phase drugs will not ultimately be approved, one should exercise caution before adding these drugs to the drug index. The only drugs which are in development that should be added are the ones with promising clinical data already presented; for example, drugs featured in plenary sessions at ASCO or ASH and described in phase I or II trials published in high impact journals.

It is also difficult to tell if a drug has officially been dropped from further development, so updating drugs in clinical trials is difficult. If you are certain that a drug has been discontinued from development, you can remove it from the medication list and make a note on the medication page.

Drugs that have lost FDA approval

A prime example was Gemtuzumab ozogamicin (Mylotarg), which was withdrawn from the US market for approximately 7 years. These withdrawn drugs may remain on the drug index because the information could still be useful to someone looking at older literature and because they may still be investigated in other studies to evaluate them for new indications, leading to re-listing as was the case with gemtuzumab ozogamicin. These should be denoted:

*[[Lepirudin (Refludan)]] '''discontinued'''

List of medications by category

This section of the [drug index] page was created prior to the extensive use of Mediawiki semantic tags, and will eventually be removed. The same information can be found by starting at the top of the drugs category page.

Interesting and helpful links

This list is currently unordered and could use some refinement.

Medication pages

General information

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This section should contain a brief description of the class/mechanism of the drug, either in your own words or borrowed (with attribution) from a public site such as Wikipedia or the NCI Drug Dictionary.

==General information==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}
Class/mechanism: Short description about the medication's class and mechanism of action, written in your own words. Try to use information contained within the package insert--if available--for this information.<ref name=insert>[http://www.manufacturer.com/link_to_package_insert.pdf Generic_name (Brand_name) package insert]</ref><ref>[[:File:Generic_name.pdf | Generic_name (Brand_name) package insert (locally hosted backup)]]</ref><ref>[http://www.brand_name.com/ Brand_name manufacturer's website]</ref>
<br>Route: IV, PO, SC, IM, IT, nasal, NG, GT, topical, transdermal, sublingual, intraocular, rectal, intravesicular, intralesional
<br>Extravasation: no information, none, n/a (e.g. for oral medications), [[vesicant]], and/or [[irritant]]

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 [http://www.thomsonhc.com/home/dispatch Micromedex], [http://online.lexi.com/ Lexicomp], [http://www.utdol.com/online/content/search.do UpToDate (courtesy of Lexicomp)], or the prescribing information.<ref name="insert"></ref>

Diseases for which it is used

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This section should contain a list of all the diseases for which there is some demonstrated degree of efficacy for the particular medication, as monotherapy or in a regimen. This is 'not the same as FDA approved indications, which are only a minority of potential indications (see below).

==Diseases for which it is used==
*[[Bladder cancer]]
*[[Breast cancer]]
*[[Cervical cancer]]
*[[Esophageal cancer]]
*[[Gastric cancer]]
*[[Hodgkin lymphoma]]
*[[Melanoma]]

Patient drug information

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This section should contain links of direct relevance to patients, including package inserts and patient-specific drug information.

==Patient drug information==
*[http://www.manufacturer.com/link_to_package_insert.pdf#page=10 Generic_name (Brand_name) package insert PDF pages 10-12]<ref name="insert"></ref>
*Patient counseling information can be found on [http://www.manufacturer.com/link_to_package_insert.pdf#page=8 page 8 of the Generic_name (Brand_name) package insert]<ref name="insert"></ref>
*[http://chemocare.com/chemotherapy/drug-info/generic_name.aspx Generic_name (Brand_name) patient drug information (Chemocare)]<ref>[http://chemocare.com/chemotherapy/drug-info/generic_name.aspx Generic_name (Brand_name) patient drug information (Chemocare)]</ref>
*[http://www.uptodate.com/contents/generic_name-patient-drug-information Generic_name (Brand_name) patient drug information (UpToDate)]<ref>[http://www.uptodate.com/contents/generic_name-patient-drug-information Generic_name (Brand_name) patient drug information (UpToDate)]</ref>

History of changes in FDA indication

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This section should quote FDA approvals verbatim, along with the date that they were issued. A link to the press announcement is optional, mostly because the FDA archives these links after several years so that they are no longer active. Optional but highly desired are page tags within the approval statement itself, as shown in the below example from the Trastuzumab (Herceptin) page. A useful site to get information about FDA approval histories is here.

==History of changes in FDA indication==
*9/25/1998: Initial FDA approval as a single agent for treatment of patients with metastatic [[Breast_cancer,_HER2-positive|breast cancer whose tumors overexpress the HER2 protein]] and who have received one or more chemotherapy regimens for their metastatic disease.
*8/28/2002: Label revised: trastuzumab in combination with [[Paclitaxel (Taxol) | paclitaxel]] is indicated for treatment of patients with metastatic [[Breast_cancer,_HER2-positive| breast cancer whose tumors overexpress the HER2 protein]] and who have not received chemotherapy for their metastatic disease.
*11/16/2006: Label revised: trastuzumab as part of a treatment regimen containing [[Doxorubicin (Adriamycin) | doxorubicin]], [[Cyclophosphamide (Cytoxan) | cyclophosphamide]], and [[Paclitaxel (Taxol) | paclitaxel]] is indicated for the adjuvant treatment of patients with [[Breast_cancer,_HER2-positive|HER2-overexpressing, node-positive breast cancer]].
*1/18/2008: Labeling simplified: indicated for the treatment of [[Breast_cancer,_HER2-positive|HER2 overexpressing breast cancer]].
*10/20/2010: Label expanded to include the treatment of HER2-overexpressing metastatic [[Gastric cancer | gastric]] or [[Esophageal cancer | gastroesophageal junction]] adenocarcinoma.

