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VINCRISTINE DOXORUBICIN CYCLOPHOSPHAMIDE

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VINCRISTINE DOXORUBICIN CYCLOPHOSPHAMIDE Powered By Docstoc
					SA-VDC               08/29/2008 CCO   Eligibility Form Required              CLINICAL MONITORING:
VINCRISTINE-DOXORUBICIN-CYCLOPHOSPHAMIDE                                      - Urinalysis (RBCs) periodic and in response to patient complaint.
                                                                              - Clinical exam for symptoms of CHF.
Chemotherapy
                                                                              - Periodic cardiac tests for all patients with cardiac risk factors or patients at
Ewing`s Sarcoma / Peripheral Neuroectodermal Tumour (PNET) / Small
                                                                              or above the threshold dose levels (Doxorubicin 450mg/m2).
Round Blue Cell Tumour - adjuvant/palliative                                  Cardiac
VINCRISTINE                                                                   0. None 1. None 2. Asymptomatic, resting ejection fraction decline by >
1.5mg/m2           IV     Day 1                  Round to nearest 0.1mg       10% baseline; or abnormal cardiac function test (LVEF > 50 ) with no
- Mix in 50mL bag Normal Saline; infuse over 10 minutes.                      baseline for comparison 3. Mild Congestive Heart Failure, responds to
- Maximum dose = 2mg                                                          therapy 4. Severe/Refractory Congestive Heart Failure
DOXORUBICIN                                                                                          At cumulative dose threshold and subsequent
75mg/m2           IV      Day 1                 Round to nearest 1mg          intervals
- Slow push through sidearm of free flowing IV; Give 2 to 4mg (1-2mL)         For Cardiac Toxicity Ratings:
per minute.                                                                   First rating at the cumulative dose threshold of 450mg/m2, and repeat
CYCLOPHOSPHAMIDE                                                              ratings at each cumulative dose increment of 100mg/m2 above threshold.
1200mg/m2          IV     Day 1                  Round to nearest 10 mg       (Cumulative dose sooner for high risk patients, eg. pre-existing cardiac
- Mix in 500mL bag Normal Saline. Infuse over 1 hour.                         disease, prior chest irradiation).
                    REPEAT CYCLE EVERY 21 DAYS                                - Note: Threshold Cumulative dose reduced proportionately if other
                                                                              anthracycline or anthracenedione drugs have been given; cardiotoxicity is
PATIENT VISITS and APPOINTMENT TYPE:                                          additive.
 Day 1                  3 hours                  Type D                      Sensory
HYDRATION:                                                                    1. Asymptomatic; loss of deep tendon reflexes or paresthesia (including
 Pre:                                                                         tingling) but not interfering with function 2. Sensory alteration or paresthesia
- Infuse 500mL Normal Saline IV over 1 hour.                                  (including tingling), interfering with function, but not interfering with ADL 3.
TESTS:                                                                        Sensory alteration or paresthesia interfering with ADL 4. Disabling 5. Death
                                                                              Constipation
Baseline Tests - WBC HB PLT ANC Ca K Na Chloride Glucose                      1. Occasional or intermittent symptoms; occasional use of stool softeners,
                     Cr Urea T.Bili Albumin AST ALT GGT                       laxatives, dietary modification, or enema 2. Persistent symptoms with
                     AlkPhosphatase LVEF                                      regular use of laxatives or enemas indicated 3. Symptoms interfering with
Day 1              - WBC HB PLT ANC                                           ADL; obstipation with manual evacuation indicated 4. Life-threatening
Test Notes:                                                                   consequences (e.g., obstruction, toxic megacolon) 5. Death
- Additional Baseline tests: LDH , CO2 & LVEF(ordered only on specific        RATED AT EACH CLINIC VISIT
patients).                                                                    ANTIEMETIC PRE-CHEMO REGIMEN:
- Chemistry repeated if baseline abnormal.
                                                                              Level C       - Days 1
- Consider monitoring LFT after 3 cycles.
                                                                              - Ondansetron 8mg PO/IV or Granisetron 1mg PO/IV
TOXICITIES:                                                                   - Dexamethasone 20mg PO/IV
Hematologic                                                                   ANTIEMETIC TAKE-HOME REGIMEN:
1. If ANC < 1.5 x 109/L ,or PLT< 100 x 109/L, HOLD dose for 1 week (Until     Level B/C      - Day 1
AGC > 1.5 x 109/L).                                                           - Ondansetron 8mg PO BID for 2-3 days, or
Hepatic Dysfunction                                                             Granisetron 1mg PO 12 hours post chemotherapy, then 2mg PO OD for 2-3
1. If T.Bili = 26-51umol/L, or AST = 60-180 IU/L, REDUCE Vincristine to 50%   days
dose and Doxorubicin to 75% dose.                                             - Dexamethasone 8mg PO BID for 2-3 days
2. If T.Bili = 52-85umol/L, or AST > 180 IU/L, REDUCE Vincristine to 25%      - Prochlorperazine 10mg PO q4-6h prn
dose, Doxorubicin to 50% dose and Cyclophosphamide to 75% dose.               Notes:
3. If T.Bili > 85 umol/L, OMIT all drugs.                                     - Oral hydration is strongly encouraged; poorly hydrated patients may need
Renal Failure                                                                 more IV hydration (to prevent renal toxicity).
1. If SrCr > 265umol/L, REDUCE Doxorubicin to 50% dose.
2. If CrCl < 0.2mL/sec, OMIT Cyclophosphamide dose.
Neurologic
1. If Neurotoxicity > Grade 2, HOLD Vincristine dose for 1 week or until
resolved.
2. If severe paresthesia or foot drop, REDUCE Vincristine to 50% dose.
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