Cycle length: 28 days.
Total cycles: 6 cycles. |
| Drug | Dose and route | Administration | Given on days |
| Carboplatin | AUC* = 5 mg/mL per min IV | Dilute in 250 mL NS¶ and administer over 30 minutes. | Day 1 |
| Pegylated liposomal doxorubicin | 30 mg/m2 IV | Dilute in D5W¶ and administer over one hour.Δ | Day 1 |
| Pretreatment considerations: |
| Emesis risk | - MODERATE (30 to 90% frequency of emesis).◊
- Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
|
| Prophylaxis for infusion reactions | - No specific premedication regimen is recommended.
- Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
|
| Vesicant/irritant properties | - Both pegylated liposomal doxorubicin and carboplatin are irritants; avoid extravasation.
- Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
|
| Infection prophylaxis | - Primary prophylaxis with G-CSF is not indicated.[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.
|
| Liver or renal dysfunction | - A lower starting dose of pegylated liposomal doxorubicin may be needed for patients with liver impairment. Each carboplatin dose should be calculated based upon renal function by use of the Calvert formula.*
- 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 dosing of anticancer agents in adults.
|
| Cardiac issues | - Pegylated liposomal doxorubicin is associated with cardiomyopathy, the incidence of which is related to total dose. Assess baseline LVEF prior to administration. Pegylated liposomal doxorubicin is contraindicated for patients with recent myocardial infarction, severe myocardial dysfunction, severe arrhythmia, or previous therapy with high cumulative doses of doxorubicin or any anthracycline-like drug.[2]
- Refer to UpToDate topics on cardiotoxicity of cancer chemotherapy agents other than anthracyclines, HER2-targeted agents, and fluoropyrimidines.
|
| Monitoring parameters: |
- Assess CBC with differential prior to each treatment cycle.
|
- Assess serum electrolytes and liver and renal function tests prior to each treatment cycle.
|
- Monitor cumulative pegylated liposomal doxorubicin dose. Reassess LVEF periodically during therapy as clinically indicated.
- Refer to UpToDate topics on cardiotoxicity of non-anthracycline cancer chemotherapy agents.
|
- Monitor for palmar-plantar erythrodysesthesias during treatment.
|
| Suggested dose modifications for toxicity: |
| Myelotoxicity | - If the ANC is ≤1500/microL or platelets ≤75,000/microL on day 1 of each cycle, therapy should be delayed until counts recover. Reduce carboplatin dose to AUC* = 4 mg/mL per min for subsequent cycles in patients who develop severe neutropenia (≤500/microL) or thrombocytopenia (≤50,000/microL).[3]
|
| Cutaneous and mucosal toxicity | - For severe or cumulative cutaneous reactions (erythema and desquamation) and/or stomatitis, hold therapy until improved and then adjust pegylated liposomal doxorubicin dose.[2] Discontinue if toxicity persists.
- Refer to UpToDate topics on oral toxicity associated with chemotherapy and cutaneous side effects of conventional chemotherapy agents.
|
| If there is a change in body weight of at least 10%, doses should be recalculated. |