Synonyms

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This section should be structured so that entries are under one of the following categories: code name(s); generic name(s); brand name(s). One source that can be used for this information is: https://www.mediguard.org/medication/facts-figures; sort and reformat the lists by copy and pasting the list to: http://sortmylist.com/

Example from the Pembrolizumab (Keytruda) page:

==Also known as==
*'''Code names:''' MK-3475, SCH 900475
*'''Generic names:''' lambrolizumab
*'''Brand name:''' Keytruda

References

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This section header should live at the bottom of the page so that any references (e.g., package insert) can be found here.

==References==
<references/>

Treatment regimen pages

The general format of each treatment regimen page is as follows. See the treatment regimen formatting section for specific information about how to describe treatment regimens in a standard way.

Header

This section is fairly standardized and should not be altered:

<!--'''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]]. If this is your first time visiting, we suggest you read the [[tutorial]].'''-->

<!--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]].-->

Number of regimens on this page: {{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Regimen |format=sum}}
<br>Number of regimen variants on this page: {{#ask: [[-Has subobject::{{FULLPAGENAME}}]] |?Variant |format=sum}}

{{TOC limit|limit=3}}

Guidelines

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Most disease-specific pages now have guidelines, organized by the issuing professional society (or societies). With the except of NCCN, which are presumed current as the link goes directly to the NCCN webpage, the year that the guideline was issued should be prominent. The title of the guideline should be in sentence case, and a link to the original article and the PubMed abstract should be provided unless there is a free version available, in which case the PubMed abstract is not needed.

=Guidelines=
==AUA, ASCO, ASTRO, SUO==
*'''2017:''' [http://www.auanet.org/guidelines/muscle-invasive-bladder-cancer-new-(2017) Treatment of non-metastatic muscle-invasive bladder cancer: AUA/ASCO/ASTRO/SUO Guideline] [https://pubmed.ncbi.nlm.nih.gov/28456635 PubMed]
==[http://www.esmo.org/ ESMO]==
*'''2014:''' [https://annonc.oxfordjournals.org/content/25/suppl_3/iii40.full.pdf+html Bladder cancer: ESMO Clinical Practice Guidelines] [https://pubmed.ncbi.nlm.nih.gov/25096609 PubMed]
==[https://www.nccn.org/ NCCN]==
*[https://www.nccn.org/professionals/physician_gls/pdf/bladder.pdf NCCN Guidelines - Bladder Cancer]

Treatment context

Headings that contain treatment regimens should be delineated by treatment context, using the following conventions:

Neoadjuvant: treatment given before a definitive surgical procedure
Adjuvant: treatment given after a definitive surgical procedure
Induction: treatment given as part of a course with primary curative intent, whether or not subsequent treatment is surgical (e.g., induction chemotherapy prior to consolidation in AML; induction chemoradiotherapy prior to surgery or consolidation in bladder cancer)
Definitive: the primary treatment for curative intent; usually surgery but can also include definitive chemoradiotherapy as in for some stage III NSCLC
Consolidation: treatment given as part of a course for primary curative intent, usually after induction or definitive therapy.
Upfront: initial treatment given with curative intent (e.g., upfront induction, upfront consolidation, etc.)
Salvage: subsequent treatment given with curative intent (e.g., salvage induction)
First-line: initial treatment given with non-curative intent
Second-line: the next treatment given with non-curative intent after first-line treatment fails
Subsequent line: any line of treatment given with non-curative intent after first-line treatment fails

Regimen name and header

We have developed guidelines for regimen naming conventions which can be accessed here. For acronyms, the expansion should be provided below the main header, as shown below. If an acronym has a brand name (e.g., O is commonly used for Oncovin) that brand name should be expanded and the common generic name should be provided in parentheses, for example: Oncovin (Vincristine). Other common variants of the acronyms can also be provided here, as shown below.

Regimens should be listed in alphabetical order within a disease context. Note that every regimen on a given page needs to have a different subobject number in order to be added up properly. Best practice is to use a randomly generated number for this subobject, although other logical schemas can also be used. Make sure to also include the "back to top" table so that users can easily navigate the page.

