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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications:

Modified Machover Colonic Cancer - Adjuvant Dose 50mg 370mg/m2 Every four weeks iv/infusion/oral iv iv q Days 1-5 Days 1-5 6

Schedule: Drug Calcium Folinate 5-Fluorouracil Cycle frequency:

Total number of cycles:

Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L for one week • Suck ice before and during 5-FU injection • Calcium Folinate given first Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, cardiotoxicity, conjunctivitis, severe diarrhoea, palmar-plantar syndrome, infertility Symptomatic treatment of side effects: Prophylactic mouth care, anti-diarrhoeals, pyridoxine cream Investigations Pre-treatment: • History and Examination • Performance score, weight • FBC • U & E’s, LFTs, creatinine, urate • LDH, CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, creatinine • LDH, CEA Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle Quasar 2000. Lancet, 6; pages 1588-1596

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Department of Medical Oncology

Chemotherapy Protocols

Protocol: Indications:

Weekly QUASAR Colonic Cancer – Adjuvant Dose 50mg 370mg/m2 Every week iv/infusion/oral iv iv q Day 1 Day 1 30

Schedule: Drug Calcium Folinate 5-Fluorouracil Cycle frequency:

Total number of cycles:

Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1.5 x 109/L or platelets < 100 x 109/L for one week • Suck ice before and during 5-FU injection • Calcium Folinate given first Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage, nausea, mucositis, cardiotoxicity, conjunctivitis, severe diarrhoea, palmar-plantar syndrome, infertility Symptomatic treatment of side effects: Prophylactic mouth care, anti-diarrhoeals, pyridoxine cream Investigations Pre-treatment: • History and Examination • Performance score, weight • FBC • U & E’s, LFTs, creatinine, urate • LDH, CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score, weight • FBC • U & E’s, LFTs, creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after every 6 cycles Review in Medical Oncology Clinic 4 weeks after last cycle Quasar 2000. Lancet, 6; pages 1588-1596

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infertility Symptomatic treatment of side effects: Prophylactic mouth care. anti-diarrhoeals. pages 246-250 3rd Edition 36 . 15. creatinine. LFTs. mucositis. pyridoxine cream Investigations Pre-treatment: • History and Examination • Performance score. cardiotoxicity. nausea. reduce 5-FU dose by approximately 20% Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. conjunctivitis.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Mayo Colonic Cancer . J.. severe diarrhoea.Adjuvant Dose 50mg 425mg/m2 Every four weeks iv/infusion/oral iv iv q Days 1-5 Days 1-5 6 Schedule: Drug Calcium Folinate 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant. palmar-plantar syndrome. 1997. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. weight • FBC • U & E’s.5 x 109/L or platelets < 100 x 109/L for one week • Suck ice before and during 5-FU injection • Calcium Folinate given first Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. Oncol. or if delayed for > 1 week. urate • LDH. weight • FBC • U & E’s. If toxicity experienced. Clin. LFTs. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle O’Connell et al.

5 x 109/L or platelets < 100 x 109/L • Oxaliplatin and Calcium Folinate given concurrently Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. weight • FBC • U & E’s. Oncol. urate • LDH. weight • FBC • U & E’s. LFTs. infertility Symptomatic treatment of side effects: Prophylactic mouth care.36 3 Schedule: Drug Oxaliplatin Calcium Folinate 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group . LFTs. Post Treatment: Reference: Review in Medical Oncology Clinic 4 weeks after last cycle Wolmark et al. abstract LBA3500 3rd Edition 37 .29. J. alopecia. mucositis.8. 2005. peripheral neuropathy. Ca2+. anti-diarrhoeals Investigations Pre-treatment: • History and Examination (CNS examination) • Performance score. Clin. palmar-plantar syndrome. pharyngolaryngeal dysaesthesia.29.15. Ca2+.Moderately high with Oxaliplatin • Delay if neutrophils < 1. nausea & vomiting. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • CNS examination • Performance score. severe diarrhoea. 15 & 29 Days 1.. cardiotoxicity.8. carcinogenesis.36 Days 1.15.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: FLOX Colon Cancer (Adjuvant) Dose 85mg/m2 350mg 500mg/m2 Every eight weeks iv/infusion/oral 250mls 5% dex/2hrs 250mls 5% dex/2hrs iv (5 min) q Days 1. creatinine.22. 23(16s). creatinine • LDH. paraesthesia. conjunctivitis.22.

