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CISPLATIN ETOPOSIDE BLEOMYCIN PEB Day Chemotherapy CISPLATIN

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CISPLATIN ETOPOSIDE BLEOMYCIN PEB Day Chemotherapy CISPLATIN Powered By Docstoc
					GU-CEB - 3 DAYS         Eligibility Form Required¨ Grey STR
                      01/28/2010 CCO                        CLINICAL MONITORING:
CISPLATIN-ETOPOSIDE-BLEOMYCIN (PEB) 3 Day Chemotherapy - Oral examination upon patient complaint of a sore mouth.
                                                                                 - Clinical pulmonary exam at each visit, including auscultation, pulmonary
Testicular Cancer
                                                                                 toxicity ratings (Cough, SOB).
CISPLATIN                                                                        Sensory
50mg/m2            IV     Days 1-2               Round to nearest 1mg            1. Asymptomatic; loss of deep tendon reflexes or paresthesia (including            Hepatic
- Mix in 500mL bag Normal Saline; Infuse over 60 minutes.                        tingling) but not interfering with function 2. Sensory alteration or paresthesia   1. If T.Bili
ETOPOSIDE                                                                        (including tingling), interfering with function, but not interfering with ADL 3.   dose.
165mg/m2              IV      Days 1-3            Round to nearest 10mg                                                                                 g
                                                                                 Sensory alteration or paresthesia interfering with ADL 4. Disablin 5. Death        2. If T.Bili
- Dose < or =200mg, mix in 500mL Normal Saline; Infuse over 30-60                Hearing                                                                            3. If T.Bili
minutes.                                                                         1. Asymptomatic, detected on exam/testing only 2. Symptomatic, not                 SUGGES
- Dose > 200mg, mix in 1000mL Normal Saline; Infuse over 1 to 2 hours.           interfering with ADL
- Use Non-PVC equipment and filter.                                              3. Symptomatic, interfering with ADL 4. Life-threatening; disabling 5.
- Adjust rate if blood pressure drops.                                           Death
- Give Etoposide BEFORE Cisplatin, to hydrate patient.                           Dyspnea
                                                                                 1. Dyspnea on exertion, but can walk 1 flight of stairs without stopping 2.
BLEOMYCIN                                                                        Dyspnea on exertion but unable to walk 1 flight of stairs or 1 city block
30units            IV        Days 1, 8 &15         Round to nearest unit         (0.1km) without stopping 3. Dyspnea with ADL 4.Dyspnea at rest;
- Slow push through sidearm of free flowing IV over 10 minutes.                  intubation/ventilator indicated 5. Death
- May be given by direct IV push, followed by a Normal Saline flush.             Cough
ACETAMINOPHEN                                                                    1. Symptomatic, non-narcotic medication only indicated 2. Symptomatic and
650mg               PO      Days 1, 8 &15 325mg tablet                           narcotic medication
- Administer before Bleomycin dose.                                              indicated 3. Symptomatic and significantly interfering with sleep or ADL
           REPEAT EVERY 21 DAYS For a Total of 3-4 Cycles                        RATED AT EACH CLINIC VISIT
PATIENT VISITS and APPOINTMENT TYPE:                                             TOXICITIES:
è Days 1-2                5hrs                     Type C                        Hematologic
è Day 3                   2hrs                     Type B                        1. If ANC < 1.5 x 109/L, or if PLT < 75 x 109/L, HOLD dose for 1 week.
è Days 8 & 15             30min                    Type A                        For Day 8 and Day 15 (Bleomycin days only)
HYDRATION:                                                                       2. If PLT < 50 x 109/L, contact MD.
 Pre:                                                                            3. If Grade 2 or greater respiratory toxicities (cough, dyspnea, wheezing),
- Infuse 1000mL Normal Saline with 20mEq Potassium Chloride IV over 1            contact MD.
hour on Days 1-2.                                                                4. If Grade 3 or greater for any other non-hematological concerns, contact MD.