==R-ICE {{#subobject:123456 |Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}
R-ICE: '''<u>R</u>'''ituximab, '''<u>I</u>'''fosfamide, '''<u>C</u>'''arboplatin, '''<u>E</u>'''toposide
<br>ICE-R: '''<u>I</u>'''fosfamide, '''<u>C</u>'''arboplatin, '''<u>E</u>'''toposide, '''<u>R</u>'''ituximab

Example orders

If your regimen has example orders (or you would like to create them), the next item within the regimen should be a link to the example orders page:

===Example orders===
*[[Example orders for Regimen_name in Disease_type]]

Regimen variants

A variant is a regimen that is substantively similar to another regimen with minor differences e.g. in dosages, routes, or frequencies of administration. For example, we would consider R-CHOP that uses prednisone and R-CHOP that uses prednisolone as variants, not separate regimens. Conversely, R-CVP is considered a completely different regimen than R-CHOP, due to omission of one of the main chemotherapeutics (doxorubicin). There is no absolute rule for what order different variants of a regimen should be listed in within a regimen. One may choose to put the most commonly used version of the regimen at the top, order in reverse chronology, order by increasing dose(s), or just add new ones as successive regimen numbers in the sequence. Similar to what is used for regimens above, every variant of a regimen needs to have a different subobject number in order to be added up properly. These have to be distinct; i.e., if you use "1" for variant 1 of regimen A and of regimen B, it will only be counted one time on that page. Ideally, besides numbering the variants, also provide a very succinct description about what makes this variant different than the others under the same regimen heading.

===Regimen variant #1, 28-day cycles {{#subobject:1 |Variant=1}}===
[Insert manuscript and efficacy table here]
''Comment about variant, if needed.''
====Chemotherapy====
*[[Generic name (Brand name)]] 10 mg PO once per day on days 1 to 21

'''28-day cycles'''

===Regimen variant #2, 21-day cycles {{#subobject:2 |Variant=1}}===
[Insert manuscript and efficacy table here]
''Comment about variant, if needed.''
====Chemotherapy====
*[[Generic name (Brand name)]] 10 mg IV over 60 minutes once on day 1

'''21-day cycles'''

Treatment regimen formatting

Instructions

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The following sections get into the nitty-gritty of regimen formatting. If you would like, you can skip straight to the examples.

Treatment formatting

The standard format for describing a treatment prescription is:

*[[Generic name (Brand name)]] (dose) (units) (in what volume and type of fluid) (route[s]) (time of infusion) (frequency and/or number of times given) (schedule) (order of administration) (special comments)
**Special instructions, such when patients over a certain age receive a reduced dose, or for other needed comments about the use of this specific medication in this regimen.

If there are clear instructions for different doses based on some factor (age, cycle number, etc.), use this standard format:

*[[Generic name (Brand name)]] as follows:
**Situation A: (dose) (units) (special comments) (route[s]) (time of infusion) (frequency and/or number of times given) (schedule) (order of administration) (special comments)
**Situation B: (dose) (units) (special comments) (route[s]) (time of infusion) (frequency and/or number of times given) (schedule) (order of administration) (special comments)

Drug name

Best practice is to make sure that this links to an existing HemOnc.org page, in which case it will appear blue in the default MediaWiki view. If the linked page does not exit, it will appear red.

Dose

Don't use commas for any value less than 10,000.
If the dose is a fraction of an integer, list up to two digits beyond the decimal point; otherwise do not use a decimal point (e.g., "100" not "100.0")
If the dose in a manuscript is expressed in grams, convert to milligrams (e.g., "2000" not "2")
If the dose is given as a range, separate the bounds with the word "to" (e.g., "500 to 600")

Units

Avoid confusing abbreviations (e.g., IU should be spelled out as "international units")
For micrograms, use the abbreviation "mcg"
For BSA-based dosing, use the superscript i.e.,
```
mg/m<sup>2</sup>
```
For AUC-based dosing, make clear which formula is used

Route

Use the following standard abbreviations:
- Intramuscular: IM
- Intravenous: IV
- Oral: PO
- Subcutaneous: SC
If the regimen provides more than one route as an option, use a "/" to separate the routes (e.g., "PO/IV")

Time of infusion

For infusions of up to 1.5 hours in length, convert the time into minutes (e.g., "over 90 minutes")
For infusions of 2 hours or longer, use hours (e.g., "over 4 hours")
For infusions with a range, use the format A to B (e.g., "over 5 to 10 minutes"; "over 60 minutes to 3 hours")
For continuous infusions, use the words "continuous infusion" not the abbreviation CI

Frequency and/or number of times given

If the drug is only given once, use the word "once"
If the drug is given on more than one day of a cycle but only once on any given day, use the phrase "once per day"
If the drug is given more than once per day, try to avoid abbreviations as they may not translate to other languages correctly. Some acceptable frequencies to use are:
- twice per day (not BID)
- three times per day (not TID)
- four times per day (not QID)
- every 3 hours, every 4 hours, etc. (not q3h, q4h, etc.)
Do not use abbreviations or numbers which are on the Joint Commission (TJC), previously known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)'s "Do not use" list: U, u (unit); IU (international units); Q.D., QD, q.d., qd (daily); Q.O.D., QOD, q.o.d., qod (every other day); MS, MSO4, MgSO4 (morphine sulfate or magnesium sulfate); trailing zeroes (X.0 mg); or omitted leading zeroes (.X mg). Also, based on suggestions in Making Health Care Safer II, please do not use any abbreviations involving frequencies during a week--e.g. use "3 times a week" instead of TIW--and do not use cc as an abbreviation for mL.

