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Chemotherapy regimens |
HODGKINS DISEASE
List of abbreviations
ChlVPP = Chlorambucil, Vinbl, Procarb, Pred
LOPP = Chlorambucil, Vct, Procarbazine
PA(BL)OE = Pred, Adria, Bleo, Etoposide.
ChlVPP/PA(BL)OE = Cloram, Vinbst, Procarb, Pred, Adria, Bleo, Etop.
VAPEC-B = Vct, Adria, Pred, Etop, Cyclo, Bleomycin.
ABVD = Adria, Bleo, Vinc, DTIC
MBE = Melph, BCNU, Etop + ABMT
BEAM = BCNU, Etoposide, Araa-c, Melphalan + ABMT
MiniBEAM = BCNU, Etoposide, Araa-c, Melphalan
ECP = Etop, Cisplat, Pred
HDMP = High dose methylprednisolone
CEP = CCNU, Etoposide, Chlorambucil, Prednisolone.
Summary of protocols
Chlorambucil 6mg/msq/d (max 10mg) O 10 days
Procarbaxine 100mg/msq/d O 10 days
Vincristine 1.4mg/msq(max 2mg) iv Days 1 & 8
Prednisolone 40 mg/m2 O 14 days
Adriamycin 25mg/msq iv Day 1, 15
Bleomycin 10mg/ iv Day 1, 15
Vinblastine 6mg/(max 10mg) iv Day 1, 15
DTIC 375mg/ iv Day 1, 15
Vincristine 1.4mg/msq (max 2 mg) iv day 1 and day 8
Epirubincin 50mg/msq iv day 1
Etoposide 200mg/msq PO daily for 4 days or 100mg/msq iv daily for 4 days
Prednisolone 100mg PO daily for 8 days
Drug Modification for VEEP Severe neuropathy (WHO) grade 2 indicates replacement of VINCRISTINE by VINBLASTINE 6mg/msq (max 10mg) iv day 1 and day 8. Increase ETOPOSIDE to 5 days if on all of days 8-10-15 WBC > 1.5 X 10/L and PLT > 100 X 10/L. Decrease ETOPOSIDE to 3 days if on any of days 8-10-15 WBC< 1.0 X 10/L or PLT < 50 X 10/L.
Prednisolone 50mg/day Oral daily for 4 wks then tailed to zero over sub 10 wks
Ketoconazale 200mg bd Oral daily for 6 weeks
Co-trimoxazole 960mg bd Oral thrice weekly for 6 weeks
Cyclophos 350 mg/m2 IV Week 1 only
Adriamycin 35 mg/m2 IV Week 1 and 3
Vincristine 1.4 mg/m2 IV Week 2 and 4
Bleomycin 10 mg/m2 IV Week 2 and 4
Etoposide 100 mg/m2 Oral daily for 5 days at week 3 only.
Dose reductions - Granulocyte count < 1 x 109/l and or platelet count < 100 x 109/l. Delay one week then restart at full dose. Dose reduction by 25% should only be employed after CTC grade 3 (severe) or life threatening infection
Etoposide 50 mg/msq/d* O d 1-10
Cisplatin 60mg/msq i.v. over 4h d 1
Prednisolone 100 mg/d O d 1-5
Chlorambucil 6mg/msq/d (max10mg) O 14 days
Procarbazine 100mg/msq/d (max 200mg) O 14 days
Vinblastine 6mg/msq (max10mg) iv Days 1 & 8
Prednisolone 40 mg/m2/d O 14 days
Adriamycin 40 mg/m2 iv d1
Vct 1.4 mg/m2 iv d1+8
Pred 40 mg/m2 (max 60mg) O d1-10
Etoposide 200 mg/m2 O d1-3*
Bleomycin 10 mg/m2 iv d1+8 (Ist 4 courses)
* If nadir (day 10-14) wbc <1.0 x 109/l decrease etoposide to 2 days. If nadir wbc > 1.5 x 109/l increase etoposide to 4 days.
Start with ChlVPP (wk 1 +2) then a 2 weeks gap before PABLOE (wk 5 +6). Then leave only a weeks gap between the last day of PABLOE and the next ChlVPP (of the next cycle). A minimum of 6 courses are required (3 ChLVPP and 3 PABLOE ) and at least 2 after complete remission. Remember to modify the next PABLOE dose depending on the nadir count in weeek 7. Summary:-
Regimen Chlvpp Nil PABLOE Nil ET seq
Chlvpp
Week 1 & 2 3 & 4 5 & 6 7 ........ 8
CCNU 80 mg/m2 oral on day 1 only q 6weeks
Etoposide 100 mg/m2 oral per day for 5 days q 3 weeks
Chlorambucil 5mg/m2 oral per day for 5 days q 3 weeks
Prednisolone 40 mg/m2 oral per day for 5days q 3 weeks
NON HODGKINS LYMPHOMA
List of abbreviations
Chlb = Chlorabucil
Chlb-E = Chlorambucil , epirubicin
CVP = Cyclophosphamide, Vincristine, Prednisolone
CHOP = Cyclophosphamide, Adriamycin, Vincristine, Prednisolone
ChlOP = Chlorambucil, Vincristine, Prednisolone
HDMP = High dose Methylprednisolone
PACEBO = Cyclo, Adria, Etoposide, Bleomycin, Pred.
