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Breast Carboplatin (21D1) Docetaxel (21D1) Trastuzumab (21D1) (Part 1 of 2) (3042 VER: 10-1-15)

Breast Carboplatin (21D1) Docetaxel (21D1) Trastuzumab (21D1) (Part 1 of 2) (3042 VER: 10-1-15) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 09-27-16 (3042 VER: 10-1-15) Page 1 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Carboplatin/Docetaxel/Trastuzumab
Disease Group: Breast
Disease: Breast Cancer (Adjuvant)

Therapy:
Cycle 1: trastuzumab 8 mg/kg (loading dose) IV Day 1
DOCEtaxel 75 mg/m2 IV Day 1
CARBOplatin (AUC = 6) IV day 1

Cycles 2 through 6: trastuzumab 6 mg/kg IV Day 1
DOCEtaxel 75 mg/m2 IV Day 1
CARBOplatin (AUC = 6) IV day 1

Cycle Length: 21 days Course: 6 cycles

NOTE: May be followed by single agent trastuzumab. See additional preprinted orders.

Reference(s): Valero V, et al. J Clin Oncol 2011;29(2):149-56.

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) ___________

Pre labs:
• Obtain CBC without DIFF, ANC, Creatinine, Total Bilirubin, AST
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: WBC, ANC, Platelets, Creatinine, AST, Total Bilirubin
• Hold and notify provider for ANC ≤ 1000/µL or Platelets ≤ 100K/µL or Creatinine > ULN or AST > 1.5 X ULN or
Total Bilirubin > ULN
• Verify that patient has taken home dexamethasone and document.

Nursing Procedure, Assessment and Monitoring:
• Vital signs to be monitored every 15 minutes for the first hour and then every 30 minutes until infusion
complete for the first and second dose of DOCEtaxel administration. Monitor vital signs every 30 minutes for
all subsequent doses if previous doses tolerated.
• Flush/Line Care per Institution standards

Hydration/Fluids: sodium chloride 0.9% IV to establish line and for flushing



Final Approved VER: 09-27-16 (3042 VER: 10-1-15) Page 2 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Premedications/Antiemetics: (May substitute formulary equivalent)
Give prior to DOCEtaxel:
• dexamethasone (Decadron) 20 mg IV once PRN. For use in patients who did not take dexamethasone at
home.

Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 16 mg by mouth once. PO preferred – may give 8 mg IV if unable to tolerate PO.
 fosaprepitant (Emend) 150 mg IV once.
 aprepitant (Emend) 125 mg by mouth once.
 palonosetron (Aloxi) 0.25 mg IV once.
 Other:


Treatment Medications for Day 1: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:



 Cycle 1
• trastuzumab (Herceptin) ____________ mg (8 mg/kg) IV once. Give first dose over 90 minutes and
subsequent doses over 30 minutes. Hypersensitivity risk. For first and second dose, patient should be treated
in a location to optimize emergency care. Patient must be monitored for one hour after the first dose of
trastuzumab. Trastuzumab should be given PRIOR to any chemotherapy.

• DOCEtaxel (Taxotere) __________ mg (75 mg/m2) IV once over 60 minutes in non-PVC bag and non-PVC
tubing. Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.

• CARBOplatin (Paraplatin) _____________mg (AUC = 6) IV once over 60 minutes
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize emergency
care.

(GFR + 25) X AUC = CARBOplatin dose (mg).

NOTE: The GFR used in this equation should not exceed 125 mL/min

Calculated Creatinine Clearance =

(140 – ___Patient age) x (patient weight in _____kg) = ________
72 x serum creatinine

(for females, multiply this result by 0.85) = ________

This value will substitute for GFR to determine CARBOplatin dose

(GFR + 25) X AUC = CARBOplatin dose (mg)

(_____ + 25) X ____ = CARBOplatin _____________ mg
Treatment Medications (continued on next page)

Final Approved VER: 09-27-16 (3042 VER: 10-1-15) Page 3 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Treatment Medications for Day 1: (in order of administration) (cont.)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:




 Cycle ≥ 2
• trastuzumab (Herceptin) ____________ mg (6 mg/kg) IV once over 30 minutes. Hypersensitivity risk. For first
and second dose, patient should be treated in a location to optimize emergency care. Trastuzumab should be
given PRIOR to any chemotherapy.

• DOCEtaxel (Taxotere) __________ mg (75 mg/m2) IV once over 60 minutes in non-PVC bag and non-PVC
tubing. Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.

• CARBOplatin (Paraplatin) _____________mg (AUC = 6) IV once over 60 minutes
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize emergency
care.

(GFR + 25) X AUC = CARBOplatin dose (mg).

NOTE: The GFR used in this equation should not exceed 125 mL/min

Calculated Creatinine Clearance =

(140 – ___Patient age) x (patient weight in _____kg) = ________
72 x serum creatinine

(for females, multiply this result by 0.85) = ________

This value will substitute for GFR to determine CARBOplatin dose

(GFR + 25) X AUC = CARBOplatin dose (mg)

(_____ + 25) X ____ = CARBOplatin _____________ mg



Other Orders for Day 1:







Final Approved VER: 09-27-16 (3042 VER: 10-1-15) Page 4 of 4
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Take Home Medications - (Prescribe Cycle 1, Day 1: Review for adequate supply during treatment)
• dexamethasone (Decadron) 4 mg tablet, Disp. #36, Refills: 1
Take 2 tablets (8 mg) by mouth two times daily for 3 days starting the morning on the day prior to DOCEtaxel.

• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth two times daily for 2 days after chemotherapy and then 1 tablet (8 mg) every 8
hours as needed for nausea/vomiting.

 Other:




Follow Up
• Chemotherapy: Day 1 every 21 days

• Labs:
 Other:



• Procedures/Imaging/Scans:












• Other Orders:








MD Signature_________________________________________ Pager______________
Date __________________Time___________________

Order Verification:
RN Signature: __________________________ Date: ___________ Time: __________ Pager #: ________
RPh Signature: _________________________ Date: ___________ Time: __________ Pager #: ________