| Cycle length: 21 days. |
| Drug | Dose and route | Administration | Given on days |
| Paclitaxel | 80 mg/m2 IV | Dilute in 250 mL NS* and administer over one hour (final concentration range 0.3 to 1.2 mg/mL); special tubing needed.¶[2] | Days 1, 8, and 15 |
| Carboplatin | AUCΔ = 6 mg/mL per min | Dilute in 250 mL NS* and administer over one hour. | Day 1 |
| Pretreatment considerations: |
| Emesis risk | - MODERATE on day 1; LOW on days 8 and 15.◊
- Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
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| Prophylaxis for infusion reactions | - Premedicate with dexamethasone plus both an H1 and an H2 receptor antagonist prior to paclitaxel administration.
- Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
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| Vesicant/irritant properties | - Carboplatin is an irritant. Paclitaxel can cause significant tissue damage; avoid extravasation.
- Refer to UpToDate topics on extravasation injury from chemotherapy and other non-antineoplastic vesicants.
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| Infection prophylaxis | - Primary prophylaxis with G-CSF is not recommended (risk of febrile neutropenia approximately 9%[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.
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| Dose adjustment for baseline liver or renal dysfunction | - Each carboplatin dose should be calculated based upon renal function by use of the Calvert formula.*
- Refer to UpToDate topics on dosing of anticancer agents in adults.
- A lower starting dose of paclitaxel may be needed in patients with liver impairment.[2]
- Refer to UpToDate topics on chemotherapy hepatotoxicity and dose modification in patients with liver disease, conventional cytotoxic agents and chemotherapy hepatotoxicity and dose modification in patients with liver disease, molecularly targeted agents.
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| Monitoring parameters: |
- CBC with differential weekly.
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- Serum electrolytes and liver and renal function prior to each new treatment cycle.
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- Assess changes in neurologic function prior to each new treatment cycle.
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| Suggested dose modifications for toxicity: |
| Myelotoxicity | - Initiation of each new treatment cycle should be delayed until the ANC is >1000/microL and/or for a platelet count >75,000/microL. The day 8 and 15 doses of paclitaxel should be omitted for an ANC <500/microL and/or for a platelet count <50,000/microL. The day 1 carboplatin dose should be decreased to AUC 5 mg/mL per min for febrile neutropenia, ANC <500/microL for seven or more days, platelet count <10,000/microL, platelet count between 10,000 and 50,000/microL with bleeding, or any intracycle hematologic toxicity resulting in a treatment delay for longer than one week. If these hematologic toxicities recur despite carboplatin dose reduction to AUC 5 mg/mL per min, reduce carboplatin dose to AUC 4 mg/mL per min for subsequent cycle. Discontinue treatment for failure to recover adequate blood counts within three weeks.
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| Renal/hepatic toxicity | - Alterations in renal function during therapy may require a recalculation of the carboplatin dose.[3] Paclitaxel dose may need to be adjusted for hepatic impairment on day 1 of each cycle.
- Refer to UpToDate topics on dosing of anticancer agents in adults; chemotherapy hepatotoxicity and dose modification in patients with liver disease, conventional cytotoxic agents; and chemotherapy hepatotoxicity and dose modification in patients with liver disease, molecularly targeted agents.
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| Neurotoxicity | - For ≥grade 2 peripheral neuropathy, reduce paclitaxel dose to 70 mg/m2 for all subsequent doses.[1] If neuropathy persists or recurs despite dose reduction, paclitaxel should be further reduced to 60 mg/m2.
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| If there is a change in body weight of at least 10%, doses should be recalculated. |
