Colon Ca - UCLA-Olive View Internal Medicine Residency
Pre-docetaxel:
q 3 wkly: 8 mg po bid x 3 days (day before, day of, and day after)
along with 10 mg IV along with therapy
q wk: 8 mg po night before, IV 10 mg with, and 8 mg po morning after
Pre-paclitaxel
1st dose: 20 mg po 12 hrs and 6 hrs before (qhs and morning of) then
20 mg IV with dose, along with H2 blocker and benadryl
subsequent doses of taxol 20 mg iv with therapy (along with pepcid and
benadryl), whether q 3 wk or weekly
weekly dose can safely taper decadron if no HSR
Infusion Data
ado-trastuzumab/Kadcyla
IVPB / 1st dose 90 min, subsequent 30 min
0.22 micron filter
low emetigenic potential
cardiac monitoring
alemtuzumab / Campath
IVPB or subcut / 2 hrs / NS / 100 mL
min emetigenic potential
with escalating doses, keep 2 hr infusion time
ppx: PCP, anti-viral
amifostine / Ethyol
IVPB / 5 min / NS / 50 mL
mod emetigenic potential
give rapidly to reduce hypotension (see OV guideline for administration)
arsenic trioxide / Trisenox
IVPB / 1-2 hrs, increase to 4 hr to lessen infusion rxn/ D5W or NS 100-250 mL
mod emetigenic potential
weekly ECG, twice weekly electrolytes
azacitidine / Vidaza
IVPB / 10-40 min
subcut / >4 mL 2 syringes inject separate sites
mod emetigenic potential
bendamustine / Treanda
IVPB / 30-60 min
mod emetigenic potential
bevacizumab / Avastin
IVPB / 90 minutes / NS / 100 mL
min emetigenic potential
first dose 90 min; subsequent doses 60 min
check RUA, BP each dose
bleomycin / Blenoxane
push / 10 minutes / D5W or NS / 5 mL
min emetigenic potential
1st time - test dose of 1-2U intradermally
monitor cumulative dose
pre-med hydrocortisone 25mg
bortezomib / Velcade
subcut or IV/ decreased risk neuropathy if given subcut
min emetigenic potential
brentuximab bedotin / Adcetris
IVPB / 30 min
low emetigenic potential
carboplatin / Paraplatin
IVPB / 30-60 min / D5W / 250 mL
calculate as AUC
mod emetigenic potential
shorter infusion for lower doses
carfilzomib/Kyprolis
IVPB / 2-5 min
hydrate pre/post 250-500 mL NS
low emetigenic potential
cetuximab / Erbitux
IVPB / loading 2 hr, maintenance 1 hr
low emetigenic potential
supplied as 2 mg/mL soln; administer w/o dilution, max rate 5 mL/ min; 0.22 micron filter
monitor phos
cisplatin / Platinol
IVPB / NS
mod-high emetigenic potential depending on dose
administer @ 1 mg/min
mix with mannitol, hydrate pre/post 1L NS
cladribine / 2-CdA / Leustatin
IVPB or subcut / NS
add calculated dose to 500 mL NS and infuse over 24 hrs; repeat as per protocol
min emetigenic potential
clofarabine / Clolar
IVPB / 60-120 min
mod emetigenic potential
ppx hydrocortisone 100mg/m2 D1-3 for cap leak/SIRS
cyclophosphamide / Cytoxan
IVPB / per protocol / D5W or NS /
mix at 20 mg/mL or total volume 500 mL
mod-high emetigenic potential
provide fluid to flush through bladder
high dose monitor RUA
cytarabine / ara-C
IVPB or subcut / D5W or NS / 500 mL
low emetigenic potential for < 1 g/m2
mod emetigenic potential for higher doses
high dose – predforte ophth drops
dacarbazine / DTIC-Dome
IVPB / 30-60 min / D5W or NS / 500 mL
maximum concentration 25 mg/ml
high emetigenic potential; vesicant
post infusion: flush with SoluCortef and Heparin
dactinomycin-D / Actinomycin-D
push / 15 min / D5W or NS / 50-100 mL
max concentration 10 mcg/ mL
mod emetigenic potential; vesicant
post infusion: flush with SoluCortef and Heparin
daunorubicin
push / 2-5 min / D5W or NS / 5 mg/mL
mod emetigenic potential; vesicant
into side port of running IV
monitor cumulative dose; cardiac monitoring
daunorubicin liposomal / Daunoxome
IVPB / 1-2 hrs / D5W / 1 mg/mL
< 90 mg over 60 min; > 90 mg over 90 min;
first exposure give 20% of dose over 1 hr then rest over 2 hrs
cardiac monitoring
denileukin diftitox / Ontak
IVPB / 15 min / NS / 15 mcg/ml
keep > 0.015 mg/ mL final concentration
dexrazoxane / Zinecard
IVPB / 15-30 min / D5W or NS / < 5 mg/mL
mix in smallest volume possible; infuse before doxorubicin as cardioprotective
min emetigenic potential
docetaxel / Taxotere
IVPB / D5W or NS / 250 mL
low emetigenic potential
1 hr infusion for weekly or q3wk infusion
steroid pre-medication
doxorubicin / Adriamycin
push / 2-5 min / D5W or NS / 5 mg/mL
specify total dose in mg and pharmacy will determine volume
into side port of running IV
mod emetigenic potential; vesicant
monitor cumulative dose; cardiac monitoring
doxorubicin liposomal / Doxil
IVPB / 60-90 min / D5W / 250 mL
< 90 mg over 60 min; > 90 mg over 90 min;
first exposure give 20% of dose over 1 hr then rest over 2 hrs
low emetigenic potential
cardiac monitoring
epirubicin / Ellence
push / 2-5 midaunorubicinn / comes premixed solution
