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Cap Protocol

The BC Cancer Protocol LUOTPAC outlines treatment for unresected thymoma or thymic carcinoma using DOXOrubicin, CISplatin, and Cyclophosphamide, with specific eligibility criteria and exclusion factors. The treatment involves administering the drugs in a specified dosage every 21 days for 6 to 8 cycles, with guidelines for dose modifications based on hematologic, hepatic, and renal function. Precautions regarding potential toxicities and the importance of independent medical judgment are emphasized throughout the protocol.

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Cap Protocol

The BC Cancer Protocol LUOTPAC outlines treatment for unresected thymoma or thymic carcinoma using DOXOrubicin, CISplatin, and Cyclophosphamide, with specific eligibility criteria and exclusion factors. The treatment involves administering the drugs in a specified dosage every 21 days for 6 to 8 cycles, with guidelines for dose modifications based on hematologic, hepatic, and renal function. Precautions regarding potential toxicities and the importance of independent medical judgment are emphasized throughout the protocol.

Uploaded by

dareen.osman.egy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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BC Cancer Protocol Summary for Treatment of Thymoma with

Platinum, DOXOrubicin, and Cyclophosphamide


Protocol Code: LUOTPAC

Tumour Group: Lung

Contact Physician: Dr. Barb Melosky

ELIGIBILITY:
• Unresected thymoma or thymic carcinoma, histologically-proven, limited stage or
metastatic. Adjuvant and neoadjuvant treatment may be considered in some cases.
• Adequate hematologic, hepatic, and renal function:
o WBC greater than 4 x 109/L
o platelets greater than or equal to 125 x 109/L
o bilirubin less than or equal to 36 micromol/L
o calculated creatinine clearance greater than 60 mL/min
• ECOG performance status 0, 1 or 2.
• Protocol NOT to be delivered with concurrent radiotherapy.

EXCLUSIONS:
• History of congestive heart failure

TESTS:
• Baseline: CBC & differential, platelets, creatinine, bilirubin
• Before each treatment: CBC & differential, platelets, creatinine
• If clinically indicated: bilirubin

PREMEDICATIONS:
Antiemetic protocol for highly emetogenic chemotherapy (see protocol SCNAUSEA).

TREATMENT:

Drug Dose BC Cancer Administration Guideline

DOXOrubicin 50 mg/m2 IV push (may be given during prehydration)


Prehydrate with NS 1000 mL over 1 hour, then
CISplatin IV in NS 500 mL with potassium
CISplatin 50 mg/m2
chloride 20 mEq, magnesium sulfate 1 g,
mannitol 30 g over 1 hour
IV in NS 100 to 250* mL over 20 min to 1 hour
Cyclophosphamide 500 mg/m2
(*use 250 mL for doses greater than 1000 mg)
• Repeat every 21 days x 6 to 8 cycles.

BC Cancer Protocol Summary LUOTPAC Page 1 of 3


Activated: 1 Apr 2009 Revised: 1 Sept 2019 (institutional name, tests clarified)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any
clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or
treatment. Use of these documents is at your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use
DOSE MODIFICATIONS:

1. HEMATOLOGY
For cyclophosphamide and DOXOrubicin:
ANC (x 109/L) Platelets (x 109/L) Cyclophosphamide and
DOXOrubicin Dose
greater than or equal to 1.5 and greater than or equal to 100 100%

1.0 to less than 1.5 or 75 to less than 100 50%

less than 1.0 or less than 75 Delay

2. HEPATIC DYSFUNCTION
For DOXOrubicin:
Bilirubin (micromol/L) DOXOrubicin Dose

25 to 36 50%

greater than 36 Delay

3. RENAL DYSFUNCTION
For CISplatin:
Calculated Creatinine CISplatin dose
Clearance (mL/min)
greater than or equal to 60 100%

45 to less than 60 75% (same prehydration as full dose)

less than 45 hold CISplatin or delay with additional IV fluids

For cyclophosphamide:
Calculated Creatinine Cyclophosphamide dose
Clearance (mL/min)
greater than or equal to 10 100%

less than 10 75%

BC Cancer Protocol Summary LUOTPAC Page 2 of 3


Activated: 1 Apr 2009 Revised: 1 Sept 2019 (institutional name, tests clarified)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any
clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or
treatment. Use of these documents is at your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use
PRECAUTIONS:
1. Extravasation: DOXOrubicin can cause pain and tissue necrosis if extravasated.
Refer to BC Cancer Extravasation Guidelines.
2. Neutropenia: Fever or other evidence of infection must be assessed promptly and
treated aggressively.
3. Renal Toxicity: Nephrotoxicity is common with CISplatin. Encourage oral hydration.
Avoid nephrotoxic drugs such as aminoglycoside antibiotics. Use caution with pre-
existing renal dysfunction.
4. Cardiac Toxicity: DOXOrubicin is cardiotoxic and must be used with caution, if at
all, in patients with severe hypertension or cardiac dysfunction. Cardiac assessment
recommended if lifelong dose of 450 mg/m2 to be exceeded. Refer to the BC Cancer
Drug Manual for more information.
5. Neuropathy: Dose modification or discontinuation may be required. Refer to the BC
Cancer Drug Manual for more information.

Call Dr. Barb Melosky or tumour group delegate at (604) 877-6000 or 1-800-663-
3333 with any problems or questions regarding this treatment program.

REFERENCES:
1. Loehrer PJ, Sr., Chen M, Kim K, et al. Cisplatin, doxorubicin, and cyclophosphamide
plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup
trial. J Clin Oncol 1997;15(9):3093-9.

2. Loehrer PJ, Sr., Kim K, Aisner SC, et al. Cisplatin plus doxorubicin plus
cyclophosphamide in metastatic or recurrent thymoma: final results of an intergroup trial.
The Eastern Cooperative Oncology Group, Southwest Oncology Group, and
Southeastern Cancer Study Group. J Clin Oncol 1994;12(6):1164-8.

BC Cancer Protocol Summary LUOTPAC Page 3 of 3


Activated: 1 Apr 2009 Revised: 1 Sept 2019 (institutional name, tests clarified)
Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any
clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or
treatment. Use of these documents is at your own risk and is subject to BC Cancer's terms of use available at www.bccancer.bc.ca/terms-of-use

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