PMitCEBO = Cyclo, Mitoxantrone, Etoposide, Bleomycin, Pred.
ECP = Etop, Platinum, Pred.
CHOD/BVAM= Cyclo, Adria, Vct, Dex, / BCNU, Vct, cytarabine, Mtx
MACOP-B = Mtx, Adria, Cyclo, Vinc, Pred, Bleo
PACEBOM = Pred, Adria, Cyclo,Etop, Bleo, Vinc, Mtx
DHAP = Dex, Cisplatin, Ara-C,
BEAM = High dose BCNU, Etoposide, Ara-C, Melphalan
VANDERBILT = Cyclo, Etop, Vinc, Dox, Bleo, Mtx, Pred (McMaster , JCO 9:941-946 1991)
Summary of protocols
Chlorambucil 10 mg po daily for 14 days every 4 weeks
Prednisolone 10 mg daily for 14 days every 4 weeks
Cyclophosphamide 750 mg/msq IV stat day
Vincristine 2 mg IV stat day 1
Prednisolone 10 mg qds po days 1 to 14 with the cycle repeated every 3 weeks
Cyclophosphamide 750mg/msq iv Day 1
Adriamycin 50mg/msq iv Day 1
Vincristine 1.4mg/msq (max 2mg) iv Day 1
Prednisolone 100mg po Day 1-5
CHOD:-
Adriamycin 50mg/msq iv
Cyclophosphamide 750mg/msqiv
Vincristine 1.4mg/msq iv (max 2mg)
Dexamethasone 4 mg qds oral d1-7
BVAM:-
Methotrexate 1.5 g/m2 iv
With Folinic Acid 15mg orally 6 hourly X6 starting at 24 hours
BCNU 100mg/m2 iv
Cytarabine 3 g/m2 iv
Nystatin susp. 1 ml orally QDS Septrin 2 tab orally BD, Dose reductions of A and C, if neutrophils less than 100. Modify protocol if age over 60 years. Rxt starts 10-14 days after last ARA-c
Agent Dose Day Route Time
Dexamethasone 40mg 1-4 IV 15 mins
Cisplatin 100mg/msq1 IV-CI 24 hours
Cytarabine 4g/msq IV 2 g/msqin 200ml
(Ara-C) normal saline
3 hours q12 hrs X 2
Fludarabine phosphate 25mg/msq IV daily for 5 days either by 30 minute infusion or as a bolus over a few minutes, repeated every 28 days (see appendix for full details)
Methylpred 1.5g o/iv d 1-5
Cimetidine cover required.
Methotrexate 400mg/msq total dose given as 100mg stat then 300mg/msq in 500mls n saline +20 mmol KCL over 4 hours
With Folinic Acid 15mg orally 6 hrly X6 starting at 24 hrs
Adriamycin 50mg/msq iv
Cyclophosphamide 350mg/msq iv
Vincristine 1.4mg/msq iv (max 2mg)
Bleomycin 10mg/msq iv
Prednisolone 60mg daily, orally for 10 weeks, then reduce gradually
Nystatin susp. 1 ml orally QDS Septrin 2 tab orally BD
Dose reductions of A and C, if neutrophils less than 100.
Modify protocol if age over 60 years
| Week | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 |
| M | d1 | d1 | d1 | |||||||||
| C,A | d1 | d1 | d1 | d1 | d1 | d1 | ||||||
| V | d1 | d1 | d1 | d1 | d1 | d1 | ||||||
| B | d1 | d1 | d1 |
Methotrexate (high dose) 2 g/msq IV
1. Pre-hydration and alkalinisation 1L Dextrose saline + 70ml of 8.4% Na bicrb - 1L every 4 hrs X2
2. Methotrexate 2 g/msq in 1L N. saline over 6 hrs IV
3. Post-hydration + alkalinisation 1L N. Saline + 70ml 8.4% Na bicarbonate 1L every 6 hrs
If pH < 7 add oral bicarbonate 3g orally 3 hrly and/or iv bicarbonate by infusion
4. Folinic acid rescue at 24 hours from start of Methotrexate infusion 15mg/msq 6 hrly x 8 initially iv, then orally if tolerated.
5. Methotrexate levels at 24, 48 and 72 hrs. Continue folinic acid if levels fail to fall by 48 hrs post infusion
CARE OF PATIENTS DURING CHEMOTHERAPY
Oral hygeine should be empasised. Mouth washes used regulary together with Nystatin 1ml qds.
Patients should carry an information card stating that he or she is currently undergoing a course of chemotherapy. Patients should fully understand the importance of self referral in the event of pyrexia, other signs of infection or bleeding.
FOLLOW UP POLICY
All patients by the last week of radiotherapy neeed to have a clear understanding of follow up arrangements. These may either be standard follow up or progression to further therapy.
Standard follow :
4 weeks with FBC, U&E’s CxR. + Arrange post treatment CT
8 weeks including a review post therapy CT scan
Then three monthly 1st year with FBC and CxR
CT scans at 1 and 2 years.
Remember that hormonal failure can occur in various systems when performing clinical assessments. e.g TFT’s yearly post mantle.
Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.