push into side port of running IV
mod emetigenic potential; vesicant
monitor cumulative dose; cardiac monitoring
eribulin / Halaven
IVPB / 2-5 min / NS
low emetigenic potential
etoposide / Toposar
IVPB / 1-2 hours / D5W or NS / 500 mL
1 mg/mL remains soluble only 2 hrs; 0.4 mg/mL for 24 hrs
low emetigenic potential
PO dosing double IV dose
fludarabine / Fludara
IVPB / 30 min / D5W or NS / 100 mL
10 mg/mL max concentration
min emetigenic potential
fluorouracil / Adrucil
IVPB / 15 min / D5W or NS
low emetigenic potential
gemcitabine / Gemzar
IVPB / 30 min / NS / 250 mL
low emetigenic potential
gemtuzumab ozogamicin / Mylotarg
IVPB / 2 hrs / NS / 100 mL
low emetigenic potential
1.2 micron terminal filter
idarubicin / Idamycin
push / over 15 min / D5W / 50 mL
mod emetigenic potential
into side port of running IV; vesicant
monitor cumulative dose; cardiac monitoring
ixabepilone / Ixempra
IVPB / 3 hours
low emetigenic potential; filter with a 0.2-1.2 micron inline filter
HSR – H1 and H2 antagonist
ifosfomide / Ifed
IVPB / 30 min / D5W or NS / 500 mL
maximal concentration 25 mg/mL
mod emetigenic potential
given with mesna
monitor RUA
interferon a2b / Intron-A
IVPB, IM, subcut/ 20 min / NS / 100 mL
min emetigenic potential
10 million unit/100 mL is minimum concentration for IV administration; use smaller volumes if necessary
Irinotecan / Camptosar
Doses give q3 wk: IVPB / 90 minutes / D5W or NS / 500 mL
Doses give q1 wk: IVPB / 60 minutes / D5W or NS / 250 mL
mod emetigenic potential
early cholinergic side effects; 1 mg/mL maximal concentration - prn atropine
Ipilumimab / Yervoy
IVPB / 90 min / low protein-binding in-line filter
flush D5W or NS at end of infusion
min emetigenic potential
mechlorethamine / Mustagren
push / over 15 min / D5W / 50 mL
high emetigenic potential; vesicant
post infusion: flush with SoluCortef and heparin
methotrexate
IVPB, IM, subcut/ protocol specific / D5W or NS / max 2 mg/mL
low-min emetigenic potential
leucovorin rescue for higher doses; r/o effusion before administering
mitomycin C
push / 15 min / NS / 50 mL
into side port of running IV
low emetigenic potential; vesicant
post infusion flush solucortef and heparin
mitoxantrone
push / 5-15 min / D5W or NS / 50 mL
low emetigenic potential
cardiac monitoring
oxaliplatin / Eloxatin
IVPB / 2 hrs / D5W / 250-500 mL
mod emetigenic potential
avoid cold exposure
paclitaxel / Taxol
IVPB / 1-3 hrs / D5W or NS / < 1 mg/mL
low emetigenic potential
rate of infusion depends on dose and schedule; in-line filter of not greater than 0.22 microns
HSR – steroid pre-med
paclitaxel microparticles / Abraxane
IVPB / 30 min / NS / 5 mg/mL
low emetigenic potential
pharmacy mixes drug to 5 mg/mL concentration and delivers volume based on mg of drug ordered
no steroid or benadryl needed
pamidronate / Aredia
IVPB / 2-4 hrs / D5W or NS / 250-500 mL
min emetigenic potential
pegasparagase / Oncaspar
IM or IV / Q14 days
min emetigenic potential
weekly coags, fibrinogen, TG, LFT
pemetrexed / Almita
IVPB / 10 minutes / NS / 100 mL
low emetigenic potential
start b12/folate before 1st dose
pertuzumab / Perjeta
IVPB / NS
min emetigenic potential
loading dose over 60 min; subsequent doses over 30-60 min
>6 wks from last dose, readminister loading dose
cardiac monitoring
rituximab / Rituxan
IVPB / per protocol / D5W or NS / 500 mL
min emetigenic potential
50 mg/hr increase q 30 min to 400 mg/hr for first tx; double rates for all subsequent infusions
decadron prior to first dose
streptozocin
IVPB / 15 min / D5W or NS / 50 mL
high emetigenic potential
maximal concentration 20 mg/mL
temsirolimus / Torisel
IVPB / 30-60 min / NS / inline filter
min emetigenic potential
HSR –H1 antagonist
teniposide
IVPB / 30-60 min / D5W or NS / 250 mL
1 mg/mL remains soluble only 2 hrs; 0.4 mg/mL for 24 hrs
topotecan / Hycamtin
IVPB / 30 min / D5W or NS / 100 mL
low emetigenic potential
trastuzumab / Herceptin
IVPB / 30-90 min / NS / 250 mL
min emetigenic potential
loading dose over 90 min; subsequent doses over 30 min
missed dose > 3 week require reloading
cardiac monitoring
vinblastine / Velban
push / 3-5 min / NS / 1 mg/mL
into side port of running IV
min emetigenic potential; vesicant
vincristine / Oncovin
push / 3-5 min / NS / 1 mg/mL
into side port of running IV
min emetigenic potential; vesicant
vinorelbine / Navelbine
push / 5-15 min / D5W or NS / 50 mL
into side port of running IV; post flush IV with 100 mL
min emetigenic potential; vesicant
zoledronic acid / Zometa
IVPB / 15 min / D5W or NS / 100 mL
min emetigenic potential
longer infusions for mild azotemia; never < 15 min
check renal function prior
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