Northern Ireland Cancer Network. Lung. Systemic Anti-Cancer Therapy. Protocols

Northern Ireland Cancer Network Lung Systemic Anti-Cancer Therapy Protocols V1.1 Northern Ireland Cancer Network Lung Systemic Anti-Cancer Therapy P...
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Northern Ireland Cancer Network Lung Systemic Anti-Cancer Therapy Protocols V1.1

Northern Ireland Cancer Network Lung Systemic Anti-Cancer Therapy Protocols

Contents Contents.................................................................................................................... 1 Authorisation of Lung Systemic Anti-Cancer Therapy (SACT) Protocols ................... 2 Non Small Cell Lung Cancer Systemic Anti-Cancer Therapy Protocols ..................... 3 Cisplatin/Vinorelbine .............................................................................................. 3 Cisplatin/Etoposide + XRT ..................................................................................... 7 Gemcitabine/Carboplatin ..................................................................................... 11 Paclitaxel/Carboplatin .......................................................................................... 15 Cisplatin/Gemcitabine .......................................................................................... 19 Cisplatin/Docetaxel .............................................................................................. 23 Gemcitabine ........................................................................................................ 27 Vinorelbine 30...................................................................................................... 30 Gefitinib ............................................................................................................... 33 Erlotinib ............................................................................................................... 36 Docetaxel ............................................................................................................ 40 Small Cell Lung Systemic Anti-Cancer Therapy Protocols ...................................... 43 Cisplatin/Etoposide + XRT ................................................................................... 43 Cisplatin/Etoposide .............................................................................................. 47 Carboplatin/Etoposide Phosphate........................................................................ 51 Carboplatin .......................................................................................................... 55 Vincristine/doxorubicin/cyclophosphamide ........................................................... 57 Topotecan oral..................................................................................................... 60 Malignant Pleural Mesothelioma Anti-Cancer Therapy Protocols ............................ 63 Pemetrexed/Cisplatin ........................................................................................... 63 Version/Document control.................................................................................... 67

Valid on date of printing only

Page 1 of 67

Authorisation of Lung Systemic Anti-Cancer Therapy (SACT) Protocols Authorisation of Lung SACT Protocols Signature Print name/Title Written by: Ms M McGrady Pharmacist Regional Lead Cancer Services Pharmacist (job share) Approved by Dr P Scullin Systemic Medical Oncologist Guidelines Author

Date February 2011

February 2011

Approved by Clinical Lead

Dr J McAleese Clinical Oncologist

February 2011

Approved by Clinical Director

Dr S McAleer Clinical Director

February 2011

Review Date

February 2013

These SACT protocols are accepted as regimens for the treatment of lung cancer as stated in the Lung SACT Guidelines. Consultant Oncologist Signature

Valid on date of printing only

Print Name/Title Dr Lynn Campbell Consultant Medical Oncologist Dr Ruth Eakin Consultant Clinical Oncologist Dr Gerry Hanna Consultant Clinical Oncologist Dr Jacqui Harney Consultant Clinical Oncologist Dr Fionnuala Houghton Consultant Clinical Oncologist Dr Jonathan McAleese Consultant Clinical Oncologist Dr Darren Mitchell Consultant Clinical Oncologist Dr Paula Scullin Consultant Medical Oncologist

Page 2 of 67

NSCLC001/10

Non Small Cell Lung Cancer Systemic Anti-Cancer Therapy Protocols Cisplatin/Vinorelbine Indication:  First line adjuvant treatment of Non Small Cell Lung Cancer. Treatment intent: Curative. Eligibility criteria: Consider adjuvant therapy for post operative patients with:  Tumour >4cm or node positive disease  Performance status – ECOG PS 0-1  Adequate renal, liver and bone marrow function  Staging carried out pre op with CT scan and PET scan is adequate. Pre-treatment evaluation:  Informed consent, provision of verbal and written information  Assessment of performance status  Height, weight and BSA  Chest X ray on every other cycle or as clinically indicated  Brain scan not required unless symptomatic  CT scan prior to cycle 1 treatment  Clinical assessment of cardiac function first visit  Clinical assessment of hearing and neurological function each visit  Day 1: FBP, DWCC, U&E, Ca, Mg, LFTs, calculated GFR  Day 8: FBP, DWCC.

Valid on date of printing only

Page 3 of 67

NSCLC001/10

Regimen Drugs & dose m2 Ondansetron Dexamethasone Vinorelbine 25mg/m2 Pre Hydration

Actual dose 8mg 8mg

Mannitol 20% Sodium chloride 0.9%* Cisplatin 75mg/m2 Post hydration

Metoclopramide

Fluids or bolus

Time

Days

Sequence

Route

Bolus Bolus 50ml sodium chloride 0.9% 1000ml sodium chloride 0.9% and 20mmol potassium chloride and 4mmol magnesium sulphate 100ml bolus

2 mins 5 mins 5 mins

1 1 1&8

1 2 3&9

IV IV IV

2 hours

1

4

IV

10 mins 30 mins 2 hours 2 hours

1

5

IV

2 mins

500ml

10mg

1000ml sodium chloride 0.9% 1000ml sodium chloride 0.9% and 20mmol potassium chloride and 4mmol magnesium sulphate Bolus

IV 1

6

IV

1

7

IV

8

8

IV

* NB Only give 500ml sodium chloride 0.9% over 30 mins pre cisplatin if urine output 90%)

Valid on date of printing only

Page 4 of 67

NSCLC001/10

Is GCSF indicated? Yes- secondary prophylaxis pegfilgrastim to be given 24 hours after chemotherapy completed. Adverse effects/ Precautions & contraindications: Cisplatin see SPC Vinorelbine see SPC Available at: http://emc.medicines.org.uk/ Extravasation risk category: Available at: www.cancerni.net/extravasation Investigations prior to subsequent cycles:  Chest X ray on every other visit or as clinically indicated.  Clinical assessment of hearing and neurological function each visit  Audiogram after cumulative dose of 360mg/m2 cisplatin.  Day 1: FBP, DWCC, U&E, Ca, Mg, LFTs, calculated GFR  Day 8: FBP, DWCC. Dose modifications: Haematological: Use up to date FBC Day 1 ANC (x109/L) ≥ 1.5