| Cycle length: 21 days. |
| Drug | Dose and route | Administration | Given on days |
| Nabpaclitaxel* | 100 mg/m2 IV | Administer undiluted over 30 minutes. | Days 1, 8, 15 |
| Carboplatin | AUC¶ = 6 mg/mL per min IV | Dilute in 250 mL NSΔ and administer over 30 minutes. The carboplatin should be given immediately after the nabpaclitaxel. | Day 1 |
| Pretreatment considerations: |
| Emesis risk | - MODERATE on day 1 (30 to 90%); LOW on days 8 and 15 (10 to 30%).◊
- Refer to UpToDate topics on prevention of chemotherapy-induced nausea and vomiting in adults.
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| Prophylaxis for infusion reactions | - Premedication to prevent hypersensitivity reactions is generally not needed. Premedication may be needed in patients who have had a prior hypersensitivity reaction to nabpaclitaxel.
- Refer to UpToDate topics on infusion reactions to systemic chemotherapy.
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| Vesicant/irritant properties | - Nabpaclitaxel 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 | - The incidence of febrile neutropenia with this regimen was 1%.[1] 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.
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| Dose adjustment for baseline liver or renal dysfunction | - A lower starting dose for nabpaclitaxel may be needed for patients with liver impairment.[2] Do not administer nabpaclitaxel if AST >10 times ULN or bilirubin >5 times ULN. 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.
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| Monitoring parameters: |
- CBC with differential and platelets weekly during treatment.
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- Electrolytes, renal, and liver function weekly during treatment.
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- Monitor for infusion reactions.
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- Monitor for extravasation.
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- Assess for changes in neurologic function prior to each treatment cycle.
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| Suggested dose modifications for toxicity: |
| Myelotoxicity | - Do not administer carboplatin and nabpaclitaxel on day 1 of each new cycle unless ANC is ≥1500/microL and platelet count is ≥100,000/microL.[2,3] For patients who develop neutropenic fever OR ANC <500/microL for >7 days or delay of next cycle by >7 days or thrombocytopenia, withhold treatment until counts recover to an ANC of at least 1500/microL and platelet count of at least 100,000/microL on day 1, or to an ANC of at least 500/microL and platelet count of at least 50,000/microL on days 8 or 15 of the cycle.[2] Upon resumption of therapy, reduce nabpaclitaxel and carboplatin by 25% upon the first occurrence, an additional 25% on the second recurrence, and discontinue treatment for a third occurrence.
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| Peripheral neuropathy | - In the original trial, all patients had less than grade 2 peripheral neuropathy prior to beginning therapy.[1] Withhold nabpaclitaxel for grade 3 or 4 neuropathy during treatment. Resume nabpaclitaxel and carboplatin at reduced doses when peripheral neuropathy improves to grade 1 or completely resolves. Upon resumption of therapy, reduce nabpaclitaxel and carboplatin AUC by 25% for the first occurrence of grade 3 or 4 peripheral neuropathy, and an additional 25% for the second occurrence.[2] Discontinue treatment for a third occurrence.[2,3]
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| Hepatotoxicity | - Reduced starting doses of nabpaclitaxel are recommended for individuals with pre-existing moderate to severe hepatic impairment; the need for further dose adjustments in subsequent courses based upon ongoing hepatotoxicity should be based on individual tolerance and clinician judgment.[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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| If there is a change in body weight of at least 10%, doses should be recalculated. |