Schedule

If the drug is only given once per cycle, use the phrase "on day X"
If the drug is given twice per cycle on two distinct days, use the phrase "on days X & Y"
If the drug is given more than twice per cycle on more than two distinct days, report the days as follows:
- Contiguous days: "on days X to Y" (e.g., "on days 1 to 4")
- Discontinuous days: "on days X, Y, Z" (e.g., "on days 1, 8, 15")
- Mix of contiguous and discontinuous days: "on days A to B, X to Y" (e.g., "on days 1 to 4, 9 to 12, 15, 16")
If the drug is continuously given throughout the cycle, either specify the days (e.g., "once per day on days 1 to 28") or it can be left implied by leaving out the days ("once per day")
For a drug with an predefined event-driven endpoint, make this clear in the prose (e.g., "starting on day 6 and continuing until ANC greater than 5000/uL past nadir")

Order of administration

This is not often reported in manuscripts but is considered very important, when it is mentioned.

Denote a sequence instruction using bold (e.g., given first)
For regimens with two or more drugs, use given first, given second, given third, and so forth. Do not use given last as this does not allow for automated calculation of final ordering if there are more than two drugs.
If there is a specified time separation, mention in both sequences (e.g., given first; 30 minutes prior to drug Y and given second, 30 minutes after drug X)

Special comments

There are two places where special comments can go inline with the prescription: after units or at the end of the line.

After units, you can add information about the diluent if applicable (e.g., "400 mg/m² in 500 mL of NS")
After units, add information about capped dose, if applicable (e.g., "1.4 mg/m² (maximum dose of 2 mg)")
For continuous infusions other than those exactly 24 hours long, specify the total dose per cycle at the end of the line, in parentheses e.g., "(total dose per cycle: 200 mg/m²)"
In order to further reduce ambiguity, when thought to be beneficial, contributors may optionally add the total number of doses at the end of the instruction, e.g.:
- once on day 1 (1 dose per cycle)
- once per day on days 1 to 3 (3 doses per cycle)
- once per day on days 1 & 8 (2 doses per cycle)
- once per day on days 1, 8, 15 (3 doses per cycle)
- twice per day on days 1 to 14 (28 doses per cycle)

Order of medications within a regimen

List medications within the regimen in the same order as they are found in the title of the regimen. So, for example, if the regimen is an acronym, the medications should be listed in the same order as they are used in the acronym - even if this does not correspond to the order of administration. All regimens have a required antineoplastic section, and can have several optional sections. The antineoplastic section should have a heading which describes the general class to which the regimen belongs (e.g., chemotherapy, immunotherapy, chemoradiotherapy).

Optional: preceding and subsequent treatments

See below for a discussion of this.

Optional: supportive medications

Only list what is specifically described by the cited paper(s). Details about hydration also can go in this section. Both prn and "as needed for" may be used to describe medications taken on an as needed basis. It is encouraged to also list whether the paper specifically mentioned agents which were not used, such as:
- No routine antibiotic or antiviral prophylaxis was given
- Growth factor support was NOT allowed
If the reference gives more than one choice from a category, use the following syntax:

*ONE of the following xyz medications:
**[[Option 1]]
**[[Option 2]]

If the reference only refers to categories of medications, such as "5-HT3 antagonists," that is all that can be written; we cannot say, for example, Ondansetron (Zofran). Instead, provide a link to the relevant category, using this format (make note of the colon before and after the "Category":

*[[:Category:5-HT3 antagonists|5-HT3 antagonists]]

If there is more than one antineoplastic drug, and a supportive medication is clearly intended for use in context of one of those drugs, explicitly link the two together. Example:

====Supportive medications====
*[[Acetaminophen (Tylenol)]] 650 mg PO once as premedication for [[Rituximab (Rituxan)]]

If a supportive medication is admixed with an antineoplastic, denote this with an explicit link (this might only apply to ifosfamide). Example:

====Supportive medications====
*[[Mesna (Mesnex)]] 5000 mg/m<sup>2</sup> IV continuous infusion over 24 hours on day 4, mixed together with [[Ifosfamide (Ifex)]]

If more than one manuscript describes a regimen, but one of them describes the supportive medications more completely, make note of this. Example:

====Supportive medications====
*(as described by Kewalramani et al. 2004):

Optional: CNS therapy

If described, the drug(s) used for CNS prophylaxis and/or treatment should be under a separate heading.

Duration of cycle

This line should come after the required antineoplastic drug(s) and the optional supportive and/or CNS drugs, and should always be bolded.
For cycles lasting 6 weeks or less, report the numeric duration in days, with a dash between the number and "day" (e.g., 21-day cycle; 42-day cycle).
- Exception: for cycles that are specified as monthly, use 1-month cycle since months have different numbers of days.
For cycles lasting more than 6 weeks, report the numeric duration in weeks (e.g., 12-week cycle)
- Exception: the primary reference specifies the cycle in days which are not easily transformed to weeks, e.g., 90-day cycles or 3-month cycles
- If the total duration of a regimen is very long, as with some maintenance regimens, give the actual number of cycles as well as the total duration in parentheses: 14-day cycle for 26 cycles (1 year) and 21-day cycle for 35 cycles (2 years)
If a range is given for the cycle length in the reference, use this format: 14- to 21-day cycles
When the total number of cycles is singular, use "for X cycles", e.g., 14-day cycle for 4 cycles
When the total number of cycles has an upper bound, use "for up to X cycles", e.g., 28-day cycle for up to 4 cycles
When the total number of cycles has a lower bound, use "X or more cycles", e.g., 28-day cycle for 4 or more cycles
When the total number of cycles is a range, use "for X to Y cycles", e.g., 21-day cycle for 6 to 8 cycles
When there is additional information regarding the total number of cycles, use "(see note)" and explain in prose just below the reference table for the regimen or variant.
For regimens with no definite stopping point, report merely the cycle length, e.g., 28-day cycles. This is generally understood to be equivalent to "28-day cycles until progression, unacceptable side effects, or patient preference to discontinue."
Although there are various terms used to describe a cycle of treatment (e.g. round is often used in the literature) we encourage the consistent use of the word cycle for regimens with two or more planned repetitions
If there is only one course of treatment, as in a course of chemoradiotherapy or of induction, use the word course

