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تعداد آیتم قابل مشاهده باقیمانده : -59 مورد

Systemic therapy regimens for small cell lung cancer: Cisplatin (80 mg/m2) plus etoposide[1,2]

Systemic therapy regimens for small cell lung cancer: Cisplatin (80 mg/m2) plus etoposide[1,2]
Cycle length: Every 21 days for four cycles.
Drug Dose and route Administration Given on days
Cisplatin 80 mg/m2 IV Dilute in 250 mL normal saline (NS) and administer over 60 minutes. Do not administer with aluminum needles or sets. Day 1
Etoposide 100 mg/m2 IV daily Dilute in 500 mL NS* or 5% dextrose in water (D5W) to final concentration <0.4 mg/mL. Infuse over 30 to 60 minutes; if infused more rapidly, severe hypotension may occur. Days 1, 2, and 3
Pretreatment considerations:
Hydration
  • IV fluid to establish a urine flow of at least 100 mL/hour for at least two hours prior to and two hours after cisplatin administration.
  • Refer to UpToDate topics on cisplatin nephrotoxicity.
Emesis risk
  • HIGH.
  • Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
Prophylaxis for infusion reactions
  • Routine prophylaxis not indicated.
  • Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
Vesicant/irritant properties
  • Cisplatin is an irritant but can cause significant tissue damage; avoid extravasation.
  • Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
Infection prophylaxis
  • Primary prophylaxis with hematopoietic growth factors is not recommended (incidence of neutropenic fever is 8%[1]).
  • 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
  • The optimal approach to cisplatin therapy in patients with preexisting kidney impairment is unknown. Such patients were excluded from the original trial.[1] A lower starting dose of etoposide may be needed for patients with kidney or liver impairment.[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.
Monitoring parameters:
  • CBC with differential and platelet count weekly during treatment.
  • Basic metabolic panel (creatinine and electrolytes) and liver function tests prior to each cycle.
  • Monitor for hearing loss prior to each dose of cisplatin; audiometry as clinically indicated.
Suggested dose modifications for toxicity:
Myelotoxicity
  • A dose reduction of 25% for both etoposide and cisplatin is recommended for grade 4 neutropenia, febrile neutropenia, or grade 4 thrombocytopenia in the prior cycle.[1]
Neurotoxicity
  • Neuropathy usually is seen with cumulative doses of cisplatin >400 mg/m2, although there is marked interindividual variation.
  • Refer to UpToDate topics on overview of neurologic complications of platinum-based chemotherapy.
Nephrotoxicity
  • Hold cisplatin until serum creatinine <1.5 mg/dL and/or blood urea nitrogen <25 mg/dL. For grade ≥2 nephrotoxicity during treatment (creatinine >1.5 times normal value despite adequate hydration), creatinine clearance should be determined prior to next cycle, and cisplatin dose reduced if <60 mL/min.
  • Refer to UpToDate topics on cisplatin nephrotoxicity.
Other severe non-hematologic toxicity
  • Etoposide and cisplatin should be withheld or doses decreased depending on clinical judgement.
If there is a change in body weight of at least 10%, doses should be recalculated.
This table is provided as an example of how to administer this regimen; there may be other acceptable methods. This regimen must be administered by a clinician trained in the use of chemotherapy, who should use independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

CBC: complete blood count; IV: intravenous.

* Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibility(ies).

References:
  1. Lara PN, Natale R, Crowley J, et al. Phase III trial of irinotecan/cisplatin compared with etoposide/cisplatin in extensive-stage small-cell lung cancer: clinical and pharmacogenomic results from SWOG S0124. J Clin Oncol 2009; 27:2530.
  2. Takada M, Fukuoka M, Kawahara M, et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with cisplatin and etoposide for limited-stage small-cell lung cancer: results of the Japan Clinical Oncology Group Study 9104. J Clin Oncol 2002; 20:3054.
  3. Etoposide injection. United States Prescribing Information. US National Library of Medicine. (Available online at dailymed.nlm.nih.gov, accessed December 8, 2011).
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