/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/beacon-protocols/,/clinical/cckm-tools/content/beacon-protocols/breast/,

/clinical/cckm-tools/content/beacon-protocols/breast/name-96599-en.cckm

201611306

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UWHC,UWMF,

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Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Beacon Protocols,Breast

CSC Breast Capecitabine (21D1-14), Lapatinib (21D1-21) VER 10-3-16 (HL 940)

CSC Breast Capecitabine (21D1-14), Lapatinib (21D1-21) VER 10-3-16 (HL 940) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Breast


CSC BREAST CAPECITABINE(21D:1-14)/ LAPATINIB(21D:1-21) VER: 10-3-16 – Properties
Pre-Cycle – 10/25/2016 through 10/31/2016 (7 days), Planned
Day 1, Pre-Cycle – Planned for 10/25/2016
Treatment Plan Information
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
Take Home Medications
ondansetron (ZOFRAN) 8 MG tab
Take 1 tab by mouth every 8 hours as needed for nausea/vomiting., 8 mg, Disp-30 tab, R-5, EVERY 8 HOURS PRN starting S,
Local Printer
Cycle 1 – 11/1/2016 through 11/21/2016 (21 days), Planned
Day 1, Cycle 1 – Planned for 11/1/2016
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Treatment Conditions
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 1 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
Cycle 2 – 11/22/2016 through 12/12/2016 (21 days), Planned
Day 1, Cycle 2 – Planned for 11/22/2016
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 2 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 3 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
Cycle 3 – 12/13/2016 through 1/2/2017 (21 days), Planned
Day 1, Cycle 3 – Planned for 12/13/2016
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 4 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
Cycle 4 – 1/3/2017 through 1/23/2017 (21 days), Planned
Day 1, Cycle 4 – Planned for 1/3/2017
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 5 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 6 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
Cycle 5 – 1/24/2017 through 2/13/2017 (21 days), Planned
Day 1, Cycle 5 – Planned for 1/24/2017
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 7 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
Cycle 6 – 2/14/2017 through 3/6/2017 (21 days), Planned
Day 1, Cycle 6 – Planned for 2/14/2017
Treatment Plan Information
Reference Information (1)
BREAST CANCER: Geyer et al. N Engl J Med 2006;355:2733-43.
Treatment Plan Summary
DISEASE: Breast Cancer (Advanced); THERAPY: capecitabine 1000 mg/m2/dose by mouth twice daily Day 1 though 14, lapatinib
1250 mg by mouth once daily; CYCLE LENGTH: 21 days; COURSE: until disease progression.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 8 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

CONTINUOUS Starting when released Until Specified
Peripheral IV Size: RN Discretion
Additional PIV may be inserted as needed for repeat blood sampling or IV medication administration.
Pre-Labs
CBC WITHOUT DIFFERENTIAL
Expected-S+21 Approximate, Expires-S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected-S+21 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+21 Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S+21 Approximate, Expires-S+365, Routine
AST/SGOT
Expected-S+21 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+21 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC, Creatinine, AST, ALT, Total Bilirubin.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than 75K/µL or Creatinine greater than
or equal to 1.5 X ULN or AST greater than 5 X ULN or ALT greater than 5 X ULN or Total Bilirubin greater than 1.5 X ULN.
Treatment Parameters (2)
The solubility of lapatinib is pH-dependent. Concomitant treatment with substances that increase gastric pH (e.g. PPIs or ranitidine)
should be avoided as lapatinib solubility and absorption may decrease.
Nursing Procedure, Assessment and Monitoring
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to capecitabine or continuous fluorouracil infusion and to
call with concerns.
Flush Venous Access Device per Guidelines
Order details
sodium chloride flush 0.9% 10 mL injection
Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 10 UNIT/ML lock flush injection 1-150 units
1-150 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Flush per VAD guidelines.
heparin 100 UNIT/ML lock flush injection 500 units
500 units, Flush, PRN Starting when released Until Discontinued, flush/line care
Implanted port use ONLY to be used when de-accessing port. Flush per VAD guidelines.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): capecitabine and lapatinib.
Take Home Medications (delete all that do not apply)
capecitabine (XELODA) 500 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg
capecitabine (XELODA) 150 MG tab
Take 1,000 mg/m2 by mouth 2 times daily. Take on Day 1 through 14., 1,000 mg/m2, R-0, 2 X DAILY starting S
Round doses to available tablet sizes of 500mg and 150mg.
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 9 of 10
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org

Take Home Medications
lapatinib (TYKERB) 250 MG tab
Take 5 tabs by mouth one time daily., 1,250 mg, Disp-150 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 22 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally), Creatinine,
Total Bilirubin, AST, ALT.
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ZZtestonc,Andrew [2428787]
11/1/2016 3:07:20 PM Page 10 of 10
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Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 11/2016CCKM@uwhealth.org