Style guide

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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.

Contents

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 In fact, parts of this style guide are/will be outdated, although we do our best to keep the recommendations here concordant with our current best practice.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

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 drug index 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>[[Media: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, intranasal, 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/>

Categories

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We use semantic Mediawiki tags to categorize drugs by several axes; this information feeds the drug categorization tree as well as the HemOnc.org ontology. All drugs should be categorized at a minimum to the top level Drug index category. Ideally, they should also be categorized by route(s) of administration, mechanism(s) of action, target protein(s) if a small molecule inhibitor or monoclonal antibody, disease(s) for which they are used, and approval status. Below is a non-exhaustive list of some of the category tags that may be helpful.

[[Category:Drug index]]

[[Category:Intramuscular medications]]
[[Category:Intrathecal medications]]
[[Category:Intravenous medications]]
[[Category:Intravesicular chemotherapy]]
[[Category:Oral medications]]
[[Category:Subcutaneous medications]]

[[Category:Neutral chemotherapy]]
[[Category:Irritant chemotherapy]]
[[Category:Vesicant chemotherapy]]

[[Category:Investigational]]
[[Category:Orphan drug]]
[[Category:Discontinued]]
[[Category:Drugs FDA approved in yyyy]]

[[Category:Kinase inhibitors]]
[[Category:Aurora kinase inhibitors]]
[[Category:AKT1 inhibitors]]
[[Category:ALK inhibitors]]
[[Category:Bcr-Abl inhibitors]]
[[Category:BRAF inhibitors]]
[[Category:BTK inhibitors]]
[[Category:CDK9 inhibitors]]
[[Category:EGFR inhibitors]]
[[Category:FGFR inhibitors]]
[[Category:FLT3 inhibitors]]
[[Category:HDAC inhibitors]]
[[Category:IGF inhibitors]]
[[Category:JAK inhibitors]]
[[Category:KIT inhibitors]]
[[Category:LYN inhibitors]]
[[Category:MEK inhibitors]]
[[Category:MET inhibitors]]
[[Category:mTOR inhibitors]]
[[Category:PDGFR inhibitors]]
[[Category:PIK3CA inhibitors]]
[[Category:PLK1 inhibitors]]
[[Category:RET inhibitors]]
[[Category:ROS1 inhibitors]]
[[Category:SRC inhibitors]]
[[Category:SYK inhibitors]]
[[Category:TEK inhibitors]]
[[Category:VEGFR inhibitors]]

[[Category:Hedgehog pathway inhibitors]]
[[Category:SMO inhibitors]]

[[Category:Chemotherapy]]
[[Category:Alkylating agents]]
[[Category:Anthracyclines]]
[[Category:DNA synthesis inhibitors]]
[[Category:Enzymes]]
[[Category:Nitrogen mustards]]
[[Category:Nitrosoureas]]
[[Category:Nucleic acid analogs]]
[[Category:Platinum agents]]
[[Category:Proteasome inhibitors]]
[[Category:Taxanes]]
[[Category:Microtubule inhibitors]]
[[Category:Topoisomerase inhibitors]]
[[Category:Vinca alkaloids]]

[[Category:Antimetabolites]]
[[Category:Antifolates]]
[[Category:Purine analogues]]
[[Category:Pyrimidine analogues]]

[[Category:Endocrine therapy]]
[[Category:Antiandrogens]]
[[Category:Androgen receptor inhibitors]]
[[Category:5 alpha-reductase inhibitors]]
[[Category:GnRH agonists]]
[[Category:GnRH antagonists]]
[[Category:Aromatase inhibitors]]
[[Category:Estrogen receptor inhibitors]]
[[Category:Selective estrogen receptor modulators]]
[[Category:Steroid synthesis inhibitors]]

[[Category:Immunotherapy]]
[[Category:Antibody medications]]
[[Category:Antibody-drug conjugates]]
[[Category:Anti-CD20 medications]]
[[Category:Anti-CD38 antibodies]]
[[Category:Anti-CTLA-4 medications]]
[[Category:Anti-HER2 medications]]
[[Category:Anti-PD-1 medications]]
[[Category:Cytokine therapy]]
[[Category:IL-6 inhibitors]]
[[Category:Calcineurin inhibitors]]
[[Category:Immunomodulatory drugs (IMiDs)]]
[[Category:Retinoids]]
[[Category:Steroids]]

[[Category:Bisphosphonates]]
[[Category:RANK ligand inhibitors]]
[[Category:Somatostatin analogs]]