Concurrent:                                                                      Renal Failure
- Physician may order 250mL of 20% Mannitol solution (50G Mannitol) IV.          1. If CrCl = 0.5-1.0mL/sec, or SrCr = 136-185umol/L, REDUCE Cisplatin to
Infuse through sidearm concurrent with Cisplatin (may give Furosemide            50% dose, and Bleomycin & Etoposide to 75% dose.
40mg IV/PO instead of Mannitol).                                                 2. If CrCl < 0.5mL/sec, or SrCr > 185umol/L, OMIT Cisplatin dose.
                                                                                 3. If CrCl < 0.2mL/sec, REDUCE Bleomycin and Etoposide to 50% dose.
Post:                                                                            Hepatic Dysfunction
- Infuse 500mL Normal Saline with 10mEq Potassium Chloride IV (2G                1. If T.Bili = 26-51umol/L, or AST = 60-180 IU/L, REDUCE Etoposide to 25%
Magnesium Sulfate may also be ordered) over 1 hour after Cisplatin on Days       dose.
1-2.                                                                             2. If T.Bili = 52-85umol/L, REDUCE Etoposide to 50% dose.
TESTS:                                                                           3. If T.Bili > 85umol/L, or AST > 180 IU/L, OMIT Etoposide dose.
Baseline Tests - WBC HB PLT ANC K Na Chloride Mg Glucose                         SUGGESTED ACTION
                      Cr Urea AST ALT AlkPhosphatase
                                                                                 FORMULAE:
Day 1              - WBC HB PLT ANC Cr Urea
                                                                                 CrCl - Cockcroft & Gault (mL/sec)
Days 8 & 15        - WBC HB PLT ANC                                              Male: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)]
Test Notes:                                                                      CrCl - Cockcroft & Gault (mL/sec)
- Baseline & routine renal function tests, especially if there are other         Female: [140-age(yrs)] x TBW(Kg) / [50 x SCr(umol/L)] x 0.85
concurrent nephrotoxic drugs.
                                                                                 Creatinine Cl (mL/min)
ANTIEMETIC PRE-CHEMO REGIMEN:                                                    mL/min = 60 x CrCl mL/sec
 Level C         - Days 1-2
 - Ondansetron 8mg PO/IV or Granisetron 1mg PO/IV
 - Dexamethasone 20mg PO/IV
 Level B         - Day 3
 - Dexamethasone 8-10mg PO/IV, may add Ondansetron 8mg PO/IV or
TOXICITIES: PO/IV.
 Granisetron 1mg
 - May add or
Hematologicsubstitute Prochlorperazine 10mg/PO/IV prn.
                   109/L, & 15
1. If ANC < 1.5 -x Days 8or if PLT < 75 x 109/L, HOLD dose for 1 week.
 Level A
 - Prochlorperazine 10mg PO prn
For Day 8 and Day 15 (Bleomycin days only)
2. If PLT < 50 x 109/L, contact MD.
 ANTIEMETIC TAKE-HOME REGIMEN:
3. If Grade 2 or greater respiratory toxicities (cough, dyspnea, wheezing),
 Level B/C - Day 3
contact MD.
 - Ondansetron 8mg PO BID for 2-3 days, or Granisetron 1mg PO 12 hours
4. If Grade 3 or greater for any other non-hematological concerns, contact MD.
 post chemotherapy, then 2mg PO OD for 2-3 days
Renal Failure
 - Dexamethasone 8mg PO BID for 2-3 days
 - If CrCl = 0.5-1.0mL/sec, or q4-6h 136-185umol/L, REDUCE Cisplatin to
1. Prochlorperazine10 mg POSrCr = prn
50% dose, and Bleomycin & Etoposide to 75% dose.
 Level A         - Days 8 & 15
2. Prochlorperazine 10mg SrCrq4-6h prn           OMIT Cisplatin dose.
 - If CrCl < 0.5mL/sec, or PO > 185umol/L,
3. If CrCl < 0.2mL/sec, REDUCE Bleomycin and Etoposide to 50% dose.

				
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