| Cycle length: 21 days. |
| Drug | Dose and route | Administration | Given on days |
| Cisplatin | 20 mg/m2 IV per day | Dilute with 250 mL normal saline (NS) and administer over one hour. Do not administer with aluminum needles or intravenous sets. | Days 1 through 5 |
| Etoposide | 100 mg/m2 IV per day | Dilute with 500 mL NS (concentration less than 0.4 mg/mL) and administer over one hour. | Days 1 through 5 |
| Pretreatment considerations: |
| Hydration | - Induction of diuresis using intravenous NS minimizes the risk of cisplatin nephrotoxicity. At least 2000 mL of NS should be administered at a rate of 100 to 125 mL per hour throughout the five days of treatment and continued for at least two hours after the last dose of cisplatin.
- Refer to UpToDate topics on cisplatin nephrotoxicity.
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| Emesis risk | - HIGH (>90% frequency of emesis).
- Aprepitant can be given orally (125 mg on day 1, 80 mg on days 2 and 3) with ondansetron, prochlorperazine, and dexamethasone daily.
- Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
|
| Vesicant/irritant properties | - Both cisplatin and etoposide are irritants. Cisplatin can cause significant tissue damage; avoid extravasation.[2]
- Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
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| Infection prophylaxis | - Primary prophylaxis with granulocyte colony stimulating factors is not indicated.
- Refer to UpToDate topics on use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation.
|
| Dose adjustment for baseline liver or kidney dysfunction | - Treatment in the setting of baseline kidney dysfunction (creatinine >3.0 mg/dL or GFR <50 mL/min) requires a balanced discussion of the goals of treatment and the risks of administering cisplatin.[3]
- Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease, conventional cytotoxic agents; chemotherapy hepatotoxicity and dose modification in patients with liver disease, molecularly targeted agents; and chemotherapy nephrotoxicity and dose modification in patients with kidney impairment, conventional cytotoxic agents.
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| Monitoring parameters: |
- CBC with differential weekly during treatment.
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- Basic metabolic panel (creatinine and electrolytes) prior to each treatment cycle.
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- Liver function tests prior to each treatment cycle.
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- Monitor vital signs during etoposide infusion.
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- Monitor for neurotoxicity; monitor for hearing loss prior to each dose of cisplatin; audiometry as clinical indicated.
|
| Suggested dose modifications for toxicity: |
| Myelotoxicity | - Each cycle should begin on schedule regardless of the degree of myelosuppression.[1] If febrile neutropenia or thrombocytopenic bleeding occurs, a dose reduction of 25% for etoposide should be used for subsequent cycles.
|
| Neurologic toxicity | - Neuropathy usually is seen after cumulative doses of cisplatin beyond 400 mg/m2, although there is marked interindividual variation. Patients with mild neuropathy can continue to receive full cisplatin doses. However, if the neuropathy interferes with function, the risk of potentially disabling neurotoxicity must be weighed against the benefit of continued treatment.
- Refer to UpToDate topics on overview of neurologic complications of platinum-based chemotherapy.
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| Kidney toxicity | - It is recommended that subsequent doses of cisplatin be withheld until the serum creatinine is less than 3.0 mg/dL.
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| If there is a change in body weight of at least 10%, doses should be recalculated. |
