1.28 Protocol Name: CODOX-M/IVAC
|
|
- June Day
- 6 years ago
- Views:
Transcription
1 1.28 Protocol Name: CODOX-M/IVAC Indication Burkitt's or Burkitt's-like lymphoma - especially those with 1 of the following poor risk criteria: Lymphoblastic lymphoma - especially B subtype Acute Myeloid Leukaemia B-ALL (slg positive- usually L3 morphology Burkitt s or Burkitt-like) and Relapsed Acute Lymphoblastic Leukaemia This regimen is very intensive and was introduced by Magrath and colleagues at the National Cancer Institute, USA to treat Burkitt's lymphoma or Burkitts-like. Early results in this rare condition for both children and adults were very promising and the regimen has been adopted by many centres for the treatment of the most aggressive, poor risk high grade non-hodgkin's lymphomas. The current LY10 Trial uses lower doses of methotrexate than the previous LY06 Trial. Consult the LY10 Trial Protocol for full details. Pre-treatment evaluation and treatment Evaluate problems requiring urgent attention including impending airway obstruction, CNS disease, uric acid nephropathy, renal flow obstruction, metabolic problems or fever. Arrange for a Hickman or similar tunnelled central venous catheter to be inserted if possible. Document disease stage following clinical assessment, CXR and CT scan of chest, abdomen and pelvis (consider MRI scan for cranio-spinal involvement). Include the presence or absence of B symptoms together with WHO and ECOG performance status. Other investigations should include blood tests for FBC, ESR/PVisc, clotting screen (PT, aptt and fibrinogen), U&E, LFTs, calcium, magnesium, uric acid, LDH, immunoglobulin levels and serum protein electrophoresis. Baseline FSH, LH, oestradiol and testosterone levels should be considered CODOX-M,IVAC v 2.1 Page 1 of 11
2 An HIV test should be considered as Burkitt's lymphoma is one of the commonest histological subtypes seen in HIV-positive patients. A bone marrow aspirate (including cytogenetic analysis) and trephine biopsy must be performed as marrow involvement is common. A lumbar puncture (LP), in order to assess CSF cytology, glucose and protein, is mandatory as CNS involvement is common. It is suggested that cytarabine 70mg is given intrathecally at the time of the LP if Burkitt's or lymphoblastic lymphoma is a serious diagnostic possibility. Aspiration of pleural or ascitic fluid (including cytogenetic analysis) can sometimes be very useful for establishing a rapid diagnosis especially where the disease is, for example, intraabdominal and therefore inconvenient to biopsy. Creatinine clearance (measured by 24-hour urine collection or radio-isotopic methods) must be performed before any high dose methotrexate is given. Check & document height, weight and surface area. Consider pulmonary function tests to assess spirometry, TL CO and K CO in patients with pre-existing lung disease. Give adequate verbal/written information for patients and relatives concerning patient s disease, treatment strategy and side effects. Discuss potential risk of infertility with patient and relatives and consider sperm cryopreservation. Document WHO performance status of patient. Give adequate verbal and written information for patients and relatives concerning patient s disease, treatment strategy and side effects. Obtain written consent from patient or guardian. Serological tests for: Hepatitis B & C, CMV. ECG. CXR. ECHO if cardiac history, elderly or previous history suggestive of potential cardiac disease (Inc diabetes and hypertension) CODOX-M,IVAC v 2.1 Page 2 of 11
3 Drug Regimen - CODOX-M (OPCS code: X70.2) (methotrexate dose is reduced in patients of and over 65yrs old) Day Drug Dose Route Comments Vincristine 1.5mg/m 2 (max 2mg) IV bolus in 20mls 0.9% Saline 1 * Doxorubicin 40mg/m 2 IV bolus via fast running drip Cyclophosphamide 800mg/m 2 IV infusion in 250mls 0.9% Saline over 30mins Cytarabine 70mg IT bolus injection 2-5 Cyclophosphamide 200mg/m 2 IV infusion in up to 250mls 0.9% inc Saline over 15mins 3 Cytarabine 70mg IT bolus injection 8 Vincristine 1.5mg/m 2 IV bolus via fast running drip (max 2mg) <65yrs 300mg/m 2 IV infusion in 250mls 0.9% Saline >65yrs 100mg/m 2 over 60mins 10 Methotrexate <65yrs 2700mg/m 2 IV infusion in 1000mls 0.9% Saline >65yrs 900mg/m 2 over 23 hours 11 Calcium Folinate 15mg/m 2 13 GCSF (1amp) IV infusion in 100mls 5% dextrose over 30mins at 36 hours after the START of the methotrexate infusion then IV infusion in 100mls 5% dextrose repeated every 3hours Then every 6 hours until serum methotrexate level <5 x 10-8 M, (IV/PO as appropriate) SC daily until neutrophils >1.0x10 9 /l 15 Methotrexate 12.5mg IT bolus injection starting at T0 then starting at T1, T36 T39,T42,T45,T48 & T51 T54 onwards * Discontinue bicarbonate additives to IV infusions before starting chemotherapy. Adhere to the local Trust policy for intrathecal chemotherapy prescribing and administration. Methotrexate should only be given in the presence of a normal serum creatinine and a measured creatinine clearance of >50ml/min/m 2. Alkalinisation of urine using 3.0l/m 2 IV fluids with bicarbonate to ensure urine ph 7.0 should be commenced hours prior to the start of the methotrexate infusion and continued until Calcium Folinate rescue is no longer required. Commence methotrexate regardless of blood counts. Stop infusion at 24hours regardless of dose given. Serum methotrexate levels should be sent 48 hours after the start of the methotrexate infusion. If the 48 hour level is >2 x 10-6 M (2.0µmoles/l) the dose of Calcium Folinate should be doubled. IT IS OF PARAMOUNT IMPORTANCE that serum methotrexate levels are performed every 24 hours, Calcium Folinate rescue continued every 6 hours and urine ph maintained 7.0 until the methotrexate level is <5 x 10-8 M (0.05µmoles/l) CODOX-M,IVAC v 2.1 Page 3 of 11
