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Sarcoma Outpt Doxorubicin(21D:1)/Olaratumab(21D:1,8) (5992 VER: 01-9-17)

Sarcoma Outpt Doxorubicin(21D:1)/Olaratumab(21D:1,8) (5992 VER: 01-9-17) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


VER: 12-14-17 (5992 VER: 01-9-17) Page 1 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Doxorubicin/Olaratumab
Disease Group: Sarcoma
Disease: Soft Tissue Sarcoma

Therapy: olaratumab 15 mg/kg IV Day 1 and 8,
doxorubicin 75 mg/m2 IV Day 1

Cycle Length: 21 days Course: until disease progression (maximum of 8 cycles of doxorubicin)

Reference(s): Tap WD, et al. Lancet 2016;388(10043):488-97, Mack LA, et al. Ann Surg Oncol 2005;12(8):646-
53

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, Electrolytes, Glucose, BUN, Creatinine, Total Bilirubin, AST, ALT,
Alkaline Phosphatase, Phosphate, Magnesium, PTT, Urine Pregnancy Test (Cycle 1 only - for women of
childbearing potential)
 Other:


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


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Day 1 and 8: Verify the following labs have been obtained: CBC, ANC
• Day 1 and 8: Hold and notify provider for ANC < 1000/µL or Platelets < 100K/µL
• Cycle 1, Day 1: Verify patient has obtained pretreatment MUGA or ECHO.

Nursing Procedure, Assessment and Monitoring:
• Obtain baseline blood pressure.
• Flush/Line Care per Institution standards

Hydration/Fluids:
• Day 1: sodium chloride 0.9% IV administer 1000 mL throughout chemotherapy
• Day 8: sodium chloride 0.9% IV to establish line and for flushing

Premedications/Antiemetics: (May substitute formulary equivalent)
Cycle 1, Day 1: Give prior to olaratumab:
• diphenhydramine (Benadryl) 25 mg IV once
• dexamethasone (Decadron) 10 mg IV once

Premedications/Antiemetics (continued on next page)


VER: 12-14-17 (5992 VER: 01-9-17) Page 2 of 3
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Premedications/Antiemetics: (May substitute formulary equivalent)

Cycle 1, Day 1: Give prior to doxorubicin (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 24 mg by mouth once. PO preferred – may give 12 mg IV if unable to tolerate PO.
 dexamethasone (Decadron) 12 mg by mouth once. PO preferred – may give 10 mg IV if unable to tolerate PO.
 *aprepitant (Emend) 125 mg by mouth once.
 fosaprepitant (Emend) 150 mg IV once.
 palonosetron (Aloxi) 0.25 mg IV once.
 Other:


Cycle ≥ 2, Day 1: Give prior to doxorubicin (*indicates preferred antiemetic regimen):
 *ondansetron (Zofran) 24 mg by mouth once. PO preferred – may give 12 mg IV if unable to tolerate PO.
 *dexamethasone (Decadron) 12 mg by mouth once. PO preferred – may give 10 mg IV if unable to tolerate
PO.
 *aprepitant (Emend) 125 mg by mouth once.
 fosaprepitant (Emend) 150 mg IV 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:


• olaratumab (Lartruvo) __________mg (15 mg/kg) IV once over 60 minutes. Flush the line with normal saline
prior to and at the end of infusion.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care. Patient must be monitored for 30 minutes after the first two doses of olaratumab.

 Optional: dexrazoxane (Zinecard) ____________ mg (750 mg/m2) IV once over 15 minutes prior to
doxorubicin.

• doxorubicin (Adriamycin) __________ mg (75 mg/m2) IV side arm push into running IV. (Note: not to exceed
eight cycles)

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:


• olaratumab (Lartruvo) __________mg (15 mg/kg) IV once over 60 minutes. Flush the line with normal saline
prior to and at the end of infusion.
Hypersensitivity risk. For first and second dose, patient should be treated in a location to optimize
emergency care. Patient must be monitored for 30 minutes after the first two doses of olaratumab.

Other Orders for Day 1 and/or 8:




VER: 12-14-17 (5992 VER: 01-9-17) 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. #24, Refills: 5
Take 2 tablets (8 mg) by mouth once daily for 3 days following doxorubicin.

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

• ranitidine (Zantac) 150 mg tablet, Disp. #60, Refills: 5
Take 1 tablet (150 mg) by mouth two times daily.

 aprepitant (Emend) 80 mg capsule, Disp. #7, Refills: 5
Take 1 capsule by mouth once daily for two days following doxorubicin.
(Prescribe only if patient received aprepitant as a premedication)

 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 #: ________