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 topic on "Prevention and treatment 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 topic on "Infusion reactions to systemic chemotherapy".
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Vesicant/irritant properties | - Nabpaclitaxel 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 | - The incidence of febrile neutropenia with this regimen was 1%.[1] Primary prophylaxis with granulocyte colony stimulating factors is not indicated.
- 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 | - 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" and "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 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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If there is a change in body weight of at least 10%, doses should be recalculated. |