4 commence the next cycle as soon as possible and on the day that the unsupported neutrophil count is >1.0 x 10 9 /l and platelets count is >75 x 10 9 /l. Drug Regimen - IVAC for patients <65 years (OPCS code: X70.5) Day Drug Dose Route 1-5 Etoposide 60mg/m 2 IV infusion in mls 0.9% Saline over 60mins Ifosfamide mixed with Mesna 1500mg/m mg/m 2 IV infusion in 500mls 0.9% Saline over 60mins 1-5 Mesna 600mg/m 2 IV infusion in 1L 0.9% Saline over 8hours inc 1&2 Cytarabine 2g/m 2 IV infusion in 1000mls 0.9% Saline over 3hours, every 12 hours i.e. total of 4 doses 5 Methotrexate 12.5mg IT bolus injection 7 GCSF (1 amp.) SC continued daily until neuts >1.0 x 10 9 /l commence the next cycle (CODOX-M) as soon as possible and on the day that the unsupported neutrophil count is >1.0 x 10 9 /l and platelets count is >75 x 10 9 /l. Drug Regimen - IVAC for patients >65 years (Ifosfamide and Cytarabine doses are reduced) (OPCS code: X70.5) Day Drug Dose Route 1-5 Etoposide 60mg/m 2 IV infusion in mls 0.9% Saline over 60mins Ifosfamide mixed with Mesna 1000mg/m 2 + IV infusion in 500mls 0.9% Saline over 60mins 200mg/m inc Mesna 400mg/m 2 IV infusion in 1L 0.9% Saline over 8hours - for 2 doses 1&2 Cytarabine 1g/m 2 IV infusion in 1000mls 0.9% Saline over 3hours, every 12 hours i.e. total of 4 doses 5 Methotrexate 12.5mg IT bolus injection 6 Calcium Folinate 15mg PO 24 hours after IT methotrexate 7 GCSF (1 amp.) SC continued daily until neuts >1.0 x 10 9 /l commence the next cycle (CODOX-M) as soon as possible and on the day that the unsupported neutrophil count is >1.0 x 10 9 /l and platelets count is >75 x 10 9 /l CODOX-M,IVAC v 2.1 Page 4 of 11
5 Cycle Frequency / Treatment Duration LOW RISK ie at least 3 of the factors below Normal LDH level WHO performance status 0-1 Ann Arbor stage I-II Number of extra-nodal sites (egg bone marrow, GI tract, CNS) 1 HIGH RISK ie all remaining patients are high risk. They should have 2 or more of the following features Raised LDH level WHO performance status 2-4 Ann Arbor stage III-IV Number of extra-nodal sites >1 3 cycles of CODOX-M are given 2 alternating cycles of each regimen is given, i.e. CODOX-M IVAC CODOX-M IVAC Note: Each cycle is started as soon as possible after neutrophils have regenerated to >1.0 x 10 9 /l and platelets (unsupported) to >75 x 10 9 /l. CNS involvement at diagnosis Intensified CNS chemotherapy treatment is as indicated below, regardless of age, and is given for THE FIRST TWO CYCLES ONLY. Day Drug Intrathecal Dose Intraventricular Dose (Ommaya Reservoir) CODOX-M 1,3,5 Cytarabine 70mg 15mg 15,1 7 16,1 8 Methotrexate 12.5mg 2mg Calcium Folinate 15mg oral dose, 24 hours after lumbar puncture/cytotoxic dose IVAC 5 Methotrexate 12.5mg 2mg 6 Calcium Folinate 15mg oral dose, 24 hours after lumbar puncture/cytotoxic dose 7,9 Cytarabine 70mg 15mg Intrathecal/intraventricular therapy for cycles 3 and 4 will be given according to the schedule for high risk patients without CNS disease 1.28 CODOX-M,IVAC v 2.1 Page 5 of 11
6 Insertion of an Ommaya reservoir should rarely be needed. If it is considered appropriate, it should be sited in week 3 of CODOX-M during the period of neutrophil recovery. A neutrophil count >0.5 x 10 9 /l is recommended. Radiotherapy Radiotherapy has not been demonstrated to be beneficial in the treatment of meningeal disease and adds significantly to myelotoxicity. Radiotherapy is only considered in the presence of the following circumstances: o intracerebral mass o meningeal disease where chemotherapy cannot commence immediately because of metabolic abnormalities o testicular involvement should be discussed with the principal investigator Concurrent Medication Adequate hydration, these patients are at high risk of developing tumour lysis syndrome. Start IV hydration at a rate of at least 3.0l/m 2 /day (sodium content 75mmol/l) or as close to this figure as is tolerated. Give frusemide as required to maintain urine output. DO NOT include potassium supplements with the IV fluids unless serum potassium falls below 3.0mmol/l. Add sodium bicarbonate to the IV solutions (start with 50mmol of sodium bicarbonate per litre of solution) if the patient has a raised serum uric acid level. Keep urine ph 7.0 (by increasing the amount of sodium bicarbonate in the infusion fluids to 100mmols/l, if necessary). Stop adding bicarbonate to infusions when uric acid is back within the normal range, or serum bicarbonate >30mmol/l and/or immediately prior to commencement of chemotherapy. Since most of these patients have very high tumour cell burdens and/or significant hyperuricaemia, rasburicase at a dose of 0.2mg/kg (rounded to nearest vial size) for 5-7 days is highly recommended. Where rasburicase is not used start allopurinol at a dose of 10mg/kg/day in 2-3 divided doses. Anti-ulcer drug as per local policy Antimicrobial prophylaxis as per local protocol including Itraconazole (liquid 200mg BD) for aspergillus prevention Check fluid balance at 4hour intervals through each day, taking early action if fluid overload occurs by giving frusemide if the urine output falls below 400 ml/m 2 in any given 4-hour period. FOR CODOX-M cycles: Drugs that compromise renal function e.g. aminoglycosides and cisplatin can decrease clearance of methotrexate and lead to systemic toxicity. Avoid concurrent use of NSAIDs including salicylates and sulphonamides. Large doses of penicillin may interfere with the active renal tubular secretion of methotrexate CODOX-M,IVAC v 2.1 Page 6 of 11