Metastatic Dose 350mg 400mg/m2 2. 87. creatinine • LDH. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. pyridoxine cream Investigations Pre-treatment: • History and Examination • Performance score. Mid Treatment: Post Treatment: Reference: Re-assess after every four cycles Review in Medical Oncology Clinic 4 weeks after last cycle Cheeseman et al. pages 393-399 3rd Edition 38 . LFTs. mucositis. weight • FBC • U & E’s.8g/m2 Every two weeks iv/infusion/oral 250mls N. J. 2002.5 x 109/L or platelets < 100 x 109/L • Suck ice before and during 5-FU bolus injection • Calcium Folinate given first Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. Br. LFTs. Saline/2hrs iv (5 mins) 4L N. anti-diarrhoeals. creatinine. urate • LDH. Cancer. palmar-plantar syndrome. cardiotoxicity. conjunctivitis. nausea. infertility Symptomatic treatment of side effects: Prophylactic mouth care. weight • FBC • U & E’s. severe diarrhoea.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Modified de Gramont Colonic Cancer . Saline/46hrs q Day 1 Day 1 Days 1 & 2 up to 12 Schedule: Drug Calcium Folinate 5-Fluorouracil 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1.

infertility Symptomatic treatment of side effects: Mouth care. nausea & vomiting. mucositis. alopecia. amenorrhoea. flushing.5 mls) s/c. urate • LDH. LFTs.. Recurrent Dose 350mg/m2 Every three weeks iv/infusion/oral 250mls 5% dex/90min q Day 1 6 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high • Delay if neutrophils < 1. 1997. increased sweating and salivation. weight • FBC • U & E’s. Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle Rougier et al. or aged 70 years + Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. J. if required • Start at 250mg/ m2 if unwell. or PS=2. creatinine • LDH. LFTs. Oncol. severe diarrhoea. Clin. encourage oral fluids Investigations Pre-treatment: • History and Examination • Performance score. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. 15. Loperamide. pages 251-260 3rd Edition 39 .5 x 109/L or platelets < 100 x 109/L • Pre-medication with atropine 300 μg (0. abdominal cramps. weight • FBC • U & E’s.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Irinotecan Irinotecan Colonic Cancer – Palliative. creatinine.

2004. LFTs. Investigations Pre-treatment: • History and Examination (CNS mandatory) • Performance score.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Oxaliplatin Oxaliplatin Colonic Cancer . Ann. 15. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • CNS examination • Performance score. nausea & vomiting. weight • FBC • U & E’s. diarrhoea. weight • FBC • U & E’s. pharyngolaryngeal dysaesthesia. Oncol. Mg2+. anti-diarrhoeals. LFTs. creatinine • LDH. creatinine. Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle Ducreux et al. Ca2+. infertility Symptomatic treatment of side effects: Prophylactic mouth care.. alopecia. mucositis. urate • LDH. Mg2+. peripheral neuropathy.Metastatic Dose 130mg/m2 Every three weeks iv/infusion/oral 250mls 5% dex/2hrs q Day 1 6 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high • Delay if neutrophils < 1. pages 467-473 3rd Edition 40 . carcinogenesis. Ca2+. paraesthesia.5 x 109/L or platelets < 100 x 109/L Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage.

anti-diarrhoeals Investigations Pre-treatment: • History and Examination (CNS mandatory) • Performance score. Ca2+. Mg2+. severe diarrhoea. infertility Symptomatic treatment of side effects: Prophylactic mouth care. nausea & vomiting. J. creatinine. pages 393-399 3rd Edition 41 . LFTs. Ca2+. (alopecia). weight • FBC • U & E’s. creatinine • LDH. urate • LDH. 2002. LFTs. peripheral neuropathy. Mg2+.Metastatic Dose 85mg/m2 350mg 400mg/m2 2. mucositis. Br. Mid Treatment: Post Treatment: Reference: Restage after 6 cycles Review in Medical Oncology Clinic 4 weeks after last cycle Cheeseman et al. Saline/46hrs q Day 1 Day 1 Day 1 Days 1 & 2 up to 12 Schedule: Drug Oxaliplatin Calcium Folinate 5-Fluorouracil 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high with Oxaliplatin • Delay if neutrophils < 1. pharyngolaryngeal dysaesthesia. paraesthesia.5 x 109/L or platelets < 100 x 109/L • Oxaliplatin and Calcium Folinate given concurrently • Plan Bevacizumab if appropriate Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. cardiotoxicity. weight • FBC • U & E’s. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • CNS examination • Performance score.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Oxaliplatin with Modified de Gramont (FOLFOX6) Colonic Cancer . carcinogenesis.4g/m2 Every two weeks iv/infusion/oral 250mls 5% dex/2hrs 250mls 5% dex/2hrs iv (5mins) 4L N. Cancer. 87.

