/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/ppo/,

/clinical/cckm-tools/content/ppo/name-111554-en.cckm

20170106

page

100

UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Preprinted Paper Orders

Lung Carboplatin(21D:1,8,15) Paclitaxel(2D:1,8,15) with Concurrent XRT (359 VER: 10-3-16)

Lung Carboplatin(21D:1,8,15) Paclitaxel(2D:1,8,15) with Concurrent XRT (359 VER: 10-3-16) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 12-28-16 (359 VER: 10-3-16) Page 1 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Carboplatin/Paclitaxel with Concurrent XRT
Disease Group: Lung
Disease: Non-Small Cell Lung Cancer (Adjuvant)

Therapy: PACLItaxel 45 mg/m2 IV once weekly throughout radiotherapy
CARBOplatin (AUC = 2) IV once weekly throughout radiotherapy

Cycle Length: 21 days Course: Variable-determined by duration of radiotherapy

NOTE: This regimen is followed by CARBOplatin/PACLItaxel without XRT. See additional preprinted orders.

Reference(s): Belani, CP, et al. J Clin Oncol 2005;23:5883-91 and J Clin Oncol 2005;24:1966.

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


Cycle _______ Starting with:  Day 1 (date) _________  Day 8 (date) _________  Day 15 (date) _________

Pre labs:
• Day 1: Obtain CBC without DIFF, ANC, Electrolytes, BUN, Creatinine, Calcium, Albumin, Total Bilirubin, AST,
Alkaline Phosphatase
 Other:



• Day 8 and 15: Obtain CBC without DIFF, ANC, Creatinine
 Other:



Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: CBC, ANC, Creatinine
• Hold and notify MD for ANC < 1000/µL or Platelet < 100K/µL
• 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 every 30 minutes until infusion complete for
the first and second dose of PACLItaxel 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


VER: 12-28-16 (359 VER: 10-3-16) Page 2 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Premedications/Antiemetics: (May substitute formulary equivalent)
Give prior to PACLItaxel:
• dexamethasone (Decadron) 20 mg IV once PRN. For patients who did not take dexamethasone at home.
• diphenhydramine (Benadryl) 50 mg IV once.
• ranitidine (Zantac) 50 mg IV once.

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:




• PACLItaxel (Taxol) ________ mg (45 mg/m2) IV once over 60 minutes in non-PVC Bag IV once through non-
PVC tubing and standard in-line filter.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.


• CARBOplatin (Paraplatin) __________ mg (AUC = 2) IV once over 30 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)

VER: 12-28-16 (359 VER: 10-3-16) Page 3 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Treatment Medications for Day 8: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:




• PACLItaxel (Taxol) ________ mg (45 mg/m2) IV once over 60 minutes in non-PVC Bag IV once through non-
PVC tubing and standard in-line filter.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.


• CARBOplatin (Paraplatin) __________ mg (AUC = 2) IV once over 30 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)


VER: 12-28-16 (359 VER: 10-3-16) Page 4 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Treatment Medications for Day 15: (in order of administration)
Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:




• PACLItaxel (Taxol) ________ mg (45 mg/m2) IV once over 60 minutes in non-PVC Bag IV once through non-
PVC tubing and standard in-line filter.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care.


• CARBOplatin (Paraplatin) __________ mg (AUC = 2) IV once over 30 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, 8 and/or 15:







VER: 12-28-16 (359 VER: 10-3-16) Page 5 of 5
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Take Home Medications
• dexamethasone (Decadron) 4 mg tablet, Disp. #68, Refills: 0
Take 5 tablets (20 mg) by mouth 12 and 6 hours prior to 1
st
PACLItaxel dose, 3 tablets (12 mg) by mouth 12
hours and 6 hours before 2
nd
PACLItaxel dose and 2 tablets (8 mg) by mouth 12 hours and 6 hours prior to
remaining PACLItaxel doses. In addition, take 2 tablets (8 mg) by mouth once daily for 3 days after
chemotherapy.

• ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth every 8 hours as needed for nausea/vomiting.

 aprepitant (Emend) 80 mg capsule, Disp. #2, Refills: 5
Take 1 capsule by mouth once daily for two days following chemotherapy.
(Prescribe only if patient received aprepitant as a premedication)

 Other:



Follow Up
• Chemotherapy: Day 1, 8 and 15 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 #: ________