7 FOR CODOX-M cycles: If the serum creatinine increases by more than above baseline at 24 hours and/or the methotrexate level is greater than 5 x 10-6 M then the folinic acid rescue is increased. FOR IVAC cycles: Prednisolone 0.5% eye drops tds to avoid chemical conjunctivitis from high-dose cytarabine Investigations to be performed during chemotherapy During induction: at least daily FBC, U&E, creatinine, LFTs, uric acid, calcium, phosphate and magnesium so as to allow early recognition of tumour lysis syndrome. Thereafter: daily FBC, U&E, creatinine; thrice weekly LFTs, calcium and magnesium. Methotrexate: serum levels should be checked after high dose methotrexate as detailed above. Assessment of Response Assuming clinical response, the following is performed within 4 weeks of completion of the chemotherapy: FBC, ESR/PVisc, U&E, creatinine, LFTs and LDH CXR CT scan of areas abnormal at the time of presentation Bone marrow aspirate and trephine biopsy (if abnormal at the time of presentation) CSF cytology (if abnormal at the time of presentation) Anti-emetics Highly emetogenic as per local protocol Potential toxicities Severe myelosuppression (neutrophils <0.1 x 10 9 /l and platelets <20 x 10 9 /l) is expected Nausea & vomiting Vinca alkaloids: peripheral and autonomic neuropathy - watch for peripheral paraesthesia, constipation and paralytic ileus Mucositis Conjunctivitis (cytarabine) 1.28 CODOX-M,IVAC v 2.1 Page 7 of 11
8
9 Dose Modifications Renal dysfunction: renal outflow obstruction and/or uric acid nephropathy are not uncommon. In these circumstances, more conventional chemotherapy ± haemodialysis or the insertion of nephrostomy tubes are recommended to obtain initial control of the lymphoma and allow improved renal function before commencing CODOX-M. Vincristine: dose reduction of only in the case of severe motor dysfunction. Creatinine Clearance 45-60ml/min Allopurinol Dose Doxorubicin Dose Methotrexate Dose Etoposide Dose 30-45ml/min 80% mg daily 75% 15-30ml/min 75% 10-15ml/min <10ml/min 100 daily or alternate days avoid Ifosfamide dose Cytarabine Dose 85% 70% 60% clinical decision CI Serum Doxorubicin Dose Vincristine Dose Etoposide Bilirubin ** Dose 20-34µmol/l 34-50µmol/l if transaminases 50-85µmol/l 25% or transaminases IU/L > 2-3 normal 75% dose & & normal >85µmol/l omit transaminases transaminases >180IU/L omit or AST or AST >180 clinical decision Ifosfamide dose Not recommended in patients with a bilirubin >17mol/L or serum transaminases or ALP more than 2.5 x upper normal limit. clinical decision Cytarabine Dose.100% Escalate doses in subsequent cycles in the absence of toxicity Review dose for second and third dose according to actual methotrexate clearance on previous doses. ** Note if raised bilirubin is not caused by hepatic dysfunction, DO NOT alter the dose 1.28 CODOX-M,IVAC v 2.1 Page 9 of 11
10 1.28 CODOX-M,IVAC v 2.1 Page 10 of 11
11 West London Cancer Network References Magrath et al, JCO 1996 (14) 925 UK Lymphoma Group LY10 Protocol, Version 2.0, December 2002 Patient information Leukaemia Research Fund - Adult Acute Lymphoblastic Leukaemia booklet- Cancerbackup- Acute Lymphoblastic leukaemia booklet Revised by: Pauline McCalla, Nicki Panoskaltsis Authorised by: WLCN Haematology TWG Date for review by Haematology TWG: November CODOX-M-IVAC Version 2.1 Feb09.doc Page 11 of 11
(R) CODOX M / (R) IVAC
(R) CODOX M / (R) IVAC Indication Burkitt's or Burkitt's-like lymphoma, especially those with 1 or more of the following poor risk criteria: - Raised LDH level - WHO performance status 2-4 - Ann Arbor
More informationBurkitt s Lymphoma or DLBCL with adverse features PATIENTS WITH GOOD PERFORMANCE STATUS
Regimen R-CODOX M Indication Burkitt s Lymphoma or DLBCL with adverse features Therapeutic Intent Radical/Curative PATIENTS WITH GOOD PERFORMANCE STATUS Day Medication Dose Route Administration Details
More information1 Acute Lymphoblastic Leukaemia
1 Acute Lymphoblastic Leukaemia 1.05 Intensification - Philadelphia Negative Patients Indication ALL Philadelphia negative patients Pre-treatment Evaluation The intensification module begins two weeks
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME R-CODOX-M.DOC CONTROLLED DOC NO: HCCPG B115 CSIS Regimen Name: R-CODOXM. Rituximab + CODOX-M
Rituximab + CODOX-M Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Burkitt
More informationR-IDARAM. Dexamethasone is administered as an IV infusion in 100mL sodium chloride 0.9% over 30 minutes.
R-IDARAM Indication Secondary CNS lymphoma ICD-10 codes Codes with a prefix C85 Regimen details Day Drug Dose Route 1 Rituximab 375mg/m 2 IV infusion 1 Methotrexate 12.5mg Intrathecal 1 Cytarabine 70mg
More informationBurkitt lymphoma, double hit lymphoma or high IPI diffuse large B-cell lymphoma.