Linking portions of protocols

Often, a protocol will be divided into portions, each of which could be considered an independent regimen, e.g., upfront treatment followed by consolidation followed by maintenance. Or, some regimens are response-adopted, e.g., R-MegaCHOP with intensification treatment based on early FDG-PET in patients with high-risk diffuse large B-cell lymphoma. In these cases, even if a regimen is detailed in a single reference, we encourage breaking the regimen up across the appropriate contexts. Links should not be left implicit but rather should be detailed as follows:

Preceding treatments

If anything comes before the regimen (optional or required), the following format should be used:

Only one preceding treatment option

====Preceding treatment====
* [[Regimen A]]

More than one preceding treatment option, as part of a single non-randomized protocol

====Preceding treatment====
* [[Regimen A]] or [[Regimen B]] or [[Regimen C]]

More than one preceding treatment option, as part of a single randomized protocol

====Preceding treatment====
* [[Regimen A]] versus [[Regimen B]] versus [[Regimen C]]

More than one preceding treatment option, from more than one protocol

====Preceding treatment====
* Protocol 1 & Protocol 2: [[Regimen A]]
* Protocol 3: [[Regimen B]]
* Protocol 4: [[Regimen A]] versus [[Regimen B]]
* Protocol 5: [[Regimen A]] or [[Regimen B]]

Subsequent treatments

As opposed to preceding treatments, subsequent treatments are often conditional, i.e., they require the patient meeting some predefined parameters, such as achieving a certain level of response to the treatment regimen. When these conditional statements are complex, they should be written in narrative style with lengthy explanation as needed. When they are relatively simple (e.g., AC, then T in adjuvant breast cancer), then the links can be in a structured style analogous to the preceding treatment examples above, using "subsequent" in place of preceding.

Templates

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These templates are meant to be "plug and play" for the tables that are displayed under a regimen - copy them into a page, fill out the blanks, and you should have a new regimen table ready to go.

Non-randomized trials without efficacy

Note: the trial type is defaulted to "Phase II".

{| class="wikitable" style="width: 40%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
|-
|[https://www.nameofjournal.org/xxx yyyy et al. 20zz]
|style="background-color:#91cf61"|Phase II
|-
|}

What it looks like:

Study	Evidence
yyyy et al. 20zz	Phase II

Non-randomized trials with efficacy

Note: the trial type is defaulted to "Phase II".

{| class="wikitable" style="width: 60%; text-align:center;" 
!style="width: 33%"|Study
!style="width: 33%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 33%"|[[Levels_of_Evidence#Efficacy|Efficacy]]
|-
|[https://www.nameofjournal.org/xxx yyyy et al. 20zz]
|style="background-color:#91cf61"|Phase II
|
|-
|}

What it looks like:

Study	Evidence	Efficacy
yyyy et al. 20zz	Phase II

Randomized trials without toxicity

Note: the trial type is defaulted to "Phase III" and the comparative efficacy is defaulted to "seems not superior".

{| class="wikitable sortable" style="width: 100%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 25%"|Comparator
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
|-
|[https://www.nameofjournal.org/xxx yyyy et al. 20zz]
|style="background-color:#1a9851"|Phase III
|[[#other_regimen|Display name of other regimen]]
|style="background-color:#ffffbf"|Seems not superior
|-
|}

What it looks like:

Study	Evidence	Comparator	Comparative Efficacy
yyyy et al. 20zz	Phase III	Display name of other regimen	Seems not superior

Randomized trials with toxicity

Note: the trial type is defaulted to "Phase III" and the comparative efficacy and toxicity are defaulted to "seems not superior".

{| class="wikitable sortable" style="width: 100%; text-align:center;" 
!style="width: 20%"|Study
!style="width: 20%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 20%"|Comparator
!style="width: 20%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
!style="width: 20%"|[[Levels_of_Evidence#Toxicity|Comparative Toxicity]]
|-
|[https://www.nameofjournal.org/xxx yyyy et al. 20zz]
|style="background-color:#1a9851"|Phase III
|[[#other_regimen|Display name of other regimen]]
|style="background-color:#ffffbf"|Seems not superior
|style="background-color:#ffffbf"|Seems not superior
|-
|}

What it looks like:

Study	Evidence	Comparator	Comparative Efficacy	Comparative Toxicity
yyyy et al. 20zz	Phase III	Display name of other regimen	Seems not superior	Seems not superior

Examples

back to top

For simplicity, the references are omitted from these examples.