Post Treatment: Reference: Restage after 6 cycles Review in Medical Oncology Clinic 4 weeks after last cycle Tournigand et al. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • CNS examination • Performance score. mucositis. LFTs. pages 229-237 3rd Edition 42 . cardiotoxicity. increased sweating and salivation.5 x 109/L or platelets < 100 x 109/L • Pre-medication with atropine 300µg (0. Clin.Metastatic Dose 180mg/m2 350mg 400mg/m2 2.5mls) s/c may be required • Suck ice before and during 5-FU bolus injection • Plan Bevacizumab if appropriate Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. severe diarrhoea. creatinine. Loperamide. weight • FBC • U & E’s. flushing. abdominal cramps. 22 . J. weight • FBC • U & E’s. Saline/2hrs iv (5mins) 4L N.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Irinotecan with Modified de Gramont (FOLFIRI) Colonic Cancer . nausea & vomiting. alopecia. urate • LDH. infertility Symptomatic treatment of side effects: Prophylactic mouth care. creatinine • LDH.. Saline/46hrs q Day 1 Day 1 Day 1 Days 1 & 2 up to 12 Schedule: Drug Irinotecan Calcium Folinate 5-Fluorouracil 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderately high with Irinotecan • Delay if neutrophils < 1. LFTs. Oncol.4g/m2 Every two weeks iv/infusion/oral 250mls 5% dex/30mins 250mls N. amenorrhoea. Mid Treatment. 2004. encourage oral fluids Investigations Pre-treatment: • History and Examination (CNS mandatory) • Performance score.

infertility. 2000. urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. LFTs. skin rash. Oncol.. J. weight • FBC • U & E’s. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology outpatients 4 weeks after last cycle Van Cutsem et al. creatinine. diarrhoea. amenorrhoea. Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score. nausea & vomiting.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Capecitabine Capecitabine Colonic Cancer – Adjuvant or Metastatic Dose 1250mg/m2 bd Every three weeks iv/infusion/oral oral q Days 1-14 8 (if adjuvant) Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. LFTs. palmar-plantar syndrome. hair thinning. mucositis.5 x 109/L or platelets < 100 x 109/L • Ensure patient education regarding palmar-plantar syndrome • Round Capecitabine tablets to the nearest 150mg or 500mg (see data sheet) Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. weight • FBC • U & E’s. pages 1337-1345 3rd Edition 43 . 18. Clin.

Oncology. skin rash. flushing. amenorrhoea. cardiotoxicity. pages 353-357 3rd Edition 44 . palmar-plantar syndrome. peripheral neuropathy. weight • FBC • U & E’s. hypersensitivity reactions. 2004. increased sweating and salivation. alopecia.5 x 109/L or platelets < 100 x 109/L • Pre-medication with atropine 300ug (0. hepatic dysfunction. mucositis. 66. creatinine. fluid retention. LFTs. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology outpatients 4 weeks after last cycle Park et al.5mls) s/c may be required • Ensure patient education regarding palmar-plantar syndrome • Round Capecitabine dose to nearest 500mg or 150mg (see data sheet) • Plan Bevacizumab if appropriate Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage.Moderately high with Irinotecan • Delay if neutrophils < 1. nausea & vomiting. infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Irinotecan Capecitabine Irinotecan/Capecitabine (XELIRI) Colonic Cancer – Metastatic Dose 240mg/m2 1000mg/m2 bd Every three weeks iv/infusion/oral 250mls 5% dex/30min oral q Day 1 Days 1-14 6 -12 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group . urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. weight • FBC • U & E’s. LFTs. severe diarrhoea.

