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

CSC GI Regorafenib (28D:1-21 Oral) VER 8-15-17 (HL 5015)

CSC GI Regorafenib (28D:1-21 Oral) VER 8-15-17 (HL 5015) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GI


CSC GI REGORAFENIB (28D:1-21 ORAL) VER: 8-15-17 –  Properties
Pre-Cycle –  8/3/2017 through 8/9/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 8/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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
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
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
Cycle 1 –  8/10/2017 through 9/6/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 8/10/2017
Treatment Plan Information
Reference Information (1)
COLORECTAL CANCER: Grothey A, et al. Lancet 2013:381:303-12.
Reference Information (2)
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 1 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

GASTROINTESTINAL STROMAL TUMOR (GIST): Demetri GD, et al. Lancet 2013;381(9863):295-302.
Reference Information (3)
HEPATOCELLULAR CARCINOMA: Bruix J, et al. Lancet 2017;389(10064):56-66.
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): regorafenib (dispensed on Day 1
of Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 2 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

regorafenib (STIVARGA) 40 MG tab
Take 4 tabs by mouth one time daily. Take Day 1 thru 21. Keep in original bottle w/ desiccant.
Expires 7 weeks after opening., 160 mg, Disp-84 tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 15 FOLLOW-UP
LABS: AST, ALT, Total Bilirubin
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
Lab Only - Day 15, Cycle 1 –  Planned for 8/24/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 2 –  9/7/2017 through 10/4/2017 (28 days), Planned
This medication will not be e-prescribed. If patient is present, script will go to printer.
Otherwise, script will go to nursing or tech pool.   Invalid items: Pharmacy   
Details...
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 3 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Day 1, Cycle 2 –  Planned for 9/7/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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+28 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 4 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, regorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 15 FOLLOW-UP
LABS: AST, ALT, Total Bilirubin
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
Lab Only - Day 15, Cycle 2 –  Planned for 9/21/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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
AST/SGOT
Expected: S+14 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 5 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

ALT/SGPT
Expected: S+14 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+14 Approximate, Expires: S+365, Routine
Follow-Up
VERIFY APPOINTMENTS
Verify next day appointment(s) have been scheduled. See follow-up section on Day 1.
Cycle 3 –  10/5/2017 through 11/1/2017 (28 days), Planned
Day 1, Cycle 3 –  Planned for 10/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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+28 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALT/SGPT
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 6 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, regorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
Cycle 4 –  11/2/2017 through 11/29/2017 (28 days), Planned
Day 1, Cycle 4 –  Planned for 11/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
Consent
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 7 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

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+28 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, regorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 8 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Cycle 5 –  11/30/2017 through 12/27/2017 (28 days), Planned
Day 1, Cycle 5 –  Planned for 11/30/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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+28 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 9 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, regorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
Cycle 6 –  12/28/2017 through 1/24/2018 (28 days), Planned
Day 1, Cycle 6 –  Planned for 12/28/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Colorectal Cancer (Advanced), Gastrointestinal Stromal Tumor (GIST) (Advanced), Hepatocellular Carcinoma
(Advanced); THERAPY: regorafenib 160 mg by mouth once daily on Days 1 through 21; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Chemotherapy review council approval for 3rd line treatment for metastatic colorectal cancer in patients previously
treated with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy, anti-VEGF therapy, or anti-EGFR
therapy (if KRAS wild type).
Note to All Staff (2)
Chemotherapy review council approval for GIST in patients who have previously been treated with imatinib and
sunitinib.
Note to all Staff (3)
Chemotherapy review council approval for advanced hepatocellular carcinoma in patients who have previously been
treated and progressed on sorafenib.
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
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 10 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org

CBC WITHOUT DIFFERENTIAL
Expected: S+28 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+28 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+28 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+28 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: AST, ALT.
Treatment Parameters
Hold and notify authorizing prescriber for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure
greater than 90 mmHg or AST greater than 5 X ULN or ALT greater than 5 X ULN.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Blood pressure checks are required weekly for 6 weeks and then monthly thereafter unless more frequent blood
pressure checks are clinically indicated.
Patient Instructions(1)
Educate/reinforce with patient regarding hand and foot syndrome related to regorafenib and to call clinic at first sign.
Patient Instructions(2)
Patient to call clinic for Systolic Blood Pressure greater than 140 mmHg or Diastolic Blood Pressure greater than 90
mmHg.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, regorafenib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if to be done locally),
AST, ALT, Alkaline Phosphatase, Total Bilirubin.
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Zztestonc,Jeff J [2507481]
8/10/2017 9:43:58 AM Page 11 of 11
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 08/2017CCKM@uwhealth.org