INDICATION Burkitt lymphoma, double hit lymphoma or high IPI diffuse large B-cell lymphoma. TREATMENT INTENT Curative. PRE-ASSESSMENT 1. Ensure histology is confirmed prior to administration of chemotherapy
More information2.07 Protocol Name: CHOP & Rituximab
2.07 Protocol Name: CHOP & Rituximab Indication Intermediate and high grade, B-cell non-hodgkins lymphoma expressing CD20. Second or third line therapy for low grade, B cell non- Hodgkins lymphoma expressing
More informationMATRIX (Methotrexate, Cytarabine, Thiotepa and Rituximab)
MATRIX (Methotrexate, Cytarabine, Thiotepa and Rituximab) Indication First line treatment of primary CNS lymphoma. ICD-10 codes Codes with a prefix C85 Regimen details Day Drug Dose Route 1 and 6 Rituximab
More information(primary CNS lymphoma)
(primary CNS lymphoma) INDICATION CNS Lymphoma TREATMENT INTENT Curative PRE-ASSESSMENT 1. Ensure histology is confirmed and documented in the notes. Although it is sometimes difficult to obtain tissue
More informationR-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, Gemcitabine, Dexamethasone &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma or high grade T cell non-hodgkin
More informationStRs and CT doctors in haematology. September Folinic acid dose modified.
High dose Methotrexate and folinic acid rescue Full Title of Guideline: Author (include email and role): Division & Speciality: Clinical Guideline Review Date September 2018 GUIDELINE FOR THE USE OF HIGH
More informationR-GDP: Rituximab, Gemcitabine, Dexamethasone &Cisplatin
: Rituximab, &Cisplatin INDICATION Relapsed or refractory Hodgkin and non-hodgkin lymphoma. Omit Rituximab for patients with Hodgkin Lymphoma. TREATMENT INTENT Palliative or curative depending on context.
More informationSMILE (Etoposide, Ifosfamide, Methotrexate and Dexamethasone)
SMILE (Etoposide, Ifosfamide, Methotrexate and Dexamethasone) INDICATION Natural Killer/T-cell lymphoma TREATMENT INTENT Curative SPECIAL PRECAUTIONS This protocol causes marked myelosuppression despite
More informationX M/ (R) Dose adjusted (DA)-EPOCH-R
X M/ (R) adjusted (DA)-EPOCH-R Indication High-risk CD20+ diffuse large B cell lymphoma especially C-MYC and BCL-2 activated (i.e. double hit lymphoma) and mediastinal sclerosing (thymic) large B cell
More informationDA-EPOCH-R (Etoposide/Inpatient)
DA- (Etoposide/Inp) INDICATION High grade lymphoma. Omit rituximab if CD20 negative. PRE-ASSESSMENT 1. Ensure histology is confirmed prior to administration of chemotherapy and document in notes. 2. Record
More informationR-CODOX-M Therapy (Patients greater than 65 years)
R-CODOX-M Therapy (Patients greater than 65 years) INDICATIONS FOR USE: Regimen Code 00403a *Reimbursement Indicator INDICATION ICD10 Treatment of Burkitt Lymphoma in patients aged greater than 65 C83
More informationThis is a controlled document and therefore must not be changed or photocopied L.80 - R-CHOP-21 / CHOP-21
R- / INDICATION Lymphoma Histiocytosis Omit rituximab if CD20-negative. TREATMENT INTENT Disease modification or curative depending on clinical circumstances PRE-ASSESSMENT 1. Ensure histology is confirmed
More informationCD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated
INDICATION CD20-positive high-grade non-hodgkin Lymphoma in patients in which R-CHOP is not indicated TREATMENT INTENT Curative or Disease Modification. PRE-ASSESSMENT 1. Ensure histology is confirmed
More informationDefinition of high risk disease for diffuse large B-cell lymphoma is score 4 or 5 based on the following risk factors:
INDICATION High grade lymphoma with high risk of CNS involvement Definition of high risk disease for diffuse large B-cell lymphoma is score 4 or 5 based on the following risk factors: Age > 60 Raised serum
More informationVIP (Etoposide, Ifosfamide and Cisplatin)
VIP (Etoposide, Ifosfamide and Cisplatin) Indication First line treatment for metastatic seminoma, non seminoma or combined tumours where bleomycin is contra-indicated. Usually used for patients with intermediate
More information(R) CHOEP. May be used for stage IA - IV Diffuse Large B Cell non-hodgkin lymphoma in combination with rituximab.
