Allergies: Forename Surname. Deviations from standard treatment plan: Date Deviation Duration (eg 1 cycle only) measurable urine Bence
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1 Chemotherapy Prescription Chart Allergies: Forename Surname Address Telephone DoB Unit o HS o SUBCUTAEOUS TREATMET Consultant Ward Protocol Diagnosis Treatment Intent + DEXAMETHASOE Relapsed Multiple Myeloma Palliative, Curative, Adjuvant, eoadjuvant, Other: Planned number of Cycles: (If adjuvant state full number of cycles, if palliative, curative or neoadjuvant state number of cycles until next assessment for response) Deviations from standard treatment plan: Deviation Duration (eg cycle only) Prescribing otes: Consider withholding antihypertensives on morning of treatment. Clearance may be impaired in patients with hepatic impairment monitor closely for increased toxicity. Prescribe Proton Pump Inhibitor with high dose. (Choice of PPI according to local formulary) For bulky disease consider prescribing allopurinol Grade I Paraesthesia / Loss of reflexes (Without pain or loss of function) o action Grade I with pain or Grade II Paraesthesia / Loss of reflexes (Interfering with function but not activities of daily living) reduce to mg/m 2 Grade II with pain or Grade III Paraesthesia / Loss of reflexes (Interfering with activities of daily living) withhold until toxicity resolves, then reinitiate at 0.7mg/m2 WEEKL Grade 3 onhaematoilogical toxicities: Delay treatment. When symptoms resolve restart treatment with 25% dose reduction. 2 Cycle (Treatment on,,, ) Velcade Response Scheme: Pharmacy may not be able to supply treatment if this section is not completed. Is patient at first relapse? o eligability es Does patient have o Does patient have o measurable MProtein measurable urine Bence es Jones Protein es Record MProtein (Reassess after cycles) [Response: 50% or greater reduction] Grade IV Haematological toxicities: Delay treatment. When symptoms resolve restart treatment with 25% dose reduction. Record Bence Jones Pr (Reassess after cycles) [Response: 90% or greater reduction] Agree response criteria with OrthoBiotec before starting treatment es Criteria: Parameter: Response = Result: : Result: : : Agreed by:
2 Patient ame: of Birth: Bortezomib+Dex Cycle Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 75 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
3 Patient ame: of Birth: Bortezomib+Dex Cycle 2 Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 75 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
4 Patient ame: of Birth: Bortezomib+Dex Cycle 3 Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 50 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
5 Patient ame: of Birth: Bortezomib+Dex Cycle Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 50 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection for response before cycle 5 / Prescribed by: Confirmed by: ed by : : : : : :
6 Patient ame: of Birth: Velcade Response Scheme: Ensure a copy of this form is sent to pharmacy even if the patient is stopping treatment. Prescribed by: Confirmed by: ed by : : : : : :
7 Patient ame: of Birth: Bortezomib+Dex Cycle 5 Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 50 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
8 Patient ame: of Birth: Bortezomib+Dex Cycle 6 Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 50 st /! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Prescribed by: Confirmed by: ed by : : : : : :
9 Higher concentration injection Prescribed by: Confirmed by: ed by : : : : : :
10 Patient ame: of Birth: Bortezomib+Dex Cycle 7 Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 75 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
11 Patient ame: of Birth: Bortezomib+Dex Cycle Value ed Height cm Serum Creatinine 20µmol/l CrCl 70ml/min Hb g / litre PLT 75 x 0 9 / litre AC.0 x 0 9 / litre Type of, o of lumen: Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre Hb g / litre PLT 30 x 0 9 / litre AC 0.75 x 0 9 / litre & / Infusion ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT ODASETRO mg ORAL mg SUB CUT 2, 5, 9, 2 2, 5, 9, 2 & DEXAMETHASOE supply Qty OCE Daily on the OCE Daily on days to 2 ACICLOVIR 200mg Three times day ORAL 200mg 50 st! SUB CUTAEOUS TREATMET CHECK ROUTE CAREFULL! Higher concentration injection / Prescribed by: Confirmed by: ed by : : : : : :
12 Intentionally Blank Page
13 Document Title: Document o: Author: Approved by: Bortezomib Dexamethasone SUBCUTAEOUS Prescription CRR0H0SC Calum Polwart, etwork Pharmacist EC Diane Plews for Review: December 20 Summary of Changes 3.0a Sub Cut version 3.a Updated to add aciclovir Current Version: Approved: 3.a Dec 202
Bortezomib, Thalidomide & Dexamethasone
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NECN CHEMOTHERAPY HANDBOOK PROTOCOL
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DRAFT FOR PUBLIC CONSULTATION
SEE MYELOMA ELIGIBLE egfr < 30ml/min Multiple myeloma despite correction of hypercalcaemia and dexamethasone? Yes Transplant eligible? Yes SEE MYELOMA- RENAL SEE MYELOMA INELIGIBLE KEY Click to move to
VTDPACE. Myeloma group INDICATION
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CARFILZOMIB /DEXAMETHASONE (CarDex)
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TREATMENT INTENT Disease modification- see European LeukemiaNet (ELN) 2013 guidelines for treatment goals.