[[Category:Antibacterials]]
[[Category:Antifungals]]
[[Category:Antivirals]]
[[Category:PCP prophylaxis]]

[[Category:Emesis prevention]]
[[Category:Neurokinin 1 (NK1) antagonists]]
[[Category:Serotonin 5-HT3 antagonists]]
[[Category:Chemotherapy protective agents]]

[[Category:Radioactive agents]]
[[Category:Alpha emitters]]

[[Category:Anticoagulants]]
[[Category:Antiplatelet agents]]
[[Category:Heparins]]
[[Category:Low molecular weight heparins]]
[[Category:Vitamin K antagonists]]
[[Category:Direct thrombin inhibitors]]
[[Category:Factor Xa inhibitors]]
[[Category:P2Y12 ADP inhibitors]]
[[Category:Vitamins]]
[[Category:Iron]]

[[Category:Hemostasis medications]]
[[Category:Coagulation factors]]
[[Category:Fibrinolysis inhibitors]]

[[Category:Vasopressin analogs]]
[[Category:Phosphodiesterase inhibitors]]
[[Category:Cyclooxygenase inhibitors]]
[[Category:Chelators]]

[[Category:Hematopoietic growth factors]]
[[Category:Erythrocyte growth factors]]
[[Category:Granulocyte growth factors]]
[[Category:Megakaryocyte growth factors]]

[[Category:Solid oncology medications]]
[[Category:Anal cancer medications]]
[[Category:Basal cell and squamous cell skin cancer medications]]
[[Category:Bladder cancer medications]]
[[Category:Bone sarcoma medications]] 
[[Category:Breast cancer medications]]
[[Category:Cancer of unknown primary medications]] 
[[Category:Central nervous system (CNS) cancer medications]]
[[Category:Cervical cancer medications]]
[[Category:Colon cancer medications]]
[[Category:Esophageal cancer medications]]
[[Category:Gastric cancer medications]]
[[Category:Head and neck cancer medications]]
[[Category:Hepatobiliary cancer medications]]
[[Category:Melanoma medications]] 
[[Category:Mesothelioma medications]]
[[Category:Non-small cell lung cancer medications]]
[[Category:Neuroendocrine tumor medications]]
[[Category:Ovarian cancer medications]]
[[Category:Pancreatic cancer medications]] 
[[Category:Penile cancer medications]] 
[[Category:Prostate cancer medications]]
[[Category:Rectal cancer medications]]
[[Category:Renal cancer medications]]
[[Category:Soft tissue sarcoma medications]] 
[[Category:Small cell lung cancer medications]]
[[Category:Testicular cancer medications]]
[[Category:Thymoma medications]]
[[Category:Thyroid cancer medications]]
[[Category:Uterine cancer medications]]

[[Category:Malignant hematology medications]]
[[Category:B-cell acute lymphoblastic leukemia medications]]
[[Category:Acute myeloid leukemia medications]]
[[Category:Acute promyelocytic leukemia medications]]
[[Category:Aggressive Non-Hodgkin lymphoma medications]]
[[Category:Castleman’s disease medications]]
[[Category:Chronic lymphocytic leukemia (CLL/SLL) medications]]
[[Category:Chronic myelogenous leukemia medications]]
[[Category:Chronic myelomonocytic leukemia medications]]
[[Category:CNS lymphoma medications]]
[[Category:Follicular lymphoma medications]]
[[Category:Hairy cell leukemia medications]]
[[Category:HIV-associated lymphoma medications]]
[[Category:Hodgkin lymphoma medications]]
[[Category:Hodgkin lymphoma, nodular lymphocyte-predominant medications]]
[[Category:Light-chain (AL) amyloidosis medications]]
[[Category:Mantle cell lymphoma medications]]
[[Category:Marginal zone lymphoma medications]]
[[Category:Mast cell diseases]]
[[Category:Multiple myeloma medications]]
[[Category:Myelodysplastic syndrome medications]]
[[Category:Myelofibrosis medications]]
[[Category:T-cell lymphoma medications]]
[[Category:Waldenström macroglobulinemia medications]]

[[Category:Aplastic anemia medications]]
[[Category:Essential thrombocythemia medications]]
[[Category:Immune thrombocytopenic purpura (ITP) medications]]
[[Category:Paroxysmal nocturnal hemoglobinuria (PNH) medications]]
[[Category:Polycythemia vera medications]]

[[Category:Transplant medications]]

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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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

For regimens with 2 or more drugs that are only identified by the drugs used, e.g. Carboplatin & Docetaxel, only use the generic names. For regimens that have known acronyms, by submitter's discretion, one may 1) include the generic names as the regimen name; for example: Carboplatin, Etoposide, Ifosfamide or 2) use the acronym as the regimen name; for example: ICE. Our goal is to have a single name used consistently across all disease pages for a single regimen.

