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

/clinical/cckm-tools/content/beacon-protocols/melanoma/name-96976-en.cckm

20180130

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100

UWHC,UWMF,

Tools,

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

CSC Melanoma Dabrafenib(28D:1-28) Trametinib(28D:1-28) VER 1-30-18 (HL 5375)

CSC Melanoma Dabrafenib(28D:1-28) Trametinib(28D:1-28) VER 1-30-18 (HL 5375) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Melanoma


CSC MELANOMA DABRAFENIB(28D:1-28)/TRAMETINIB(28D:1-28) VER: 1-30-18 –  Properties
Pre-Cycle –  1/23/2018 through 1/29/2018 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 1/23/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
Consent
Verify Consent
Verify informed consent has been obtained.
Pre-Labs
CBC WITH DIFFERENTIAL
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
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
BILIRUBIN, TOTAL
Expected: S Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S Approximate, Expires: S+365, Routine
Pre-Labs (delete all that do not apply)
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 1 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

HCG, QUALITATIVE
Expected: S Approximate, Expires: S+365, Routine
Treatment Conditions
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Cycle 1 –  1/30/2018 through 2/26/2018 (28 days), Planned
Day 1, Cycle 1 –  Planned for 1/30/2018
Treatment Plan Information
Reference Information (1)
MELANOMA: Flaherty KT, et al. N Eng J Med 2012;367(18):1694-703.
Reference Information (2)
MELANOMA: Long GV, et al. N Engl J Med 2017;377:1813-23.
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or
pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 2 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should
be administered approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose
may be administered up to 6 hours prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose
within 12 hours of the next dose. When taking in combination with dabrafenib, take the once daily
trametinib dose at the same time each day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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): dabrafenib and trametinib
(dispensed Day 1 of Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
dabrafenib mesylate (TAFINLAR) 75 MG cap
Take 2 caps by mouth 2 times daily. Take on empty stomach, 1 hour before or 2 hours after meals. Do not open,
crush, or break caps., 150 mg, Disp-120 cap, R-0, 2 X DAILY starting S
trametinib dimethyl sulfoxide (MEKINIST) 2 MG tab
Take 1 tab by mouth one time daily. Take on empty stomach, 1 hour before or 2 hours after a meal., 2 mg, Disp-30
tab, R-0, 1 X DAILY starting S
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle)  RETURN TO CLINIC for appointment with provider; LABS: CBC with DIFF, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH; PROCEDURE: ECG and ECHO or MUGA.
Cycle 2 –  2/27/2018 through 3/26/2018 (28 days), Planned
Day 1, Cycle 2 –  Planned for 2/27/2018
Treatment Plan Information
Treatment Plan Summary
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...
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]
1/30/2018 1:43:26 PM Page 3 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 4 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than
1000/uL or Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL
or visual disturbances or pulmonary toxicity or diarrhea.
Treatment Condition A
Verify patient has obtained pretreatment ECG and MUGA or ECHO.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates)
due to trametinib.
Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should be administered
approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose may be administered up to 6 hours
prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of
the next dose. When taking in combination with dabrafenib, take the once daily trametinib dose at the same time each
day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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
Oral Chemotherapy Order Management
For this regimen, dabrafenib and trametinib 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, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH.
Cycle 3 –  3/27/2018 through 4/23/2018 (28 days), Planned
Day 1, Cycle 3 –  Planned for 3/27/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 5 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Treatment Plan Summary (2)
DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 6 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or
pulmonary toxicity or diarrhea.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates)
due to trametinib.
Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should be administered
approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose may be administered up to 6 hours
prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of
the next dose. When taking in combination with dabrafenib, take the once daily trametinib dose at the same time each
day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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
Oral Chemotherapy Order Management
For this regimen, dabrafenib and trametinib 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, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH. PROCEDURE (every other Cycle): ECG and ECHO
or MUGA
Cycle 4 –  4/24/2018 through 5/21/2018 (28 days), Planned
Day 1, Cycle 4 –  Planned for 4/24/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 7 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or
pulmonary toxicity or diarrhea.
Treatment Condition A
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 8 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles
beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates)
due to trametinib.
Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should be administered
approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose may be administered up to 6 hours
prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of
the next dose. When taking in combination with dabrafenib, take the once daily trametinib dose at the same time each
day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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
Oral Chemotherapy Order Management
For this regimen, dabrafenib and trametinib 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, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH. PROCEDURE (every other Cycle): ECG and ECHO
or MUGA
Cycle 5 –  5/22/2018 through 6/18/2018 (28 days), Planned
Day 1, Cycle 5 –  Planned for 5/22/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 9 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or
pulmonary toxicity or diarrhea.
Treatment Condition A
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 10 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles
beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates)
due to trametinib.
Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should be administered
approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose may be administered up to 6 hours
prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of
the next dose. When taking in combination with dabrafenib, take the once daily trametinib dose at the same time each
day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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
Oral Chemotherapy Order Management
For this regimen, dabrafenib and trametinib 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, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH. PROCEDURE (every other Cycle): ECG and ECHO
or MUGA
Cycle 6 –  6/19/2018 through 7/16/2018 (28 days), Planned
Day 1, Cycle 6 –  Planned for 6/19/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Metastatic Melanoma (Advanced) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib 150 mg by
mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days; COURSE:
until disease progression.
Treatment Plan Summary (2)
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 11 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DISEASE: Resected High Risk Melanoma (Adjuvant) with BRAF V600E or BRAF V600K mutation; THERAPY: dabrafenib
150 mg by mouth twice daily continuously, trametinib 2 mg by mouth once daily continuously; CYCLE LENGTH: 28 days;
COURSE: up to 1 year. NOTE: High Risk patient defined as stage III melanoma (stage IIIA (limited to lymph-node
metastasis of >1 mm), IIIB, or IIIC cutaneous melanoma (according to the criteria of the American Joint Committee on
Cancer, seventh edition).
Note to All Staff (1)
Trametinib is expected to cause fetal harm if administered to a pregnant woman. Women of childbearing potential
should use a highly effective contraceptive during therapy and for 4 months after treatment is complete.
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
ELECTROLYTES
Expected: S+28 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+28 Approximate, Expires: S+365, Routine
BUN
Expected: S+28 Approximate, Expires: S+365, Routine
CREATININE
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
LD, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC with DIFF, Creatinine.
Treatment Parameters
Hold treatment and notify authorizing prescriber for temperature greater than 101.3 F or ANC less than 1000/uL or
Creatinine rise of greater than 0.5 mg/dL above baseline or Creatinine greater than 2 mg/dL or visual disturbances or
pulmonary toxicity or diarrhea.
Treatment Condition A
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 12 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

