Example orders for Docetaxel (Taxotere) in non-small cell lung cancer

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.

Docetaxel (Taxotere)

Original references may be found at Docetaxel (Taxotere)

Example regimen #1

• Docetaxel (Taxotere) 75 mg/m² IV on day 1
  • Administer over 30-60 minutes. Use non-DEHP tubing/paclitaxel tubing.

21-day cycles

Supportive therapy

• Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
• Dexamethasone (Decadron) 8 mg PO twice per day the day before, day of, and day after chemotherapy

Hydration:

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, carcinoembryonic antigen
• 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 every 3+ cycles depending on symptoms

Outpatient medications:

• Dexamethasone (Decadron) as described above
• Lorazepam (Ativan) 0.5 mg PO every 6 hours prn anxiety, insomnia, nausea
• Ondansetron (Zofran) 4 mg PO every 6 hours prn nausea

Clinical scenario & comments:

• 60 year-old lady with stage IV adenocarcinoma of the lung, s/p treatment with first-line therapy for metastatic disease with Carboplatin (Paraplatin) & Pemetrexed (Alimta), with good response. Progressed after maintenance therapy with Pemetrexed (Alimta).

Example regimen #2 - dose reduction & neulasta for pancytopenia

• Docetaxel (Taxotere) 60 mg/m² IV on day 1
  • Administer over 30-60 minutes. Use non-DEHP tubing/paclitaxel tubing.

21-day cycles

Supportive therapy

• Pegfilgrastim (Neulasta) 6 mg SC x1 on day 2, 24 hours after completion of day 1 chemotherapy
• Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea
• Dexamethasone (Decadron) 8 mg PO twice per day the day before, day of, and day after chemotherapy

Hydration:

• 500 ml NS at KVO rate. Use as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, carcinoembryonic antigen
• Once on day 10-14, check nadir CBC with differential, absolute neutrophil count (ANC). Transfuse RBCs as needed.
• Assess for response with CT scan every 3+ cycles depending on symptoms

Outpatient medications:

• Dexamethasone (Decadron) as described above
• Lorazepam (Ativan) 0.5 mg PO every 6 hours prn anxiety, insomnia, nausea
• Ondansetron (Zofran) 4 mg PO every 6 hours prn nausea

Clinical scenario & comments:

• 72 year-old lady with stage IV adenocarcinoma of the lung with bony metastases and history of pathologic fracture, s/p treatment with first-line therapy for metastatic disease with Carboplatin (Paraplatin) & Pemetrexed (Alimta), who initially responded but them progressed on CT imaging after cycle 5 of therapy. Cycle 1 of therapy was given as above in example #1, but due to significant neutropenia, anemia, and thrombocytopenia (50-60) at nadir blood count, Docetaxel (Taxotere) was dose reduced as above, and Pegfilgrastim (Neulasta) added. In later cycles, neutropenia was not an issue, RBC transfusion need was minimal, and platelet counts were adequate for treatment.