Regimens should be listed in alphabetical order within a disease context. When there is more than one acronym in the literature, please use your judgment to pick the best one to alphabetize by (e.g. ICE-R versus R-ICE), and include the others below the heading, as in this example below. 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:1 |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]]

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.

===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'''

===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, use standard terms. Some acceptable frequencies to use are:
    • once per day
    • once per week
    • once
    • BID
    • TID
    • every 4 hours
    • q4h, q6h, q8h, q12h
    • 3 times a day
  • 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")
  • 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 drugs, use given first and given last (not "given second")
  • For regimens with three drugs, use given first, given second, and given last (not "given third")
  • If there is a specified time separation, mention in both sequences (e.g., given first, 30 minutes prior to drug Y and given last, 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)
    • BID on days 1 to 14 (28 doses per cycle)
    • three times per week (number of doses varies with length of cycle)
    • once per week on weeks 1, 3, 5, 7 (4 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").
  • For cycles lasting more than 6 weeks, report the numeric duration in weeks (e.g., "3-month cycle")
    • Exception: the primary reference specifies the cycle in days which are not easily transformed to weeks, e.g., "90-day cycles"
    • If the total duration of a regimen is very long, as with some maintenance regimens, it is acceptable to report the total duration of treatment, as opposed to the actual number of 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 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 below this line.
  • When the reference explicitly identifies a number or range of cycles, this should be reported (spelling out "to" instead of using a dash, so as to avoid confusion).
  • 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 or course are often used in the literature) we encourage the consistent use of the word cycle.
    • Exception: if there is only one course of treatment, as in a course of chemoradiotherapy, 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: 100%; text-align:center;" 
!Study
![[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: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
![[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" style="width: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
!Comparator
![[Levels_of_Evidence#Efficacy|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 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" style="width: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
!Comparator
![[Levels_of_Evidence#Efficacy|Efficacy]]
![[Levels_of_Evidence#Toxicity|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 Efficacy Toxicity
yyyy et al. 20zz Phase III Display name of other regimen Seems not superior Seems not superior

Examples

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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: 100%; text-align:center;" 
!Study
![[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" style="width: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
!Comparator
![[Levels_of_Evidence#Efficacy|Efficacy]]
|-
|[http://jco.ascopubs.org/content/26/30/4952.long Wiernik et al. 2008 (NHL-002)]
|style="background-color:#ffffbe"|Phase II, <20 pts in subgroup
|style="background-color:#d3d3d3"|
|style="background-color:#d3d3d3"|
|-
|[http://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"|
|-
|[http://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"|
|-
|[http://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 {{#subobject:65ad86|Regimen=1}}==
{| class="wikitable" style="float:right; margin-left: 5px;"
|-
|[[#top|back to top]]
|}
===Regimen {{#subobject:dd8477|Variant=1}}===
{| class="wikitable" style="width: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
!Comparator
![[Levels_of_Evidence#Efficacy|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|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" style="width: 100%; text-align:center;" 
!Study
![[Levels_of_Evidence#Evidence|Evidence]]
!Comparator
![[Levels_of_Evidence#Efficacy|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|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 BID the day before, the day of, and day after [[Docetaxel (Taxotere)]]
*ONE of the following 5-HT3 antagonists:
**[[Ondansetron (Zofran)]] 8 mg
**[[Granisetron (Kytril)]] 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.

===Variant #2, with range {{#subobject:67eda7|Variant=1}}===
{| class="wikitable" style="width: 100%; text-align:center;" 
!Study
![[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.

Format

We use the format that is used by PubMed under the Summary (text), with the exception that we remove doi: as these are visually distracting. For example, see this link. We also add special labels for several article types:

  • Phase I: as the label implies, this is a phase I report, usually with small numbers of patients
  • Retrospective: self-explanatory
  • Review: self-explanatory
  • Abstract: these are references that are only available in the gray literature, e.g., conference abstracts. Links often break from year-to-year as the conference websites refresh/update.

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. We also nest several other categories under the original reference:

  • Update: as described above
  • 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

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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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://www.ncbi.nlm.nih.gov/pubmed/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