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CSC GU m-Tip Cisplatin(21D:1,2,3) Ifosfamide(21D:1,2,3) Paclitaxel(21D:1) (Penile) VER 12-1-16 (HL 5619)

CSC GU m-Tip Cisplatin(21D:1,2,3) Ifosfamide(21D:1,2,3) Paclitaxel(21D:1) (Penile) VER 12-1-16 (HL 5619) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, GU


CSC GU m-TIP CISPLATIN(21D1,2,3)IFOSFAMIDE(21D1,2,3)PACLITAXEL(21D1) (PENILE) VER 12-1-16 (HL 5619) – 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: Penile Cancer (Advanced); THERAPY: PACLItaxel 175 mg/m2 IV Day 1, mesna 400 mg/m2 IV prior to the start of
ifosfamide followed by mesna 200 mg/m2 IV (or 400 mg/m2 by mouth) 4 and 8 hours after the start of ifosfamide Days 1, 2, 3,
ifosfamide 1200 mg/m2 IV Days 1, 2, 3, CISplatin 25 mg/m2 IV Days 1, 2, 3; GROWTH FACTOR REQUIRED; CYCLE LENGTH: 21
to 28 days; COURSE: 4 cycles.
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
ELECTROLYTES
Expected-S Approximate, Expires-S+365, Routine
BUN
Expected-S Approximate, Expires-S+365, Routine
CREATININE
Expected-S Approximate, Expires-S+365, Routine
MAGNESIUM
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
ALBUMIN
Expected-S Approximate, Expires-S+365, Routine
URINALYSIS, NO MICROSCOPY
Expected-S Approximate, Expires-S+365, Normal, Routine
Take Home Medications
dexamethasone (DECADRON) 4 MG tab
Take 5 tabs by mouth 12 & 6 hours prior to PACLItaxel and 2 tabs once daily on Days 4, 5, and 6., Disp-50 tab, R-1, starting S,
Local Printer
prochlorperazine (COMPAZINE) 10 MG tab
Take 1 tab by mouth every 6 hours as needed for nausea/vomiting., 10 mg, Disp-30 tab, R-5, EVERY 6 HOURS PRN starting S,
Local Printer
Take Home Medications (delete all that do not apply)
TBO-filgrastim (GRANIX) 300 MCG/0.5ML soln prefilled syringe
Inject 300 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than *** after nadir., 300 mcg,
Disp-10 Syringe, R-5, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
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Zztestonc,Jeff J [2507481]
6/15/2017 7:38:25 AM Page 1 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org

TBO-filgrastim (GRANIX) 480 MCG/0.8ML soln prefilled syringe
Inject 480 mcg under skin one time daily in evening. Begin Day ***. Continue until ANC is greater than *** after
nadir., 480 mcg, Disp-10 Syringe, R-5, 1 X DAILY (PM) starting S, Local Printer
RPh may substitute filgrastim at an equivalent dose and qty based on insurance coverage.
Cycle 1 – 6/15/2017 through 7/5/2017 (21 days), Planned
Cycle 2 – 7/6/2017 through 7/26/2017 (21 days), Planned
Cycle 3 – 7/27/2017 through 8/16/2017 (21 days), Planned
Cycle 4 – 8/17/2017 through 9/6/2017 (21 days), Planned
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Zztestonc,Jeff J [2507481]
6/15/2017 7:38:25 AM Page 2 of 2
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
06/2017CCKM@uwhealth.org