Chemotherapy

vinblastine

inhibits microtubule assembly M phase 0.1-0.5 mg/kg/week given weekly Extravasation Alopecia, leukopenia

MESNA dosing

ASCO guideline: It is suggested that the daily dose of mesna be calculated to equal 60% of the total daily dose of ifosfamide, administered as three bolus doses given 15 minutes before, and 4 and 8 hours after, administration of each dose of ifosfamide

Ifosfamide

Alkylating agent 1.5 g/m2 (4 day dosing) Hemorrhagic cystitis n/v, alopecia, lethargy, confusion MESNA binds to Ifos by-products in the urine (same dose as Ifos)

methotrexate

Antimetabolite (S phase) Analog of folic acid, binds to dihydrofolate reductase Stomatitis, diarrhea, bad in pregnancy 30-50 mg/m2 IM weekly or 1 mg/kg IM every other day (8 day)

gemcitabine

Antimetabolite 1000mg/m2 weekly Give over 30 minutes Bone marrow suppression, ARDS (rare)

Calvert Formula

Carboplatin dose (mg) = AUC x GFR + 25 GFR can be estimated using Jelliffe formular (age, Cr, corrected for female gender)

Carboplatin

DNA cross linking, Myelosuppression (platelets), leukemia G-CSF D1-10 Hypersensitivity: 12% of patients, usually cycle #8 Desensitization: 1/1000 over 90 min 1/100 over 90 min 1/10 over 90 min Remainder over 11 hours

Cisplatin

DNA cross-links Pre-hydration and mannitol N/V, rare myelosuppression 40 mg/m2 (chemorads) 75 mg/m2 (q 3 weeks for cervix cancer)

G-CSF

Do NOT use for afebrile neutropenia. Dose reduction is first line. Consider in: ANC < 100, complicated fever and neutropenia May reverse effect of RT 5 microgram/kg/day for Neupogen (subQ) Neulasta: 6 mg SC Neupogen starts at least 24 hours after chemo, continue until ANC > 10,000

Cyclophosphamide (Cytoxan)

Ester of nitrogen mustard 600-1000 mg/m2 IV 50-200 mg PO Qd x 14 days, 1 week rest Hemorrhagic cystitis

Topotecan

Inhibits topoisomerase I, single-strand DNA breakage 3-5 mg/m2 1 day 1-1.5 mg/m2 5 day Give topo before platinum Neutropenia, alopecia, n/v

Actinomycin D

Intercalates into DNA inhibiting RNA transcription Single agent: 1.25 mg/m2 q 2 weeks EMA-CO: 0.5 mg IV push D1 and D2 Vesicant Radiation recall Myelosuppression, n/v, mucositis, alopecia

Docetaxel

Microtubule assembly Pre-med with oral steroids (dex 8 mg PO BID day prior, day of, day after) to reduce fluid retention 60-100mg/m2 IV q 3 weeks Neutropenia, alopecia, fluid retention, dose reduce in liver impairment

Vincristine

Part of EMA-CO (c= choriocarcionoma) Part of VAC (germ cell tumors) inhibits microtubules (M phase) vesicant 1 mg/m2

paclitaxel

Pre-meds: Dex 20 mg PO 12 and 6 hrs prior Benadryl 50 mg IV Ranitidine 50 mg IV Longer infusion decreases neurotoxicity Myelosuppression, alopecia

Febrile neutropenia

RCT (Freifeld NEJM 1999) PO Cipro + Augmentin vs IV ceftazidime Similar success rates in both groups (70% each)

Etoposide

Topoisomerase II inhibitor Risk of AML < 1% if cumulative lifetime dose is < 2000 mg/m2 Bone marrow suppression 50-120 mg/m2

Adriamycin/Doxil

Total lifetime dose= 500 mg/m2 Cardiotoxicity (free radicals end up in heart where there is minimal catalase) Radiation recall Vesicant Active in: Advance/recurrent uterine Dosed: 60mg/m2 q 3 weeks

Bleomycin

antibiotic, acts with metals to induce DNA breaks 20-30 Units/m2 (BEP) 1 unit = 1 mg (about) Can use for pleurodesis: 60 units/m2 Limit total dose to 360U Reduce if >15% change in DLCO NON-MYELOSUPRESSIVE Mucositis, rash, alopecia

5-FU

antimetabolite (inhibits thymidylate synthetase activity) 750-1000mg/m2 Liver metabolism Cardiotoxicity Xeloda (capecitabine): pro-drug of 5FU Topical (for VAIN): 1 g qhs x 1 week