Verify patient has obtained pretreatment ECG and MUGA or ECHO obtained every 2 to 3 Cycles
beginning Cycle 2.
Nursing Procedure, Assessment and Monitoring
Monitoring Parameters (1)
Monitor patient for complaints of visual disturbances due to trametinib and need for ophthalmological evaluation.
Monitoring Parameters (2)
Monitor patient for signs and symptoms of pulmonary toxicity (cough, dyspnea, hypoxia, pleural effusion, or infiltrates)
due to trametinib.
Patient Instructions(1)
Educate patient to take dabrafenib orally at least 1 hour before or 2 hours after a meal. Doses should be administered
approximately 12 hours apart. Do not open, crush, or break capsules. A missed dose may be administered up to 6 hours
prior to the next dose.
Educate patient to take trametinib 1 hour before or 2 hours after a meal. Do not take a missed dose within 12 hours of
the next dose. When taking in combination with dabrafenib, take the once daily trametinib dose at the same time each
day with either the morning or evening dose of dabrafenib.
Patient Instructions(2)
Educate patient regarding risk of diarrhea, rash, and visual disturbances due to trametinib.
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 lock flush 10 UNIT/ML 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
Oral Chemotherapy Order Management
For this regimen, dabrafenib and trametinib 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, Electrolytes, Glucose,
BUN, Creatinine, AST, ALT, Alkaline Phosphatase, Total Bilirubin, LDH. PROCEDURE (every other Cycle): ECG and ECHO
or MUGA
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Zztestonc,Jeff J [2507481]
1/30/2018 1:43:26 PM Page 13 of 13
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org