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

/clinical/cckm-tools/content/ppo/name-117035-en.cckm

201705146

page

100

UWHC,UWMF,

Tools,

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

GYN Carboplatin(21D1) Docetaxel(21D1) (391 VER: 10-03-16)

GYN Carboplatin(21D1) Docetaxel(21D1) (391 VER: 10-03-16) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 05-25-17 (391 VER: 10-03-16) Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Carboplatin/Docetaxel
Disease Group: Gynecology Oncology
Disease: Ovarian (Adjuvant/Advanced), Primary Peritoneal, Fallopian Tube, Uterine, Cervical, Vulvar, Vaginal
Cancer

Therapy: DOCEtaxel 60 to 75 mg/m2 IV Day 1,
CARBOplatin (AUC = 4 to 6) IV Day 1,

Cycle Length: 21 days Course: 4 to 6 cycles

Reference(s): Vasey PA, et al. J Natl Cancer Inst 2004;96:1682-91

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


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

Pre labs:
• Day 1: Obtain CBC without DIFF, ANC, Electrolytes, Glucose, CA 125, Magnesium, BUN, Creatinine, Total
Bilirubin
 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 provider for: ANC ≤ 1500/µL or Platelets ≤ 100K/µL or Creatinine > ULN
• Verify that patient has taken home dexamethasone and document.

Nursing Procedure, Assessment and Monitoring:
• Monitor vital signs 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

Premedications/Antiemetics: (May substitute formulary equivalent)
Give prior to DOCEtaxel:
• dexamethasone (Decadron) 20 mg IV once PRN. For use only 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:


VER: 05-25-17 (391 VER: 10-03-16) Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
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:


• DOCEtaxel (Taxotere) __________ mg (______ mg/m2, range 60 to 75 mg/m2) IV once over 60 minutes. In
non-PVC bag. Infuse through non-PVC tubing. Maximum BSA = 2 m2 (per physician discretion).
Hypersensitivity Risk. For first and second dose, patient should be treated in a location to optimize emergency
care.

• CARBOplatin (Paraplatin) _____________mg (Dosed AUC = _____ , range 4 to 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:












VER: 05-25-17 (391 VER: 10-03-16) Page 3 of 3
Copyright © 2017 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. Take for 3 days, starting AM on the day prior to DOCEtaxel.

• 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 every 21 days

• Labs:
 Day 10 – Obtain CBC, ANC (DIFF if done locally)
 Other:


• Procedures/Imaging/Scans:









• Other Orders:







MD Signature_________________________________________ Pager______________
Date __________________Time___________________

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