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201706166

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CSC GU Enzalutamide(28D:1-28) VER 12-1-16 (HL 4869)

CSC GU Enzalutamide(28D:1-28) VER 12-1-16 (HL 4869) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU ENZALUTAMIDE(28D:1-28) VER: 12-1-16 (HL 4869) – Properties
Pre-Cycle – 6/8/2017 through 6/14/2017 (7 days), Planned
Day 1, Pre-Cycle – Planned for 6/8/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
Expected-S Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S Approximate, Expires-S+365, Routine
ELECTROLYTES
Expected-S Approximate, Expires-S+365, Routine
GLUCOSE
Expected-S Approximate, Expires-S+365, Routine
BUN
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
CALCIUM
Expected-S Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S Approximate, Expires-S+365, Routine
BILIRUBIN, TOTAL
Expected-S Approximate, Expires-S+365, Routine
Cycle 1 – 6/15/2017 through 7/12/2017 (28 days), Planned
Day 1, Cycle 1 – Planned for 6/15/2017
Treatment Plan Information
Reference Information (1)
PROSTATE CANCER: Scher HI, et al. N Eng J Med. 2012;367(13):1187-97.
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 1 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
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: Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
See Take Home Medication(s)
Refer to take home medications section for the following treatment medication(s): enzalutamide (dispensed Day 1 of Cycle 1 only -
subsequent refills will be ordered through the medication activity).
Take Home Medications (delete all that do not apply)
enzalutamide (XTANDI) 40 MG cap
Take by mouth one time daily., R-0, 1 X DAILY starting S, Local Printer
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
Cycle 2 – 7/13/2017 through 8/9/2017 (28 days), Planned
Day 1, Cycle 2 – Planned for 7/13/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
Consent
Verify Consent
Verify informed consent has been obtained.
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 2 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, enzalutamide 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 with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
Cycle 3 – 8/10/2017 through 9/6/2017 (28 days), Planned
Day 1, Cycle 3 – Planned for 8/10/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 3 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
Pre-Labs (delete all that do not apply)
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Order every 3rd cycle ONLY.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Verify Labs (2)
Verify pre-treatment lab has been obtained: Total Bilirubin every 3rd cycle ONLY.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, enzalutamide 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 with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
Cycle 4 – 9/7/2017 through 10/4/2017 (28 days), Planned
Day 1, Cycle 4 – Planned for 9/7/2017
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 4 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
Pre-Labs (delete all that do not apply)
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Order every 3rd cycle ONLY.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Verify Labs (2)
Verify pre-treatment lab has been obtained: Total Bilirubin every 3rd cycle ONLY.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 5 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Oral Chemotherapy Order Management
For this regimen, enzalutamide 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 with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
Cycle 5 – 10/5/2017 through 11/1/2017 (28 days), Planned
Day 1, Cycle 5 – Planned for 10/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
Pre-Labs (delete all that do not apply)
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Order every 3rd cycle ONLY.
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 6 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Verify Labs (2)
Verify pre-treatment lab has been obtained: Total Bilirubin every 3rd cycle ONLY.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, enzalutamide 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 with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
Cycle 6 – 11/2/2017 through 11/29/2017 (28 days), Planned
Day 1, Cycle 6 – Planned for 11/2/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Prostate cancer (Advanced); THERAPY: enzalutamide 160 mg by mouth daily continuously; CYCLE LENGTH: 28 days;
COURSE: until disease progression.
Note to All Staff (1)
Dosage adjustment is needed for concomitant use with strong CYP2C8 inhibitors (for example, gemfibrozil). Avoid concomitant use
if possible. If coadministration is necessary, reduce enzalutamide dose to 80 mg once daily. If the strong CYP2C8 inhibitor is
discontinued, adjust the enzalutamide dose back up to the dose used prior to the initiation of the inhibitor.
Note to All Staff (2)
Patients with history of seizures may be at increased risk for seizures with this medication.
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 WITH DIFFERENTIAL
Expected-S+28 Approximate, Expires-S+365, Routine
ALKALINE PHOSPHATASE
Expected-S+28 Approximate, Expires-S+365, Routine
PSA TOTAL, DIAGNOSTIC
Expected-S+28 Approximate, Expires-S+365, Routine
LD, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
CREATININE
Expected-S+28 Approximate, Expires-S+365, Routine
CALCIUM
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 7 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

Expected-S+28 Approximate, Expires-S+365, Routine
ALBUMIN
Expected-S+28 Approximate, Expires-S+365, Routine
ALT/SGPT
Expected-S+28 Approximate, Expires-S+365, Routine
Pre-Labs (delete all that do not apply)
BILIRUBIN, TOTAL
Expected-S+28 Approximate, Expires-S+365, Routine
Order every 3rd cycle ONLY.
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: Creatinine.
Verify Labs (2)
Verify pre-treatment lab has been obtained: Total Bilirubin every 3rd cycle ONLY.
Treatment Parameters
Hold and notify authorizing prescriber for Creatinine Clearance less than 30 mL/min.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, enzalutamide 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 with DIFF, Alkaline Phosphatase, PSA,
Electrolytes, Glucose, BUN, Creatinine, Calcium, ALT, and Total Bilirubin.
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Zztestonc,Jeff J [2507481]
6/15/2017 7:55:12 AM Page 8 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org