Regimen example #1, single drug

Cladribine monotherapy in mantle cell lymphoma

==Cladribine monotherapy {{#subobject:f729d6|Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}

===Regimen {{#subobject:986eae|Variant=1}}===
{| class="wikitable" style="width: 40%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
|-
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465670/ Inwards et al. 2008 (NCCTG 95-80-53)]
|style="background-color:#91cf61"|Phase II
|-
|}
====Chemotherapy====
*[[Cladribine (Leustatin)]] 5 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 5 

'''28-day cycle for up to 6 cycles'''

===References===

Regimen example #2, single drug with many references

Lenalidomide monotherapy in mantle cell lymphoma

==Lenalidomide monotherapy {{#subobject:b5de78|Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}

===Regimen {{#subobject:2d2b4a|Variant=1}}===
{| class="wikitable sortable" style="width: 100%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 25%"|Comparator
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
|-
|[https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2141.2009.07626.x/full Habermann et al. 2009]
|style="background-color:#ffffbe"|Phase II, <20 pts in subgroup
|style="background-color:#d3d3d3"|
|style="background-color:#d3d3d3"|
|-
|[http://annonc.oxfordjournals.org/content/22/7/1622.long Witzig et al. 2011 (NHL-003)]
|style="background-color:#91cf61"|Phase II
|style="background-color:#d3d3d3"|
|style="background-color:#d3d3d3"|
|-
|[https://onlinelibrary.wiley.com/doi/10.1111/bjh.12008/full Eve et al. 2012]
|style="background-color:#91cf61"|Phase II
|style="background-color:#d3d3d3"|
|style="background-color:#d3d3d3"|
|-
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4879693/ Goy et al. 2013 (MCL-001, EMERGE)]
|style="background-color:#91cf61"|Phase II
|style="background-color:#d3d3d3"|
|style="background-color:#d3d3d3"|
|-
|[https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00559-8/fulltext Trněný et al. 2016 (MCL-002, SPRINT)]
|style="background-color:#1a9851"|Randomized Phase II
|Investigator's choice
|style="background-color:#1a9850"|Superior PFS
|-
|}

''Participants in '''EMERGE''' "were required to have had prior treatment with rituximab, cyclophosphamide and anthracycline (or mitoxantrone), and to have relapsed or progressed (<12 months) after or were refractory to bortezomib." Investigator's choice in the '''SPRINT''' trial was restricted to single-agent therapy with cytarabine, rituximab, gemcitabine, fludarabine, or chlorambucil.''
====Chemotherapy====
*[[Lenalidomide (Revlimid)]] 25 mg PO once per day on days 1 to 21

'''28-day cycles'''

''Patients in Eve et al. 2012 proceeded to receive [[#Lenalidomide_monotherapy_2|maintenance lenalidomide]] after 6 cycles.''

===References===

Regimen example #3, two drugs with sequencing

Carboplatin & Gemcitabine for ovarian cancer

==Carboplatin & Gemcitabine (GCb) {{#subobject:65ad86|Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}
===Regimen {{#subobject:dd8477|Variant=1}}===
{| class="wikitable sortable" style="width: 100%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 25%"|Comparator
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
|-
|[http://www.gynecologiconcology-online.net/article/S0090-8258(11)00703-7/abstract Gordon et al. 2011]
|style="background-color:#1a9851"|Phase III
|[[Ovarian_cancer#Carboplatin_.26_Paclitaxel_.28CP.29|Carboplatin & Paclitaxel]]
|style="background-color:#ffffbf"|Seems not superior
|-
|}
====Chemotherapy====
*[[Carboplatin (Paraplatin)]] AUC 5 IV over 30 minutes once on day 1, '''given second'''
*[[Gemcitabine (Gemzar)]] 1000 mg/m<sup>2</sup> IV over 30 minutes once per day on days 1 & 8, '''given first'''

'''21-day cycle for up to 6 cycles'''

''Patients with complete response could optionally proceed to receive [[Ovarian_cancer#Paclitaxel_monotherapy|paclitaxel consolidation]].''

===References===

Regimen example #4, supportive medications with optionality and explicit linking

Carboplatin & Docetaxel for ovarian cancer

==Carboplatin & Docetaxel {{#subobject:1113e0|Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}
===Regimen {{#subobject:e5c1b0|Variant=1}}===
{| class="wikitable sortable" style="width: 100%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
!style="width: 25%"|Comparator
!style="width: 25%"|[[Levels_of_Evidence#Comparative_efficacy|Comparative Efficacy]]
|-
|[http://jnci.oxfordjournals.org/content/96/22/1682.long Vasey et al. 2004]
|style="background-color:#1a9851"|Phase III
|[[Ovarian_cancer#Carboplatin_.26_Paclitaxel_.28CP.29|Carboplatin & Paclitaxel]]
|style="background-color:#ffffbf"|Seems not superior
|-
|}
====Chemotherapy====
*[[Carboplatin (Paraplatin)]] AUC 5 IV over 60 minutes once on day 1, '''given second'''
*[[Docetaxel (Taxotere)]] 75 mg/m<sup>2</sup> IV over 60 minutes once on day 1, '''given first'''

====Supportive medications====
*[[Dexamethasone (Decadron)]] 8 mg PO twice per day the day before, the day of, and day after [[Docetaxel (Taxotere)]]
*ONE of the following 5-HT3 antagonists:
**[[Ondansetron (Zofran)]] 8 mg
**[[Granisetron]] 3 mg

'''21-day cycle for 6 cycles'''

===References===

Regimen example #5, preceding and subsequent regimens

Adjuvant AC in breast cancer (variant 2)
Note: in this particular regimen, the preceding "regimen" is surgery and is not further specified. The subsequent regimens are all for HER2-positive breast cancer and are as such on a separate page from this regimen (AC), which is generically for any type of breast cancer. Note also that there is a mix of randomization ("versus") and non-randomized choices ("or") in the subsequent treatment options.