. alopecia. hypersensitivity reactions. Oncol. peripheral neuropathy. amenorrhoea. nausea & vomiting. Clin.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Oxaliplatin Capecitabine Oxaliplatin/Capecitabine (XELOX) Colonic Cancer – Metastatic Dose 130mg/m2 1000mg/m2 bd Every three weeks iv/infusion/oral 250mls 5% dex/2hrs oral q Day 1 Days 1-14 6 -12 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group . pages 2084-2091 3rd Edition 45 . paraesthesia. 22. urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. creatinine.5 x 109/L or platelets < 100 x 109/L • Ensure patient education regarding palmar-plantar syndrome • Round Capecitabine dose to nearest 500mg or 150mg (see data sheet) • Plan Bevacizumab if appropriate Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage.. weight • FBC • U & E’s. palmar-plantar syndrome. pharyngolaryngeal dysaesthesia.Moderately high with Oxaliplatin • Delay if neutrophils < 1. weight • FBC • U & E’s. severe diarrhoea. skin rash. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology outpatients 4 weeks after last cycle Cassidy et al. 2004. LFTs. infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score. hepatic dysfunction. cardiotoxicity. LFTs. mucositis.

pages 337-345 3rd Edition 46 . creatinine. anorexia.Department of Medical Oncology Chemotherapy Protocols Protocol: Indication: Schedule: Drug Cetuximab Cetuximab Cetuximab (Erbitux) Colorectal cancer . hypotension. chills/fevers.. weight • FBC • U & E’s. LFTs. urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. creatinine • LDH Post Treatment: Reference: Review in Medical Oncology Clinic 4 weeks after last cycle Cunningham et al. constipation. skin rash. 2004. asthenia. stomatitis. rigors. J. N. Engl. LFTs. Med. weight • FBC • U & E’s.0 x 109/L or platelets < 100 x 109/L • Pre-med with Chlorpheniramine • With Irinotecan (180 – 350mg/m2 ) every three weeks Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. bronchospasm. hyper-sensitivity reaction. allergic-like reaction. acne Symptomatic treatment of side effects: Supportive therapy Investigations Pre-treatment: • History and Examination • Performance score. 351.metastatic Dose 400mg/m2 250mg/m2 Every week Discuss with Consultant iv/infusion/oral iv (2hrs) as per datasheet iv (1hr) as per datasheet q Day 1 weekly Indefinite Cycle frequency: Dose modification: Total number of cycles: Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. infertility. carcinogenesis. nausea.

blood pressure. 350. creatinine. weight. administer 4 cycles only Toxicities: Hypersensitivity reaction. 2004. Clin. 23. proteinuria • FBC • U & E’s. urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score.. LFTs.Department of Medical Oncology Chemotherapy Protocols Protocol: Indication: Schedule: Drug Bevacizumab Bevacizumab (Avastin) Colorectal cancer . allergic-like reaction. pages 792-799 3rd Edition 47 . 2005.metastatic Dose 5mg/kg Every 2 weeks iv/infusion/oral 100mls N. J. proteinuria. skin rash. GI perforation Symptomatic treatment of side effects: Supportive therapy Investigations Pre-treatment: • History and Examination • Performance score. LFTs. Saline (as below) q each cycle Indefinite Total number of cycles: Discuss with Consultant Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. impaired wound healing. weight. pages 2335-2342 Miller et al..0 x 109/L or platelets < 100 x 109/L • 1st infusion – 90mins. Engl. N. Saline (as below) q each cycle Indefinite Cycle frequency: OR Drug Bevacizumab Cycle frequency: Dose modification: Total number of cycles: Dose 7. blood pressure. creatinine • LDH Post Treatment: Reference: Review in Medical Oncology Clinic 4 weeks after last cycle Hurwitz et al. Oncol. proteinuria • FBC • U & E’s.5mg/kg Every 3 weeks in/infusion/oral 100mls N. hypertension. 3rd infusion – 30mins • If the patient is a candidate for surgery. Med. thromboembolism. J. 2nd infusion – 60mins.

conjunctivitis. weight • FBC • U & E’s. Med. 1994. urate • LDH. LFTs. mucositis. anti-diarrhoeals. severe diarrhoea. If toxicity experienced.. creatinine. 331. nausea. pyridoxine cream Investigations Pre-treatment • History and Examination • Performance score. palmar-plantar syndrome. LFTs.Department of Medical Oncology Chemotherapy Protocols Protocol: Indication: Modified O’Connell (5-Fluorouracil/RT) Rectal Cancer – Adjuvant Dose 425mg/m2 45Gy 225mg/m2/24hrs Every four weeks iv/infusion/oral iv 5 weeks continuous infusion q Days 1-5 Start day 56 for 5 weeks 4 Schedule: Drug 5-Fluorouracil Radiotherapy With 5-Fluorouracil Cycle frequency: Dose modification: Total number of cycles: Discuss with Consultant. Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle O’Connell et al.5 x 109/L or platelets < 100 x 109/L for one week • Suck ice before and during 5-FU injection Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. or if delayed for > 1 weeks. infertility Symptomatic treatment of side effects: Prophylactic mouth care. reduce 5-FU dose by 20% Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. N. Engl. CEA • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. creatinine • LDH. J. pages 502-507 3rd Edition 48 . weight • FBC • U & E’s. cardiotoxicity.

