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Lung Docetaxel (21D1)_Ramucirumab (21D1) (5582 VER: 2-20-15)

Lung Docetaxel (21D1)_Ramucirumab (21D1) (5582 VER: 2-20-15) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Preprinted Paper Orders


Final Approved VER: 9-23-15 (5582 VER: 2-20-15) Page 1 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Title: Docetaxel/Ramucirumab
Disease Group: Lung
Disease: Non-Small Cell Lung Cancer (Advanced)

Therapy: ramucirumab 10 mg/kg IV Day 1,
DOCEtaxel 75 mg/m2 IV Day 1,
NOTE: for East Asian patients reduce DOCEtaxel dose to 60 mg/m2 IV Day 1

Cycle Length: 21 days Course: until disease progression

Note to All Staff: Chemotherapy Council approved for patients with advanced (stage 4) squamous or non-
squamous non-small cell lung cancer who progressed during or after a first-line platinum based chemotherapy
regimen.

Reference(s): Garon EB, et al. Lancet 2014;384(9944):665-73
Garon EB, et al. Clin Lung Cancer 2012;13(6):505-9

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, BUN, Creatinine, Calcium, Albumin, Total
Protein, Total Bilirubin, AST, ALT, Alkaline Phosphatase, Urinalysis without microscopy
 Other:


Treatment Conditions:
• Verify Informed consent obtained Day 1 of each cycle.
• Verify the following labs have been obtained: CBC, ANC, Urinalysis without microscopy
• Hold and notify provider for: ANC < 1000/µL or Platelets < 100K/µL or Urine Protein > 100 mg/dL or Blood
Pressure > 160/90 mmHg
• 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 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.
• Advise patients to report any bleeding or symptoms of bleeding.
• Flush/Line Care per Institution standards

Hydration/Fluids: sodium chloride 0.9% IV to establish line and for flushing







Final Approved VER: 9-23-15 (5582 VER: 2-20-15) Page 2 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
Premedications/Antiemetics
Give prior to chemotherapy:
• diphenhydramine (Benadryl) 25 mg IV once.
• dexamethasone (Decadron) 20 mg IV once PRN. For use only in patients who did not take dexamethasone at
home.
 Cycle 2+: acetaminophen (Tylenol) 650 mg by mouth once. For use in patients who have previously reacted to
ramucirumab.

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:


• ramucirumab (Cyramza) __________mg (10 mg/kg) IV once over 60 minutes.
Administer with 0.22 micron filter. DO NOT FREEZE OR SHAKE the infusion solution. DO NOT dilute with
other solutions or co-infuse with other electrolytes or medications. Hypersensitivity risk. For first and
second dose, patient should be treated in a location to optimize emergency care.

• DOCEtaxel (Taxotere) ____________ mg (75 mg/m2) IV once over 60 minutes.
In non-PVC bag and 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:





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 morning of 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.

 Other:










Final Approved VER: 9-23-15 (5582 VER: 2-20-15) Page 3 of 3
Copyright © 2016 University of Wisconsin Hospitals and Clinics Authority Contact: CCKM@uwhealth.org
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 #: ________