(R) CHOEP Indication Treatment of stage IA - IV T cell non-hodgkin lymphoma as an alternative to CHOP in younger, fitter patients with normal LDH level. May be used for stage IA - IV Diffuse Large B Cell
More informationHigh Dose Cytarabine plus high dose Methotrexate for CNS Lymphoma
High Dose Cytarabine plus high dose Methotrexate for CNS Lymphoma Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton
More information4.05 Protocol name: Alemtuzumab (MabCampath ), intravenous
4.05 Protocol name: (MabCampath ), intravenous Indication Treatment of CLL refractory to fludarabine (either primary i.e. 17p deletion, or secondary i.e. following previous fludarabine treatment), without
More informationVincristine Ifosfamide Doxorubicin Etoposide (VIDE) Sarcoma
Systemic Anti Cancer Treatment Protocol Vincristine Ifosfamide Doxorubicin Etoposide (VIDE) Sarcoma PROTOCOL REF: MPHAVIDE (Version No: 1.0) Approved for use in: Ewings sarcoma Desmoplastic small round
More informationPVACE-BOP (Hodgkin s Lymphoma)
DRUG ADMINISTRATION SCHEDULE Day Drug Dose Route Diluent Rate 1 Ondansetron 8mg IV / Oral vinblastine 6mg/m 2 (Max: 10mg) IV Infusion Etoposide 100mg/m 2 IV infusion Patients over 65 years by 15 min infusion
More informationNCCP Chemotherapy Protocol. CHOEP Therapy 21 days. Treatment of T-cell Non-Hodgkins Lymphoma C a
CHOEP Therapy 21 days INDICATIONS FOR USE: INDICATION ICD10 Protocol Code Treatment of T-cell Non-Hodgkins Lymphoma C85 00396a ELIGIBILTY: Indication as above Age < 60 years Adequate haematological, renal
More informationLung Pathway Group Cisplatin & PO Vinorelbine in Non- Small Cell Lung Cancer (NSCLC)
Lung Pathway Group Cisplatin & PO Vinorelbine in Non- Small Cell Lung Cancer (NSCLC) Indication: First line in radical/induction treatment in locally advanced NSCLC First line palliative treatment in advanced/metastatic
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME SMILE.DOC CONTROLLED DOC NO: HCCPG B57 CSIS Regimen Name: SMILE. SMILE chemotherapy
SMILE chemotherapy Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Extranodal
More informationLung Pathway Group Cisplatin & IV Vinorelbine in Non- Small Cell Lung Cancer (NSCLC)
Lung Pathway Group Cisplatin & IV Vinorelbine in Non- Small Cell Lung Cancer (NSCLC) Indication: First line in radical/induction treatment in locally advanced NSCLC First line palliative treatment in advanced/metastatic
More informationGUIDELINE FOR THE MANAGEMENT AND PREVENTION OF ACUTE TUMOUR LYSIS SYNDROME IN HAEMATOLOGICAL MALIGNANCIES
GUIDELINE FOR THE MANAGEMENT AND PREVENTION OF ACUTE TUMOUR LYSIS SYNDROME IN HAEMATOLOGICAL MALIGNANCIES Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target
More informationCisplatin and Vinorelbine and radiotherapy (NSCLC)
Cisplatin and Vinorelbine and radiotherapy (NSCLC) Indication First-line chemotherapy for use with concomitant radical radiotherapy for early or locally advanced non-small cell carcinoma (NSCLC) ICD-10
More informationCisplatin and Vinorelbine and radiotherapy (NSCLC)
Cisplatin and Vinorelbine and radiotherapy (NSCLC) Indication First-line chemotherapy for use with concomitant radical radiotherapy for early or locally advanced non-small cell carcinoma (NSCLC) ICD-10
More information(High dose METHOTREXATE, high dose CYTARABINE, RITUXIMAB and THIOTEPA)
MATRix (High dose METHOTREXATE, high dose CYTARABINE, RITUXIMAB and THIOTEPA) INDICATION CNS Lymphoma. TREATMENT INTENT Curative. PRE-ASSESSMENT 1. Ensure histology is confirmed and documented in the notes.
More informationNB. This version combines both previous inpatient and ambulatory protocols. See DRUG REGIMEN section for details.
DA- INDICATION High grade lymphoma. Omit rituximab if CD20 negative. NB. This version combines both previous inpatient and ambulatory protocols. See DRUG REGIMEN section for details. TREATMENT INTENT Curative
More informationCarfilzomib and Dexamethasone (CarDex)
Carfilzomib and Dexamethasone (CarDex) Indication Relapsed multiple myeloma for patients who have had only one previous line of therapy (that did not include bortezomib). (NICE TA457) ICD-10 codes Codes
More informationALL Phase 2 Induction (25-60 years)
ALL Phase 2 (25-60 years) INDICATION of remission in Adult Acute Lymphoblastic Leukaemia (ALL) patients This protocol is suitable for patients aged 25-60 years. It may sometimes be used in older patients
More informationNECN CHEMOTHERAPY HANDBOOK PROTOCOL
DRUG ADMINISTRATION SCHEDULE Day Drug Dose Route Diluent Rate 1* to 5 Prednisolone 40mg/m 2 Oral Once Daily For 5 days 1 Paracetamol 1gram Oral Once Only Chlorphenamine 10mg IV bolus Ondansetron 8mg IV
More informationCisplatin + Etoposide IV / Oral therapy followed by Chemo-radiotherapy in Small Cell Carcinoma of the Cervix
Cisplatin + Etoposide IV / Oral therapy followed by Chemo-radiotherapy in Small Cell Carcinoma of the Cervix Indication: Neoadjuvant chemotherapy followed by Chemo-radiotherapy in Small Cell Carcinoma
More informationCisplatin and Gemcitabine (bladder)
Cisplatin and Gemcitabine (bladder) Indication Palliative therapy for locally advanced or metastatic bladder cancer in patients with good renal function. Palliative therapy for urothelial transitional
More informationDoxorubicin and Ifosfamide Sarcoma
Systemic Anti Cancer Treatment Protocol Doxorubicin and Ifosfamide Sarcoma PROTOCOL REF: MPHADOXIFO (Version No:.0) Approved for use in: Soft tissue sarcoma Dosage: Drug Dosage Route Frequency Doxorubicin
More informationR-GemOx. Lymphoma group INDICATION. Relapsed or Refractory Lymphoma, for patients unsuitable for R-GDP regimen. Omit rituximab if CD20- negative
R-GemOx INDICATION Relapsed or Refractory Lymphoma, for patients unsuitable for R-GDP regimen. Omit rituximab if CD20- negative TREATMENT INTENT Disease modification PRE-ASSESSMENT 1. Ensure histology
More informationTIP: Paclitaxel / Ifosfamide / Cisplatin in Relapsed Germ Cell Tumour
TIP: Paclitaxel / Ifosfamide / Cisplatin in Relapsed Germ Cell Tumour Indication: Second line therapy in Relapsed Germ Cell Tumours Regimen details: Paclitaxel 175mg/m 2 IV Cisplatin 20mg/m 2 IV - D5 Ifosfamide
More informationO-CVP with maintenance Obinutuzumab
with maintenance Obinutuzumab INDICATION Follicular Lymphoma: 1 st line treatment in advanced symptomatic patients (NICE TA513 for FLIPI score 2 or higher - BLUETEQ required) TREATMENT INTENT Disease modification.
