Chemotherapy Regimens

Gyne-oncology

Created by: Vesela Ivanova

Access to chemotherapy prescriptions

• Drive S: Global share

• MUHC_Oncology_PPO_adults (type PPO in

search box)

• Gynecology
Request for
chemotherapy
Updated weight and
• Must be submitted height from day of visit

with every new

regimen, in addition to c
chemotherapy
prescription Obligatory to fill
c
• Submitted for standard
chemotherapy, clinical
trials, chemotherapy
Case-by-case basis c
with concomitant
radiation, etc
Signature!
First line treatments
Carboplatin + Taxol
• Cycle = 3 weeks
• 1 line = 4-6 cycles
• Ovarian cancer c Limits for blood test

▫ First line or Second line

(recurrence) Hydration and pre-
treatment medications
• Endometrial cancer
▫ First line for high grade
or advanced stage
• ***Cervical cancer***
▫ Recurrent (not first Post-treatment medications

line)
Carboplatin + Taxol

• Taxol dose:
▫ Calculated with Body Surface Area (BSA). Must fill
• Carboplatin dose
▫ Pharmacy calculates with Creatinine level.
• Dose reductions:
▫ Side effects (e.g. peripheral neuropathy)
▫ Thrombocytopenia and/or Neutropenia and/or Anemia
▫ Age and/or functional status
Hypersensitivity reactions

• Reaction to Taxol
▫ Dexamethasone (Decadron) prescribed to take the night before
treatment
▫ When pre-medication does not work  Change to Abraxane
• Reaction to Carboplatin
▫ Change to Cisplatin
IP Carbo + Taxol
• Cycle = 3 weeks
• 6 cycles
• Stage 3 ovarian cancer
• Intraperitoneal port installed
during surgery
• Cycle 1 received as regular IV
treatment (standard
Carbo+Taxol prescription)
• Cycles 2-6 IP regimen:
▫ Day 1
 Taxol IV
 Carboplatin IP
▫ Day 8
 Taxol IP
Carboplatin + Taxol
(dose-dense)

• Advanced ovarian
cancer
• Cycle = 3 weeks
• 6 cycles
▫ Carboplatin on Day 1
▫ Taxol on Days 1,8,15
 Lower dose 80 mg
Second, third, fourth line treatments
 Caelyx

• Cycle = 4 weeks
• 6 cycles and more until
patient stops responding (up
to 1-2 years)
• Recurrent ovarian cancer
• Recurrent endometrial
cancer
▫ Dose calculated with BSA
• Well tolerated generally
▫ Side effects: skin
irritation/dryness, mouth
ulcers
Gemcitabine
• Cycle = 3 or 4 weeks
• 6 cycles
• Relapsed ovarian cancer
• Dose calculated with BSA
▫ Day 1 and 8
▫ Day 1, 8 and 15
Cisplatin + Radiotherapy

• Cycle = 1 week
• Advanced cervical cancer
• Cisplatin on Day 1
▫ Dose calculated with BSA
• Radiotherapy on Days 1-5
• 1 prescription is valid for 3
treatments (weeks 1 to 3)
• Patients are seen before
cycle 1 and before cycle 4.
Otherwise followed by
radiation team.
Cisplatin + Adriamycin
• Cycle = 3 weeks
• Maximum 7 cycles
• Advanced or metastatic
endometrial cancer
• Uterine leiomyosarcoma
• Dose calculated with BSA
Non-formulary drugs
Non-standard
chemotherapy

• Avastin
▫ VEGF inhibitor. Anti-
angiogenesis
▫ Form to be signed by
requesting physician +
Department head (Dr.
Gilbert)
▫ Usually given in
combination with
another chemotherapy
drug for recurrent cancer
(e.g. Caelyx + Avastin)
▫ Pharmacy has to approve
request
Questions?