===Regimen variant #2, with range {{#subobject:67eda7|Variant=1}}===
{| class="wikitable" style="width: 40%; text-align:center;" 
!style="width: 25%"|Study
!style="width: 25%"|[[Levels_of_Evidence#Evidence|Evidence]]
|-
|[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5538020/ von Minckwitz et al. 2017 (APHINITY)]
|style="background-color:#91cf61"|Non-randomized portion of RCT
|-
|}
''Patients in '''APHINITY''' had HER2-positive breast cancer. Note that ranges for AC are given in the protocol, replicated here.''
====Preceding treatment====
*[[Surgery]]
====Chemotherapy====
*[[Doxorubicin (Adriamycin)]] 60 mg/m<sup>2</sup> IV once on day 1 
*[[Cyclophosphamide (Cytoxan)]] 500 to 600 mg/m<sup>2</sup> IV once on day 1

'''21-day cycle for 4 cycles'''
====Subsequent treatment====
*[[Breast_cancer,_HER2-positive#TH_.28Taxol.29_2|TH (Taxol)]] versus [[Breast_cancer,_HER2-positive#THP_.28Taxol.29_2|THP (Taxol)]] or [[Breast_cancer,_HER2-positive#TH_.28Taxotere.29_2|TH (Taxotere)]] versus [[Breast_cancer,_HER2-positive#THP_.28Taxotere.29_2|THP (Taxotere)]]

References

For each regimen, references should be listed in chronologic order, with the oldest references at the top, and the newest references at the bottom. References have a standard format, as explained below, following this example:

#'''CHAARTED:''' Sweeney CJ, Chen YH, Carducci M, Liu G, Jarrard DF, Eisenberger M, Wong YN, Hahn N, Kohli M, Cooney MM, Dreicer R, Vogelzang NJ, Picus J, Shevrin D, Hussain M, Garcia JA, DiPaola RS. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015 Aug 20;373(8):737-46. Epub 2015 Aug 5. [https://www.nejm.org/doi/full/10.1056/NEJMoa1503747 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pmc/articles/pmc4562797/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26244877 Pubmed] NCT00309985
##'''Update:''' Kyriakopoulos CE, Chen YH, Carducci MA, Liu G, Jarrard DF, Hahn NM, Shevrin DH, Dreicer R, Hussain M, Eisenberger M, Kohli M, Plimack ER, Vogelzang NJ, Picus J, Cooney MM, Garcia JA, DiPaola RS, Sweeney CJ. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer: long-term survival analysis of the randomized phase III E3805 CHAARTED trial. J Clin Oncol. 2018 Apr 10;36(11):1080-1087. Epub 2018 Jan 31. [https://doi.org/10.1200/JCO.2017.75.3657 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891129/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/29384722 PubMed]

Primary references

Numbering

Each primary reference should start with a "#" sign in Wiki markup, which will automatically convert to the appropriate number.

Header

In order to increase the findability of references, we generally try to tag them with the bolded study name, CHAARTED in the example. We use special labels for several article types:

Retrospective: self-explanatory
Review: self-explanatory
Abstract: these are references that are only available in the gray literature, e.g., conference abstracts.

Author list

This should be the full author list (no et al.) in the format Last Name First Initial (Middle Initial). This is the format that PubMed provides when using the "Cite" button.

Study group

If provided in PubMed, the study group should be listed after the authors, separated by a semicolon.

Article title

This is easiest copied directly from PubMed. If time allows, we try to use sentence case. Some journals capitalize every word in the title, and this has to be undone manually.

Journal title

Use the standard abbreviations provided by PubMed.

Publication date and pages

Use the format directly from PubMed, including the Epub date if it is provided. The main publication and Epub date are often separated by a doi:xyz in the PubMed citation; this portion should be removed as it is visually distracting.

Link to original article

This should be the DOI: link as provided on PubMed. To get the link, right click (PC) or CTRL+click (Mac) on the hyperlink just to the right of the PMID:, below the author list. Choose "Copy Link" and then paste the link into the reference. The reason to use the DOI: link is that journals often change publishers and do not always leave behind redirects. This is a work in progress for HemOnc.org - as you'll see in the example above, the NEJM article has a direct link to the NEJM website, whereas the JCO article uses the DOI link. For abstracts, links often break from year-to-year as the conference websites refresh/update - something to be aware of but there is no easy fix.

Link to PMC article

If the manuscript has been deposited in PubMed Central, please add the PMC link, so that users from around the world can access otherwise paywalled content. This should be done even if the PMC link is still under embargo.

Link to PubMed

Nearly every reference on HemOnc.org should have an entry in PubMed. Provide the link here.

