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201708223

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UWHC,UWMF,

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

CSC GI-Sarcoma Sunitinib(42D:1-28) VER 8-15-17 (HL 409)

CSC GI-Sarcoma Sunitinib(42D:1-28) VER 8-15-17 (HL 409) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Beacon Protocols, Sarcoma


CSC GI/SARCOMA SUNITINIB(42D: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); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
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 9/18/2017 (42 days), Planned
Day 1, Cycle 1 –  Planned for 8/8/2017
Treatment Plan Information
Reference Information (1)
GASTROINTESTINAL STROMAL TUMOR: Casali PG, et al. J Clin Oncol; 2006; ASCO Meeting Proceedings 24:9513.
Reference Information (2)
GASTROINTESTINAL STROMAL TUMOR: Demetri GD, et al. Lancet 2006;368(9544):1329-38.
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 1 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
See Take Home Medication(s)
Refer to the take home medications section for the following treatment medication(s): sunitinib (dispensed on Day 1 of
Cycle 1 only - subsequent refills will be ordered through the medication activity).
Take Home Medications
sunitinib (SUTENT) 50 MG cap
Take 1 cap by mouth one time daily. Take for 28 days, followed by 14 days off., 50 mg, Disp-28 cap, R-0, 1 X DAILY
starting S
Follow-Up
DAY 43 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 –  9/19/2017 through 10/30/2017 (42 days), Planned
Day 1, Cycle 2 –  Planned for 9/19/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
Consent
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]
8/8/2017 2:06:33 PM Page 2 of 9
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+42 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+42 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+42 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+42 Approximate, Expires: S+365, Routine
BUN
Expected: S+42 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+42 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+42 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+42 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+42 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+42 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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sunitinib will be ordered through the medication activity after the initial order.
Follow-Up
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 3 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

DAY 43 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 3 –  10/31/2017 through 12/11/2017 (42 days), Planned
Day 1, Cycle 3 –  Planned for 10/31/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
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+42 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+42 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+42 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+42 Approximate, Expires: S+365, Routine
BUN
Expected: S+42 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+42 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+42 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+42 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+42 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+42 Approximate, Expires: S+365, Routine
Treatment Conditions
Verify Labs
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 4 of 9
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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sunitinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 43 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 –  12/12/2017 through 1/22/2018 (42 days), Planned
Day 1, Cycle 4 –  Planned for 12/12/2017
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
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+42 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+42 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+42 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+42 Approximate, Expires: S+365, Routine
BUN
Expected: S+42 Approximate, Expires: S+365, Routine
CREATININE
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 5 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Expected: S+42 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+42 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+42 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+42 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+42 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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sunitinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 43 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 3/5/2018 (42 days), Planned
Day 1, Cycle 5 –  Planned for 1/23/2018
Treatment Plan Information
Treatment Plan Summary
DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once daily for 4 weeks
(28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until disease progression.
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]
8/8/2017 2:06:33 PM Page 6 of 9
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+42 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+42 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+42 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+42 Approximate, Expires: S+365, Routine
BUN
Expected: S+42 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+42 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+42 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+42 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+42 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+42 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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
Oral Chemotherapy Order Management
For this regimen, sunitinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 43 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 –  3/6/2018 through 4/16/2018 (42 days), Planned
Day 1, Cycle 6 –  Planned for 3/6/2018
Treatment Plan Information
Treatment Plan Summary
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 7 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

DISEASE: Gastrointestinal Stromal Tumor (GIST) (Advanced); THERAPY: sunitinib 50 mg by mouth once
daily for 4 weeks (28 days) followed by 2 weeks (14 days) rest; CYCLE LENGTH: 42 days; COURSE: until
disease progression.
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+42 Approximate, Expires: S+365, Routine
ABSOLUTE NEUTROPHIL COUNT
Expected: S+42 Approximate, Expires: S+365, Routine
ELECTROLYTES
Expected: S+42 Approximate, Expires: S+365, Routine
GLUCOSE
Expected: S+42 Approximate, Expires: S+365, Routine
BUN
Expected: S+42 Approximate, Expires: S+365, Routine
CREATININE
Expected: S+42 Approximate, Expires: S+365, Routine
BILIRUBIN, TOTAL
Expected: S+42 Approximate, Expires: S+365, Routine
AST/SGOT
Expected: S+42 Approximate, Expires: S+365, Routine
ALT/SGPT
Expected: S+42 Approximate, Expires: S+365, Routine
ALKALINE PHOSPHATASE
Expected: S+42 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 Parameters (2)
Baseline evaluation of LVEF should be considered for all patients. Periodic evaluations of LVEF should also be
considered for patients with CARDIAC RISK FACTORS. In the presence of clinical manifestations of CHF, discontinuation
of sunitinib is recommended. The dose of sunitinib should be interrupted and/or reduced in patients without clinical
evidence of CHF but have an EF less than 50% and greater than 20% below baseline.
Treatment Medications
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Zztestonc,Jeff J [2507481]
8/8/2017 2:06:33 PM Page 8 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org

Oral Chemotherapy Order Management
For this regimen, sunitinib will be ordered through the medication activity after the initial order.
Follow-Up
DAY 43 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 2:06:33 PM Page 9 of 9
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
08/2017CCKM@uwhealth.org