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DTPACE. Myeloma group INDICATION
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BCCA Protocol Summary for the Treatment of Relapsed or Refractory Advanced Stage Aggressive B-Cell Non-Hodgkin s Lymphoma with Ifosfamide, CARBOplatin, Etoposide and rituximab Protocol Code Tumour Group
PANOBINOSTAT / BORTEZOMIB (VELCADE) / DEXAMETHASONE (PanBorDex)
PANOBINOSTAT / BORTEZOMIB (VELCADE) / DEXAMETHASONE () INDICATION Relapsed or relapsed and refractory multiple myeloma in patients who have received at least 2 prior lines of therapy including bortezomib
Rituximab-CHOP Regimen - ENRICH Study
Rituximab-CHOP Regimen - Study Randomised, open label study of Rituximab/Ibrutinib vs Rituximab/Chemotherapy in older patients with untreated mantle cell lymphoma ***See protocol for further details***
Cisplatin 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
Breast 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
Integrated Care Pathway (ICP) for the. Management of clozapine INPATIENT INITIATION
Document Reference MM 048 Integrated Care Pathway (ICP) for the Management of clozapine INPATIENT INITIATION Surname Title Address Forenames Date of Birth RT/NHS number Care Co-ordinator GP CS number Consultant
E 90 C followed by Weekly Paclitaxel
E 90 C followed by Weekly Paclitaxel 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
BORTEZOMIB (VELCADE) WEEKLY / Cyclophosphamide / Dexamethasone (VCD)
BORTEZOMIB (VELCADE) WEEKLY / Cyclophosphamide / Dexamethasone () INDICATION Appropriate therapy for multiple myeloma patients with relapsed or refractory disease who have received at least one line of
Gemcitabine + 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
X 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
Use ideal body weight (IBW) unless actual body weight is less. Use the following equation to calculate IBW:
Amikacin is a partially restricted (amber) antibiotic for the treatment of infections due to gentamicin resistant Gram negative bacilli or as advised by microbiology. As with other aminoglycosides, therapeutic
Obinutuzumab+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
Cisplatin100 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
This 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
Subcutaneous Rituximab with or without Ibrutinib, Maintenance Period - ENRICH Study
Subcutaneous Rituximab with or without Ibrutinib, Maintenance Period Study Randomised, open label study of Rituximab/Ibrutinib vs Rituximab/Chemotherapy in older patients with untreated mantle cell lymphoma
DERBY-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
Irinotecan Capecitabine (14 day regimen) (I-Cap)
Systemic Anti Cancer Treatment Protocol Irinotecan (14 day regimen) (I-Cap) PROTOCOL REF: MPHAICAP (Version No: 1.0) Approved for use in: Advanced colorectal cancer first line Advanced colorectal cancer
(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
Carboplatin and Gemcitabine
Systemic Anti Cancer Treatment Protocol Carboplatin and Gemcitabine PROTOCOL REF: MPHACAGELU (Version No: 1.0) Approved for use in: Advanced non-small cell lung cancer Performance status: 0 to 2 Re-challenge
THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST
Outpatient Anti Cancer Treatment Handbook LCV Lomustine, Cisplatin, Vincristine Packer Regimen Repeated every 6 weeks for a maximum of 6 cycles Approved for use in: Medulloblastoma adjuvant therapy Dosage:
NCCP Chemotherapy Regimen. Carfilzomib, Lenalidomide and Dexamethasone (KRd) Therapy - 28 day
, Lenalidomide and Dexamethasone (KRd) Therapy - INDICATIONS FOR USE: INDICATION ICD10 Regimen Code Reimbursement Status *, lenalidomide and dexamethasone therapy is indicated for the treatment of adult
DERBY-BURTON CANCER NETWORK CONTROLLED DOC NO:
OBINUTUZUMAB+CHLORAMBUCIL Regimen RDH; Day 1 and 2 Dose to be given on Ward Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community
Cisplatin 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
in people with intermediate 2 or high-risk disease, AND if the company provides ruxolitinib with the discount agreed in the patient access scheme.
RUXOLITINIB INDICATION Licensed / NICE TA386 is recommended as an option f treating disease-related splenomegaly symptoms in adults with primary myelofibrosis (also known as chronic idiopathic myelofibrosis),
Guideline for the Use of Granulocyte Colony Stimulating Factor (G-CSF) for Adults in Oncology and Haematology
(G-CSF) for Adults in Oncology and Haematology For Use in: By: Oncology and Haematology Inpatients and Outpatients Oncologists and Haematologists For: Division responsible for document: Key words: Name
Gemcitabine (1000mg/m 2 ) Monotherapy - 28 day
Gemcitabine (1000mg/m 2 ) Monotherapy - 28 day INDICATIONS FOR USE: Regimen INDICATION ICD10 Code Adjuvant chemotherapy for pancreatic adenocarcinoma C25 00284a Treatment of elderly patients or patients
Cisplatin / 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
Carboplatin / Liposomal Doxorubicin CARBO/CAELYX Gynaecological Cancer
Systemic Anti Cancer Treatment Protocol Carboplatin / CARBO/CAELYX Gynaecological Cancer PROCTOCOL REF: MPHAGYNCCX (Version No: 1.0) Approved for use in: Advanced ovarian cancer in women who have progressed
Breast 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
BCCA Protocol Summary for Therapy of Multiple Myeloma Using Pomalidomide with Dexamethasone
BCCA Protocol Summary for Therapy of Multiple Myeloma Using Pomalidomide with Dexamethasone Protocol Code UMYPOMDEX Tumour Group Contact Physician Contact Pharmacist Lymphoma, Leukemia/BMT Dr. Kevin Song
TIP 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