More informationRituximab, Gemcitabine, Dexamethasone and Cisplatin RGDP Regimen
Rituximab, Gemcitabine, Dexamethasone and Cisplatin RGDP Regimen Available for Routine Use in Burton in-patient N/A Derby in-patient Burton day-case Derby day-case Burton outreach chemotherapy clinic N/A
More informationR-ICE Regimen- Rituximab, Etoposide, Ifosfamide (with MESNA), Carboplatin (+ Depocyte if CNS involvement)
R-ICE Regimen- Rituximab, Etoposide, Ifosfamide (with MESNA), Carboplatin (+ Depocyte if CNS involvement) Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case
More informationGemcitabine, Dexamethasone and Cisplatin GDP Regimen
Gemcitabine, Dexamethasone and Cisplatin GDP Regimen Available for Routine Use in Burton in-patient N/A Derby in-patient Burton day-case Derby day-case Burton outreach chemotherapy clinic N/A Derby outreach
More informationNote: There are other bendamustine protocols, ensure this is the correct one for a given patient.
INDICATIONS 1 st line treatment for follicular lymphoma with FLIPI score 2 or higher: (NICE TA513- BLUETEQ required) Rituximab refractory follicular lymphoma (progression on R-chemo, R-maintenance or within
More informationCisplatin Vinorelbine (Oral) therapy +/- radiotherapy
1 REGIMEN TITLE: Cisplatin Vinorelbine (Oral) therapy +/- radiotherapy Page 1 of 5 Indication: First line in Radical/ Induction, Adjuvant and Advanced & Palliative treatment of Non-small cell lung cancer
More informationCisplatin Doxorubicin Sarcoma
Systemic Anti Cancer Treatment Protocol Cisplatin Doxorubicin Sarcoma PROCEDURE REF: MPHACISDOX (Version No. _1.0) Approved for use in: Osteosarcoma Palliative / advanced disease Not suitable for PAM schedule
More informationCisplatin / Capecitabine (+ Trastuzumab) in Gastric Cancer
Cisplatin / Capecitabine (+ Trastuzumab) in Gastric Cancer Page 1 of 5 Indication: Confirmed HER2-positive (3+ or FISH+) metastatic adenocarcinoma of the stomach or gastrooesophageal junction. Patient
More informationBreast Pathway Group EC x 4 Docetaxel x 4: Epirubicin & Cyclophosphamide followed by Docetaxel in Early Breast Cancer
Breast Pathway Group EC x 4 Docetaxel x 4: Epirubicin & Cyclophosphamide followed by Docetaxel in Early Breast Indication: Neoadjuvant therapy for high risk and fit breast cancer patients suitable for
More informationBreast Pathway Group EC x 4: Epirubicin & Cyclophosphamide in Early Breast Cancer
Breast Pathway Group EC x 4: & in Early Breast Cancer Indication: Neoadjuvant or adjuvant treatment for moderate to high risk breast cancer Regimen details: 90 mg/m 2 IV Day 1 600 mg/m 2 IV Day 1 Administration:
More informationBreast Pathway Group EC x 4 Paclitaxel x 4 (3-weekly): Epirubicin & Cyclophosphamide x 4 followed by Paclitaxel x 4 (3-weekly) in Early Breast Cancer
Breast Pathway Group EC x 4 Paclitaxel x 4 (3-weekly): Epirubicin & Cyclophosphamide x 4 followed by Paclitaxel x Indication: Neoadjuvant or adjuvant therapy for moderate to high risk node positive breast
More informationTumour Lysis Syndrome (TLS)
(TLS) Overview: Tumour lysis syndrome refers to a number of metabolic disturbances (hyperuricaemia, hyperphosphataemia, hyperkalaemia and hypocalcaemia) that occur as the result of rapid cell lysis. This
More informationCisplatin and Pemetrexed (NSCLC, mesothelioma)
Cisplatin and Pemetrexed (NSCLC, mesothelioma) Indication First-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC) if the histology of the tumour has been confirmed as
More informationWeekly Cisplatin + Radiotherapy - Interlace study -
Weekly Cisplatin + Radiotherapy - Interlace study - A phase III multicentre trial of weekly induction chemotherapy followed by standard chemoradiation versus standard chemoradiation alone in patients with
More informationCisplatin100 plus Radiotherapy for locally Advanced Squamous Cell Carcinoma Head and Neck
Cisplatin100 plus Radiotherapy for locally Advanced Squamous Cell Carcinoma Head and Neck Indication: 1) Concomitant chemo-radiotherapy for locally advanced squamous cell carcinoma head and neck 2) Post-operative
More informationBEACOPP-14/ BEACOPP- Escalated
BEACOPP-14/ BEACOPP- Escalated INDICATION Early Stage Classical Hodgkin Lymphoma with positive interim PET-CT (Deauville 3 or more) Advanced Classical Hodgkin lymphoma This protocol should normally be
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME CEOP.DOC CONTROLLED DOC NO: HCCPG B21 CSIS Regimen Name: CEOP. CEOP Regimen
CEOP Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication T-cell non-hodgkin
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME ESHAP.DOC CONTROLLED DOC NO: HCCPG B44. ESHAP Regimen