Oncol. Ca2+..5 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function • Hickman line required • Pre & post hydration. pyridoxine Investigations Pre-treatment: • History and Examination • Performance score. weight • FBC • U & E’s. creatinine clearance • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after 3 cycles (endoscopy +/. diarrhoea. potassium & magnesium Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. weight • FBC • U & E’s. Metastatic. Mg2+.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Epirubicin Cisplatin 5-Fluorouracil ECF (Epirubicin/Cisplatin/5-Fluorouracil) Oesophageal/Gastric – Neoadjuvant.radiology) Review in Medical Oncology Clinic 4 weeks after last cycle Findlay et al. mucositis. Locally advanced Dose 50mg/m2 60mg/m2 200mg/m2/24hrs Every three weeks in/infusion/oral iv 1L N. Saline/2hrs continuous infusion q Day 1 Day 1 Days 1-21 6 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – High • Delay if neutrophils < 1. pages 609-616 3rd Edition 49 . 1994. Cardiotoxicity. nausea & vomiting. mannitol. Mg2+. infertility Symptomatic treatment of side effects: Mouth care. carcinogenesis. anti-diarrhoeals. Ann. Ca2+. alopecia. peripheral neuropathy. urate. 5. creatinine. Nephrotoxicity. palmar-plantar syndrome. LFTs. LFTs.

weight • FBC • U & E’s. Mg2+. carcinogenesis.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Cisplatin 5-Fluorouracil CF (Cisplatin/5-Fluorouracil) Oesophageal – Neoadjuvant Dose 75mg/m2 1g/m2/24 hrs Every three weeks iv/infusion/oral 1L N. peripheral neuropathy. Ca2+. 359. anti-diarrhoeals. palmar-plantar syndrome. infertility Symptomatic treatment of side effects: Mouth care. pyridoxine Investigations Pre-treatment: • History and Examination • Performance score. creatinine clearance • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. LFTs. Mg2+. creatinine. alopecia.5 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function • Pre & post hydration. Lancet. mannitol. cardiotoxicity. LFTs. ototoxicity. pages 1727-1733 3rd Edition 50 . urate. nephrotoxicity. diarrhoea. potassium & magnesium Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. Saline/2hrs continuous infusion q Day 1 Days 1-4 2 Cycle frequency: Total number of cycles: (neoadjuvant) Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – High • Delay if neutrophils < 1. weight • FBC • U & E’s.radiology) Review in Medical Oncology Clinic 3 weeks after last cycle MRC Oesophageal Cancer WP. 2002. Ca2+. creatinine • LDH Mid Treatment: Post Treatment: Reference: Re-assess after 2 cycles (endoscopy +/. nausea & vomiting. mucositis.

infertility Symptomatic treatment of side effects: Mouth care. pyridoxine Investigations Pre-treatment • History and Examination • Performance score. N. Mg2+. Saline/2hrs continuous infusion 5 weeks q Day 1 Days 1-4 Start Day 1 4 Cycle frequency: Total number of cycles: (First 2 cycles with RT) Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – High • Delay if neutrophils < 1. anti-diarrhoeals. palmar-plantar syndrome. urate.Department of Medical Oncology Chemotherapy Protocols Protocol: Indication: Schedule: Drug Cisplatin 5-Fluorouracil Radiotherapy Herskovic (Cisplatin/5-Fluorouracil/RT) Oesophageal – Locally advanced (inoperable) Dose 75mg/m2 1g/m2/24hrs 50Gy Every four weeks iv/infusion/oral 1L N. cardiotoxicity. weight • FBC • U & E’s. Mg2+. diarrhoea. creatinine • LDH Mid Treatment: Post Treatment: Reference: Review in Medical Oncology post-radiotherapy Review in Medical Oncology Clinic 4 weeks after last cycle Herskovic et al. LFTs. J. carcinogenesis. mannitol. nausea & vomiting. Engl. Ca2+.. pages 1593-1598 3rd Edition 51 . creatinine. alopecia. potassium & magnesium • Concurrent radiotherapy may be necessary • Doses may change according to radiotherapy schedule Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. Ca2+. creatinine clearance • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. 1992. Med. weight • FBC • U & E’s.5 x 109/L or platelets < 100 x 109/L • Ensure adequate renal function • Pre & post hydration. nephrotoxicity. 326. mucositis. peripheral neuropathy. ototoxicity. LFTs.

