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

CSC GI Sarcoma Imatinib(28D:1-28) VER 8-15-17 (HL 408)

CSC GI Sarcoma Imatinib(28D:1-28) VER 8-15-17 (HL 408) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Sarcoma


CSC GI/SARCOMA IMATINIB(28D:1-28) VER: 8-15-17 –  Properties
Pre-Cycle –  8/1/2017 through 8/7/2017 (7 days), Planned
Day 1, Pre-Cycle –  Planned for 8/1/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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
GLUCOSE
Expected: S Approximate, Expires: S+365, Routine
BUN
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
ALKALINE PHOSPHATASE
Expected: S Approximate, Expires: S+365, Routine
Cycle 1 –  8/8/2017 through 9/4/2017 (28 days), Planned
Day 1, Cycle 1 –  Planned for 8/8/2017
Treatment Plan Information
Reference Information (1)
GASTROINTESTINAL STROMAL TUMOR (GIST): Demetri GD, et al. N Engl J Med;2002;347:472-80.
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 1 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Reference Information (2)
GASTROINTESTINAL STROMAL TUMOR (GIST): Heikki J, et al. JAMA 2012;307(12):1265-72.
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): imatinib (dispensed on Day 1 of
Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
imatinib (GLEEVEC) 100 MG tab
Take  by mouth one time daily., 1 X DAILY starting S, Local Printer
Daily dose = 400 mg or 600 mg or 800 mg PO daily. The 800 mg daily dose may be administered as once daily dose or
as split dose = 400 mg PO BID.  (Round doses to available tablet sizes of 100 mg and 400 mg)
imatinib (GLEEVEC) 400 MG tab
Take  by mouth one time daily., 1 X DAILY starting S, Local Printer
Daily dose = 400 mg or 600 mg or 800 mg PO daily. The 800 mg daily dose may be administered as once daily dose or
as split dose = 400 mg PO BID.  (Round doses to available tablet sizes of 100 mg and 400 mg)
Follow-Up
DAY 29 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
Cycle 2 –  9/5/2017 through 10/2/2017 (28 days), Planned
Day 1, Cycle 2 –  Planned for 9/5/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 2 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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
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
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: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, imatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 29 FOLLOW-UP
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 3 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
Cycle 3 –  10/3/2017 through 10/30/2017 (28 days), Planned
Day 1, Cycle 3 –  Planned for 10/3/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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
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
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
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 4 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, imatinib 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 done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
Cycle 4 –  10/31/2017 through 1/22/2018 (84 days), Planned
Day 1, Cycle 4 –  Planned for 10/31/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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
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
BILIRUBIN, TOTAL
Expected: S+28 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 5 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

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: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, imatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 85 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
Cycle 5 –  1/23/2018 through 4/16/2018 (84 days), Planned
Day 1, Cycle 5 –  Planned for 1/23/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
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+84 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+84 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+84 Approximate, Expires: S+365, Routine
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 6 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

GLUCOSE
Expected: S+84 Approximate, Expires: S+365, Routine
BUN
Expected: S+84 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+84 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+84 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+84 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+84 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+84 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, imatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 85 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
Cycle 6 –  4/17/2018 through 7/9/2018 (84 days), Planned
Day 1, Cycle 6 –  Planned for 4/17/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST)(Advanced/Adjuvant); THERAPY: imatinib 400 mg or 600 mg or 800 mg
by mouth daily; CYCLE LENGTH: 28 days; COURSE: 3 cycles followed by THERAPY: imatinib 400 mg or 600 mg or 800
mg by mouth daily; CYCLE LENGTH: 84 days; COURSE: Advanced GIST: until disease progression; Adjuvant GIST: up to
36 months.
Consent
Verify Consent
Verify informed consent has been obtained.
IV Access
Insert and Maintain Peripheral IV
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 7 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@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+84 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+84 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+84 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+84 Approximate, Expires: S+365, Routine
BUN
Expected: S+84 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+84 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+84 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+84 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+84 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+84 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
Verify pretreatment labs have been obtained: CBC, ANC.
Treatment Parameters
Hold and notify authorizing prescriber for ANC less than or equal to 1,000/µL or Platelets less than or equal to 75K/µL.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, imatinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 85 FOLLOW-UP
(Day 1 of next cycle) RETURN TO CLINIC for appointment with provider; LABS: CBC, ANC (DIFF if done locally),
Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT, Alkaline Phosphatase.
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Zztestonc,Jeff J [2507481]
8/8/2017 2:04:27 PM Page 8 of 8
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org