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Sarcoma Docetaxel(21D8) Gemcitabine(21D1,8)(3359 VER 5-1-17)

Sarcoma Docetaxel(21D8) Gemcitabine(21D1,8)(3359 VER 5-1-17) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 6-5-17 (3359 5-1-17) Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uw health.org
Title: Docetaxel/Gemcitabine
Disease Group: Sarcoma
Disease: Bone Sarcoma (Advanced), Soft Tissue Sarcoma (Advanced)

Therapy:
Bone Sarcoma: gemcitabine 675 mg/m2 IV Day 1 and 8,
DOCEtaxel 100 mg/m2 IV Day 8,
GROWTH FACTOR REQUIRED
Soft Tissue Sarcoma: gemcitabine 900 mg/m2 IV Day 1 and 8,
DOCEtaxel 100 mg/m2 IV Day 8,
GROWTH FACTOR REQUIRED

Cycle Length: 21 days Course: Bone Sarcoma: until disease progression
Soft Tissue Sarcoma: 6 to 8 cycles or until disease progression

Reference(s): Navid F, et al. Cancer 2008;113(2):419-25; Leu KM, et al J Clin Oncol 2004;22(9):1706-12;

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


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

Pre labs:
• Day 1: Obtain CBC without DIFF, ANC, Creatinine, AST, Total Bilirubin
 Other:

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

Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained:
 Day 1 and 8: CBC, ANC, Creatinine, Total Bilirubin
 Day 8: CBC, ANC
• Hold and notify provider for:
 Day 1 and 8: ANC ≤ 1000/µL or Platelets ≤ 100K/µL or Total Bilirubin > 3 mg/dL
 Day 8: ANC ≤ 1000/µL or Platelets ≤ 100K/µL
• Day 8: Verify that patient has taken home dexamethasone and document.

Nursing Procedure, Assessment and Monitoring:
• Day 8: 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



VER: 6-5-17 (3359 5-1-17) Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uw health.org
Premedications/Antiemetics: (May substitute formulary equivalent)
Day 8: Give prior to DOCEtaxel:
• dexamethasone (Decadron) 20 mg IV once PRN. For use only in patients who did not take dexamethasone at
home.

Day 1 and 8: Give prior to chemotherapy (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 8 mg by mouth once. PO preferred – may give 8 mg IV if unable to tolerate PO.
 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:


• gemcitabine (Gemzar) __________mg (_______ mg/m2, starting dose 675 or 900 mg/m2) IV once over 30
minutes. Additional sodium chloride 0.9% may be y-set into IV site to decrease site irritation.


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:


• gemcitabine (Gemzar) ____________ mg (_______ mg/m2, starting dose 675 or 900 mg/m2) IV once over 30
minutes. Additional sodium chloride 0.9% may be y-set into IV site to decrease irritation.


• DOCEtaxel (Taxotere) __________mg (100 mg/m2) IV once over 60 minutes. In non-PVC bag. Infuse through
non-PVC tubing. Hypersensitivity risk. For first and second dose, patient should be treated in a location to
optimize emergency care.



Other Orders for Day 1 and/or 8:





VER: 6-5-17 (3359 5-1-17) Page 3 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uw health.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 2 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.

• prochlorperazine (Compazine) 10 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (10 mg) by mouth every 6 hours as needed for nausea/vomiting.

Select One: (May substitute formulary equivalent)
 filgrastim (Neupogen) 300 mcg/0.5 mL syringe. Disp. 10 syringes, Refills: 5
Inject one syringe (300 mcg) under skin one time daily in evening. Begin Day ______. Continue until ANC is
greater than _______ after nadir.

 filgrastim (Neupogen) 480 mcg/0.8 mL syringe. Disp. 10 syringes, Refills: 5
Inject one syringe (480 mcg) under skin one time daily in evening. Begin Day ______. Continue until ANC is
greater than _______ after nadir.

 Other:


Follow Up
• Chemotherapy: Day 1 and 8 every 21 days

• Labs:
 Day 15 – 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 #: ________