8. creatinine. nausea. severe diarrhoea.4g/m2 Every three weeks iv/infusion/oral iv 250mls N. 1997. Saline/46hrs q Day 1 Day 1 Day 1 Days 1 & 2 4 Schedule: Drug Mitomycin C Calcium Folinate 5-Fluorouracil 5-Fluorouracil Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group – Moderate • Delay if neutrophils < 1. conjunctivitis. weight • FBC • U & E’s. pages 995-1001 3rd Edition 52 . infertility. creatinine • LDH • Blood film Mid Treatment: Post Treatment: Reference: Re-assess after every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle. no red cell fragmentation Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. Ross et al.5 x 109/L or platelets < 100 x 109/L • Suck ice before and during 5-Fluorouracil bolus injection • Ensure serum creatinine is within normal levels • Blood film is normal i. palmar-plantar syndrome Symptomatic treatment of side effects: Prophylactic mouth care. mucositis. cardiotoxicity.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: MMC with Modified de Gramont Gastric Cancer – Advanced Dose 6mg/m2 350mg 400mg/m2 2.. anti-diarrhoeals. pyridoxine cream Investigations Pre-treatment: • History and Examination • Performance score. Saline/2hrs iv (5mins) 4L N. Ann Oncol. urate • LDH • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score.e. LFTs. weight • FBC • U & E’s. LFTs.

weight • FBC • U & E’s. anti-diarrheals. or if delayed for > 1 week. Med. If toxicity experienced. infertility Symptomatic treatment of side effects: Prophylactic mouth care. palmar-plantar syndrome. 345. severe diarrhoea. pyridoxine cream Investigations Pre-treatment • History and Examination • Performance score..Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Modified MacDonald (5-Fluorouracil/FA/RT) Gastric Cancer – Adjuvant Dose 40mg/m2 425mg/m2 45Gy 20mg/m2 400mg/m2 Every four weeks iv/infusion/oral iv iv 5 weeks iv iv q Days 1-5 Days 1-5 Start day 29 First 4 & last 3 days of RT First 4 & last 3 days of RT 3 Schedule: Drug Calcium Folinate 5-Fluorouracil Radiotherapy Calcium Folinate 5-Fluorouracil Cycle frequency: Total number of cycles: (1 cycle prior to RT) Dose modifications: Discuss with Consultant. • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. conjunctivitis. LFTs. cardiotoxicity. creatinine. urate • LDH. pages 725-730 3rd Edition 53 . J. Engl. reduce 5-FU dose by 20% Administration and safety: • Anti-emetic group – Low • Delay if neutrophils < 1. weight • FBC • U & E’s. Post Treatment: Reference: Review in Medical Oncology Clinic 4 weeks after last cycle Macdonald et al. mucositis. N. LFTs.5 x 109/L or platelets < 100 x 109/L for one week • Suck ice before and during 5-FU injection • Calcium Folinate given first Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage. nausea. 2001. creatinine • LDH.

CA19-9 Mid Treatment: Post Treatment: Reference: After every two cycles Review in Medical Oncology Clinic 4 weeks after last cycle Burris et al. mucositis. Saline/30mins q Days 1. 15. CA19-9 • ECG • Staging investigations as per protocol Prior to each cycle: • Performance score. 1997. hair thinning. J. creatinine • LDH. infertility Symptomatic treatment of side effects: Mouth care Investigations Pre-treatment: • History and Examination • Performance score. flu-like symptoms. 8 &15 6 Cycle frequency: Total number of cycles: Dose modifications: Discuss with Consultant Administration and safety: • Anti-emetic group .Moderate • Delay if neutrophils < 1. rash. LFTs. Oncol. LFTs.5 x 109/L or platelets < 100 x 109/L • If unable to tolerate. weight • FBC • U & E’s.Department of Medical Oncology Chemotherapy Protocols Protocol: Indications: Schedule: Drug Gemcitabine Gemcitabine Pancreatic Cancer – Palliative Dose 1000mg/m2 Every four weeks iv/infusion/oral 200mls N. Clin. pages 2403-2413 3rd Edition 54 . urate • LDH.. nausea. weight • FBC • U & E’s. amenorrhoea. diarrhoea. creatinine. omit day 15 and give every 3 weeks Toxicities: Myelosuppression and risk of neutropenic sepsis or haemorrhage.