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 topic on "Prevention and treatment 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 topic 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 topic 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 topic 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 topic 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 topic 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" and "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. |