ESHAP Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Relapsed/ refractory
More informationPanobinostat, Bortezomib and Dexamethasone
Panobinostat, Bortezomib and Dexamethasone Indication Treatment of relapsed/refractory multiple myeloma in patients who have received at least 2 prior regimens, including bortezomib and an immunomodulatory
More informationNordic Protocol (MaxiCHOP/R-MaxiCHOP plus R-HDAraC)
Nordic Protocol (MaxiCHOP/R-MaxiCHOP plus R-HDAraC) Available for Routine Use in Burton in-patient Derby in-patient (First cycle if bulky disease & risk of tumour lysis syndrome) Burton day-case Derby
More informationNorth West London Cancer Network
GUIDELINES FOR THE MANAGEMENT OF ADULT ACUTE LEUKAEMIA INITIAL MANAGEMENT CONSIDERATIONS N.B.: If AML is suspected definitively diagnosed, please ensure that the patient is transferred immediately f treatment
More informationANAPLASTIC LARGE CELL LYMPHOMA TREATMENT ROAD MAP (Modified ALCL99)
ANAPLASTIC LARGE CELL LYMPHOMA TREATMENT ROAD MAP (Modified ALCL99) CLASSIFICATION OF TREATMENT GROUPS: 1. Isolated Skin lesions, < 5 skin lesions. Treatment course: ( No treatment, wait and see approach)
More informationCisplatin + Etoposide + Thoracic Radiotherapy (TRT) INDICATIONS FOR USE:
Cisplatin + Etoposide + Thoracic Radiotherapy (TRT) INDICATIONS FOR USE: Protocol INDICATION ICD10 Code Small cell lung cancer (SCLC) limited disease C34 00279a ELIGIBILTY: Indications as above ECOG 0-2
More informationLung Pathway Group Carboplatin & PO Vinorelbine in Non-Small Cell Lung Cancer (NSCLC)
Lung Pathway Group Carboplatin & PO Vinorelbine in Non-Small Cell Lung Cancer (NSCLC) Indication: First line in radical/induction treatment in locally advanced NSCLC First line palliative treatment in
More informationOxaliplatin and Gemcitabine
Oxaliplatin and Gemcitabine Indication Palliative treatment for relapsed metastatic seminoma, non seminoma or combined tumours. ICD-10 codes Codes pre-fixed with C38, C48, C56, C62, C63, C75.3. Regimen
More informationR-BAC-500 (Rituximab, Bendamustine, Cytarabine) for Mantle Cell Lymphoma
R-BAC-500 (Rituximab, Bendamustine, Cytarabine) for Mantle Cell Lymphoma Not routinely commissioned, each case requires prior documented approval before offering & commencing therapy from NHS England Cancer
More informationO-CHOP with Obinutuzumab maintenance
O-CHOP with Obinutuzumab maintenance Indication Adult patients with untreated advanced follicular lymphoma with Follicular Lymphoma International Prognostic Index (FLIPI) score of 2 or above. (NICE TA513)
More informationDocetaxel-EC: Docetaxel followed by Epirubicin / Cyclophosphamide in Breast Cancer
Docetaxel-EC: Docetaxel followed by Epirubicin / Cyclophosphamide in Breast Cancer Indication: Neoadjuvant therapy f HER 2 negative high risk and fit Breast Cancer patients, suitable f a taxane containing
More informationCHEMOTHERAPY PROTOCOL FOR ADMINISTRATION OF VENETOCLAX
CHEMOTHERAPY PROTOCOL FOR ADMINISTRATION OF VENETOCLAX Therapeutic Indications: Venetoclax monotherapy is indicated for the treatment of chronic lymphocytic leukaemia (CLL) in the presence of 17p deletion
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME R-GCVP.DOC CONTROLLED DOC NO: HCCPG B12 CSIS Regimen Name: R-GCVP. R-GCVP Regimen
R-GCVP Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication CD 20 positive
More informationDERBY-BURTON LOCAL CANCER NETWORK FILENAME R-IVE.DOC CONTROLLED DOC NO: HCCPG B53 CSIS Regimen Name: R-IVE. R-IVE Regimen
R-IVE Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Relapsed/ refractory
More informationBreast Pathway Group FEC75 (Fluorouracil / Epirubicin / Cyclophosphamide) in Early Breast Cancer
Breast Pathway Group FEC75 (Fluorouracil / Epirubicin / Cyclophosphamide) in Early Breast Cancer Indication: Neoadjuvant or adjuvant therapy in early breast cancer Regimen details: Fluorouracil 600mg/m
More informationALL Phase 1 Induction (25-60 years)
ALL Phase 1 (25-60 years) INDICATION of remission in Adult Acute Lymphoblastic Leukaemia (ALL) patients This protocol is suitable for patients aged 25-60 years. It may sometimes be used in older patients
More informationFludarabine + Cyclophosphamide + Rituximab (FCR) - FLAIR Study
Fludarabine + Cyclophosphamide + Rituximab (FCR) - FLAIR Study Front-Line therapy in CLL: Assessment of Ibrutinib-containing Regimes. ***See protocol for further details*** Available for Routine Use in
More informationBEACOPP-14/ Escalated BEACOPP
BEACOPP-14/ Escalated BEACOPP Indication Advanced stage Hodgkin Lymphoma where escalated therapy is indicated. Early Stage Classical Hodgkin Lymphoma with positive interim PET-CT (Deauville 3 or more).
