Cycle length: 21 days (docetaxel and carboplatin for 6 cycles, trastuzumab for 1 year). | |||
Drug | Dose and route | Administration | Given on days |
Docetaxel* | 75 mg/m2 IV | Dilute in 250 mL NS¶ to a final concentration of 0.3 to 0.74 mg/mL and administer over 60 minutes. | Day 1 (cycles 1 to 6) |
Carboplatin | AUCΔ = 6 mg/mL per min IV | Dilute in 250 mL NS¶ and administer over 30 to 60 minutes. | Day 1 (cycles 1 to 6) |
Trastuzumab,◊ loading dose§ | 8 mg/kg IV | Dilute in 250 mL NS¶ and administer over 90 minutes. DO NOT mix with D5W and DO NOT infuse as an IV push or bolus. | Day 1 (cycle 1) |
Trastuzumab,◊ maintenance dose | 6 mg/kg IV | Dilute in 250 mL NS¶ and administer over 30 minutes. DO NOT mix with D5W and DO NOT infuse as an IV push or bolus. | Day 1 (cycle 2 and beyond, to complete one year of trastuzumab) |
Pretreatment considerations: | |||
Emesis risk |
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Prophylaxis for infusion reactions |
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Vesicant/irritant properties |
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Infection prophylaxis |
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Dose adjustment for baseline liver or renal dysfunction |
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Cardiopulmonary issues |
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Dose adjustment for known drug interactions |
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Monitoring parameters: | |||
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Suggested dose modifications for toxicity: | |||
Myelotoxicity |
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Hepatotoxicity |
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Cardiotoxicity |
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Pulmonary toxicity |
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Gastrointestinal toxicity |
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Infusion reactions |
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If there is a change in body weight of at least 10%, doses should be recalculated. |
ANC: absolute neutrophil count; AUC: area under the concentration × time curve; BSA: body surface area; CBC: complete blood count; CYP3A4: cytochrome P450 3A4; D5W: 5% dextrose in water; FISH: fluorescence in situ hybridization; GFR: glomerular filtration rate; HER2: human epidermal growth factor receptor 2; IHC: immunohistochemical staining; IV: intravenous; LVEF: left ventricular ejection fraction; NCCN: National Comprehensive Cancer Network; NS: normal saline; NSAID: nonsteroidal anti-inflammatory drug; ULN: upper limit of normal.
* If the calculated BSA of the patient is >2.2 m2, the dose of docetaxel should be calculated with BSA 2.2 m2. The patient's actual body weight should be used to calculate BSA.[1]
¶ Diluent solutions should not be modified without consulting a detailed reference due to potential incompatibility(ies).
Δ AUC is converted to a patient-specific carboplatin dose (in mg) according to renal function by using the Calvert formula. The Calvert formula is total dose (mg) = (target AUC) × (GFR + 25). If using measured serum creatinine, limit the maximal GFR for the calculation to 125 mL/min.[5,6] Refer to the UpToDate topic on "Dosing of anticancer agents in adults" and the UpToDate calculator "Calculator: AUC dose calculation for carboplatin (Calvert formula)".
◊ High levels of HER2 overexpression, as determined by either 3+ IHC or positive FISH, are used to select patients for therapy with trastuzumab. Refer to the UpToDate topic on "HER2 and predicting response to therapy in breast cancer".
§ A repeat loading dose of trastuzumab is required if scheduled treatment has been delayed for over one week.[4]
¥ Consensus-based guidelines from the NCCN classify higher carboplatin doses (AUC ≥4) as highly emetogenic; by contrast, the American Society of Clinical Oncology and the Multinational Association for Supportive Care in Cancer guidelines consider all carboplatin doses to be moderately emetogenic. Although many institutions classify carboplatin-containing regimens as moderately emetogenic, a benefit for adding a neurokinin 1 receptor antagonist on day 1 has been shown in many studies; additional prophylaxis beyond day 1 for delayed emesis is not needed for most patients. Refer to UpToDate topic on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults".
‡ A list of strong and moderate CYP3A4 inhibitors is available as a separate table in UpToDate. Specific interactions may be determined by use of the drug interactions program included within UpToDate.Do you want to add Medilib to your home screen?