Clinical trial ID

If there is a clinical trial ID, such as the NCT number assigned by ClinialTrials.gov, add as plain text (no link necessary) at the end of the reference. Most trials started after 2010 should have a clinical trial ID, although sometimes it is not easy to find in the reference.

Updates and sub-group analyses

When an interim or final update is published, we try to include these references, nested under the original publication. Depending on the trial, there can be zero, one, or many updates.

Numbering

In order to make these nested, they need to start with a double "##" sign in Wiki markup, which will automatically convert to the appropriate number.

Header

We also nest several other categories under the original reference:

Update: this is the default header for any interim or final update
Sub-group analysis: a pre-planned or post-hoc analysis of defined subgroups of the original study population
HRQoL analysis: a pre-planned or post-hoc analysis of health-related quality of life outcomes

Remainder of citation

The remainder of an update follows the format of the primary analysis, except that the clinical trial ID should not be appended to the end again.

Review status

If a reference says contains verified protocol, that means the original paper has been reviewed by the submitter, with the details of the regimen confirmed with the primary literature. If the reference just says contains protocol, the reference contains details about the regimen, but it was not personally reviewed by the submitted. Exception: numerous regimens on HemOnc.org were manually verified prior to the adoption of the contains verified protocol tag and instead only currently say contains protocol. Those regimens will be changed over time to contains verified protocol as the content is re-reviewed during an update of each page's regimens.

For example, if a submitter is able to see which dosages are described in the abstract, but the submitter lacks a subscription to access the complete paper, the reference would be labelled as contains protocol. A review article which discusses the regimen would not contain one of these labels unless it specifically describes the fine details of the regimen. Review articles are generally discouraged unless they add significant further information to the primary references for treatment regimens. Meta-analyses and comparative effectiveness research articles could be added.

===References===
# Authors of reference 1. Title of reference 1. Journal, volume, page of reference 1. [http://journal.com/link_to_article.html link to original article] '''contains verified protocol''' [https://pubmed.ncbi.nlm.nih.gov/10000000 PubMed]
## '''Update:''' Authors of update 1. Title of update 1. Journal, volume, page of update 1. [http://journal.com/link_to_article.html link to original article] [https://pubmed.ncbi.nlm.nih.gov/10000000 PubMed]
# Authors of reference 2. Title of reference 2. Journal, volume, page of reference 2. [http://journal.com/link_to_article.html link to original article] '''contains protocol''' [https://pubmed.ncbi.nlm.nih.gov/10000000 PubMed]
# Authors of reference 3. Title of reference 3. Journal, volume, page of reference 3. [http://journal.com/link_to_article.html link to original article] '''does not contain protocol''' [https://pubmed.ncbi.nlm.nih.gov/10000000 PubMed]

Units of measurement

We are currently trying to unify our units of measurement, to be concordant with SI units (unless otherwise noted below, e.g., hemoglobin). Further details about conversions between conventional and SI units, here.

Measure	Example(s)	Wiki code
Separators for large numbers	1000 10,000 10,000,000
BSA-based dosing	mg/m²	`mg/m<sup>2</sup>`
Micrograms	mcg
Ranges: don't use dashes	1 to 2
Bounds: don't use symbols	greater than greater than or equal to less than less than or equal to
Platelet count	25 x 10⁹/L	`25 x 10<sup>9</sup>/L`
Hemoglobin (Hb)	12 g/dL
Absolute neutrophil count (ANC)	500/uL
White blood cell (WBC) count	3.5 x 10⁹/L	`3.5 x 10<sup>9</sup>/L`
Creatinine	0.8 mg/dL
Creatinine clearance (CrCl)	90 mL/min/1.73m²	`90 mL/min/1.73m<sup>2</sup>`
Bilirubin	1.4 mg/dL
Methotrexate level	100 nmol/L

Style guide

Introduction

Drug index

Alphabetical list of medications

Examples

Drugs in preclinical or early phase clinical trials

Drugs that have lost FDA approval

List of medications by category

Interesting and helpful links

Medication pages

General information

Diseases for which it is used

Patient drug information

History of changes in FDA indication

Synonyms

References

Categories

Treatment regimen pages

Header

Guidelines

Treatment context

Regimen name and header

Example orders

Regimen variants

Treatment regimen formatting

Instructions

Treatment formatting

Drug name

Dose

Units

Route

Time of infusion

Frequency and/or number of times given

Schedule

Order of administration

Special comments

Order of medications within a regimen

Optional: preceding and subsequent treatments

Optional: supportive medications

Optional: CNS therapy

Duration of cycle

Linking portions of protocols

Preceding treatments

Subsequent treatments

Templates

Non-randomized trials without efficacy

Non-randomized trials with efficacy

Randomized trials without toxicity

Randomized trials with toxicity

Examples

Regimen example #1, single drug

Regimen example #2, single drug with many references

Regimen example #3, two drugs with sequencing

Regimen example #4, supportive medications with optionality and explicit linking

Regimen example #5, preceding and subsequent regimens

References

Primary references

Numbering

Header

Author list

Study group

Article title

Journal title

Publication date and pages

Link to original article

Link to PMC article

Link to PubMed

Clinical trial ID

Updates and sub-group analyses

Numbering

Header

Remainder of citation

Review status

Units of measurement

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