More informationBleomycin, Etoposide and CISplatin (BEP) Therapy
Bleomycin, Etoposide and CISplatin (BEP) Therapy INDICATIONS FOR USE: INDICATION ICD10 Regimen Code Adjuvant treatment of high risk (vascular invasion C62 00300a carcinoma) stage 1 nonseminoma germ cell
More informationECX. Anti-emetics: Day 1: highly emetogenic Days 2 21: mildly emetogenic
Page 1 of 5 As an alternative to ECF: For locally advanced (inoperable) or metastatic oesophageal or gastric cancer; peri-operative use in oesophageal or gastric cancer; adenocarcinoma of unknown primary
More informationSAALT3W Sarcoma Dr. Meg Knowling. Protocol Code Tumour Group Contact Physician
BCCA Protocol Summary for Etoposide, Ifosfamide-Mesna (SAIME) Alternating with vincristine, DOXOrubicin and Cyclophosphamide (with or without Mesna)(SAVAC or SAVACM) with Filgrastim Support at a THREE
More informationLD-ARA-C and Clofarabine
LD-ARA-C and Clofarabine INDICATION Induction plus consolidation chemotherapy for patients with acute myeloid leukaemia (AML). Its use is particularly for patients over 60 years of age but it can be applied
More informationTIP Paclitaxel, Ifosfamide and Cisplatin
Systemic Anti Cancer Treatment Protocol TIP Paclitaxel, Ifosfamide and Cisplatin PROTOCOL REF: MPHATIPGC (Version No: 1.0) Approved for use in: Second line treatment of germ cell tumours Dosage: Drug Dosage
More informationGemcitabine & Cisplatin
Gemcitabine & Cisplatin Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication Advanced
More informationDTPACE. Myeloma group INDICATION
INDICATION Relapsed or refractory myeloma patients suitable for intensive salvage chemotherapy. Plasma cell leukaemia or presentation with extra-medullary disease. TREATMENT INTENT Disease Modification
More informationALL MAINTENANCE (25-60 years)
ALL MAINTENANCE (25-60 years) INDICATION Adult Acute Lymphoblastic Leukaemia (ALL) in remission not eligible for allogeneic transplantation This protocol is suitable for patients aged 25-60 years. It may
More informationFLAG-Ida + Gemtuzumab Ozogamicin Regimen (Also known as FLAG-Ida + GO3x2) (AML19 Trial Course 1)
FLAG-Ida + Gemtuzumab Ozogamicin Regimen (Also known as FLAG-Ida + GO3x2) (AML19 Trial Course 1) AML19 Adults with Acute Myeloid Leukaemia or High-Risk Myelodysplastic Syndrome ***Refer to trial protocol
More informationCARFILZOMIB /DEXAMETHASONE (CarDex)
CARFILZOMIB /DEXAMETHASONE (CarDex) INDICATIONS First Relapse multiple myeloma in bortezomib naïve patients [NICE TA457] Requires Blueteq Application TREATMENT INTENT Disease modification PRE-ASSESSMENT
More informationCisplatin and Fluorouracil (palliative)
Cisplatin and Fluorouracil (palliative) Indication Palliative chemotherapy for recurrent or metastatic head and neck squamous cell cancer where combination treatment with cetuximab is not indicated. PS0-1
More informationNCCP Chemotherapy Regimen. LEAM Autologous Transplant Conditioning Protocol
INDICATIONS FOR USE: LEAM Autologous Transplant Conditioning Protocol Regimen *Reimbursement INDICATION ICD10 Code Status Autologous conditioning in non-hodgkins Lymphoma (NHL) C85 00468a Hospital Autologous
More informationCisplatin / 5-Fluorouracil for Vulval Cancer
Cisplatin / 5-Fluorouracil for Vulval Cancer Indication: Palliative therapy in patients with Vulval Cancer Regimen details: Cisplatin 75mg/m 2 (*) IV 5-Fluorouracil (5-FU) 1000mg/m 2 /24 hours IV D4 (*)Consider
More informationBreast Pathway Group TC (Docetaxel / Cyclophosphamide) in Early Breast Cancer
Breast Pathway Group TC (Docetaxel / Cyclophosphamide) in Early Breast Cancer Indication: Neoadjuvant or adjuvant treatment for patients in whom anthracyclines are contraindicated or inappropriate Regimen
More informationNCCP Chemotherapy Regimen. DOXOrubicin, Cyclophosphamide (AC 60/600) 21 day followed by weekly PACLitaxel (80) and weekly Trastuzumab Therapy (AC-TH)
DOXOrubicin, Cyclophosphamide (AC 60/600) 21 day followed by weekly PACLitaxel (80) and weekly Trastuzumab Therapy (AC-TH) Note: There is an option for Dose Dense DOXOrubicin, cyclophosphamide PACLitaxel
More informationHigh Intensity Chemotherapy Guidelines for Haematology Patients at ASPH
High Intensity Chemotherapy Guidelines for Haematology Patients at ASPH Contents: Page No. 1. Overview 2 2. Admission 3 3. Admission Checklist 5 4. Inpatient management during chemotherapy 6 5. Inpatient
More informationObinutuzumab+Bendamustine followed by Obinutuzumab Maintenance Burton in-patient Derby in-patient Burton day-case Derby day-case
Obinutuzumab+Bendamustine followed by Obinutuzumab Maintenance Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Available
More informationGemcitabine + Cisplatin Regimen
Gemcitabine + Cisplatin Regimen Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient Indication
More informationBreast Pathway Group Epirubicin & Cyclophosphamide x 4 followed by Carboplatin & Paclitaxel x 4 for Early Breast Cancer
Breast Pathway Group Epirubicin & Cyclophosphamide x 4 followed by Carboplatin & Paclitaxel x 4 for Early Breast Cancer Indication: Neoadjuvant therapy for patients with BRCA1/2 mutations EC Regimen details:
More informationEC-Docetaxel: Epirubicin / Cyclophosphamide followed by Docetaxel in Breast Cancer
EC-Docetaxel: Epirubicin / Cyclophosphamide followed by Docetaxel in Breast Cancer Indication: Neoadjuvant therapy f high risk and fit Breast Cancer patients, suitable f a taxane containing regimen EC
More informationTREATMENT INTENT Disease modification- see European LeukemiaNet (ELN) 2013 guidelines for treatment goals.
BOSUTINIB INDICATION Licensed / NICE TA401 (BLUETEQ required) The treatment of adult patients with chronic, accelerated and blast phase Philadelphia chromosome positive chronic myeloid leukaemia (Ph+ CML)
More informationBreast Pathway Group Oral Vinorelbine 3 weekly cycle in Advanced Breast Cancer
Breast Pathway Group Oral Vinorelbine 3 weekly cycle in Advanced Breast Cancer Indication: Regimen details: Administration: Frequency: Pre-medication: Anti- emetics: Supportive medication: Extravasation:
More informationBortezomib, Thalidomide and Dexamethasone (VTD) 28 day
Bortezomib, Thalidomide and Dexamethasone (VTD) 28 day Indication First line treatment of multiple myeloma in patients who are eligible for stem cell transplantation. (NICE TA311) ICD-10 codes Codes with
More information