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Temozolomide (42D-daily) Concurrent XRT (991 VER: 04-30-15)

Temozolomide (42D-daily) Concurrent XRT (991 VER: 04-30-15) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 11-24-15 (991 VER: 04-30-15) Page 1 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Temozolomide with Concurrent XRT
Disease Group: Brain
Disease: High Grade Glioma (Adjuvant)

Therapy (Stupp Regimen): temozolomide 75 mg/m2 by mouth once daily continuously up to Day 42
Cycle Length: 6 weeks concurrent XRT plus 4 weeks rest Course: Length of radiotherapy
NOTE (1): May be followed by maintenance phase temozolomide after 4 week break.
NOTE (2): If BSA greater than 2.2 m2, consider dosing at adjusted body weight

Therapy (Combs Regimen): temozolomide 50 mg/m2 by mouth once daily continuously up to Day 42
Cycle Length: 6 weeks concurrent XRT plus 4 weeks rest with no post-radiation temozolomide
Course: Length of radiotherapy
NOTE (1): This dose level is to be used in elderly patients or patients with poor performance status or multiple
co-morbidities.
NOTE (2): If BSA greater than 2.2 m2, consider dosing at adjusted body weight
Note to all Staff (1): Monitor for sudden and precipitous drop in Platelet count typically between week 3 to 5, as
it is often followed by precipitous drop in ANC and White Blood Cells 7 to 10 days later. If Platelet count drops
suddenly (close to or below 100K/µL), stop temozolomide and consider using pegfilgrastim before ANC goes
below 1200/µL to ensure adequate stem cells available for stimulation. Most often seen in young women, can be
life-threatening and may require many weeks of Platelet support.

Note to all Staff (2): Pneumocystis Carinii prophylaxis required during radiation. Consider using pentamidine,
sulfamethoxazole-trimethoprim, or dapsone.

Reference(s): Stupp R, et al. N Engl J Med 2005;10:987-96, Stupp R, et al. Lancet Oncol 2009;10(5):459-66,
Combs S, et al. Int J Radiat Oncol Biol Phys 2008;71(4):999-1005, Combs S, et al. Strahlenther Onkol
2005;181(6):372-7.

Allergies:  NKDA  Other ____________________________

Height _________cm Weight __________kg BSA ________m
2


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

Pre labs:
• Day 1: Obtain CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine, Calcium, Albumin, Total Protein, Total
Bilirubin, AST, ALT, Alkaline Phosphatase
 Other:

• Day 8, 15, 22, 29, 36, 43, 50, 57, 64: Obtain CBC with DIFF

Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Day 1: Verify the following labs have been obtained: CBC with DIFF, Electrolytes, Glucose, BUN, Creatinine,
Calcium, Albumin, Total Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase
• Day 1, 8, 15, 22, 29, 36, 43, 50, 57, 64: Hold and notify provider for: Platelets ≤ 105K/µL or > 100K/µL
decrease since last Platelet count or ANC ≤ 1000/µL.
• Notify provider to start Zoster prophylaxis for Absolute Lymphocyte Count < 400/µL

Final Approved VER: 11-24-15 (991 VER: 04-30-15) Page 2 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Nursing Procedure, Assessment and Monitoring:
• For nausea not controlled by ondansetron, switch to another 5-HT3-receptor antagonist. Avoid the use of
prochlorperazine.
• Educate/reinforce with patient regarding oral chemotherapy and home safety.
• Flush/Line Care per Institution standards

Hydration/Fluids: none

Premedications/Antiemetics: none

Treatment Medications for Day 1: See Take Home Medication Section

Dose modifications from previous day/cycle?  No  Yes – list which drugs and indicate dose reduction below:



Take Home Medications - (Prescribe Cycle 1, Day 1: Review for adequate supply during treatment)
• Temozolomide (Temodar) – Daily dose = ________ mg/m2.
Multiple capsule sizes available. Round dose to available capsule sizes of 5 mg, 20 mg, 100 mg, 140 mg, 180
mg. Note: Multiple strengths may be used to make up daily dose.
Disp. # ___________ caps of _____________ mg strength. Refills: ______

Take ______ mg by mouth one time daily at bedtime beginning ____________ (date) through ____________
(date). Swallow whole on empty stomach.

• Ondansetron (Zofran) 8 mg tablet, Disp. #30, Refills: 5
Take 1 tablet (8 mg) by mouth 1 hour before temozolomide for the first 7 days, then ½ to 1 tab (4 to 8 mg)
every 8 hours as needed for nausea/vomiting.

 Trimethoprim-Sulfamethoxazole (Bactrim) 160/800 mg tablet, Disp. #16, Refills: 5
Take 1 tablet by mouth twice daily on Saturdays and Sundays of each week.

 Other:






Final Approved VER: 11-24-15 (991 VER: 04-30-15) Page 3 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org

Follow Up
• Clinic Visit: Day 29

• Labs: 8, 15, 22, 29, 36, 43, 50, 57, 64: CBC with DIFF
 Other:




• Procedures/Imaging/Scans:







• Other Orders:






Order Verification:


MD Signature_________________________________________ Pager______________
Date __________________Time___________________

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