Cycle length: Carboplatin and paclitaxel are each given weekly for five weeks with concurrent RT followed by surgery. |
Drug | Dose and route | Administration | Given on days |
Paclitaxel | 50 mg/m2 IV | Dilute in 250 mL NS* and administer over one hour; special tubing needed.¶ | Days 1, 8, 15, 22, and 29 |
Carboplatin | AUCΔ = 2 mg/mL × min IV | Dilute in 250 mL NS* and administer over 30 minutes after paclitaxel. | Days 1, 8, 15, 22, and 29 |
Pretreatment considerations: |
Emesis risk | - MODERATE (30 to 90% frequency of emesis). We recommend prophylaxis with a combination of a 5-HT3 receptor antagonist plus dexamethasone on days 1, 8, 15, 22, and 29, and with a 5-HT3 antagonist on days when radiation alone is given.
- Refer to UpToDate topics on "Prevention and treatment of chemotherapy-induced nausea and vomiting in adults" and "Radiotherapy-induced nausea and vomiting: Prophylaxis and treatment".
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Prophylaxis for infusion reactions | - Premedicate with dexamethasone plus both an H1 and an H2 receptor antagonist prior to paclitaxel administration.
- Refer to UpToDate topic on "Infusion reactions to systemic chemotherapy".
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Vesicant/irritant properties | - Carboplatin is an irritant. Paclitaxel can cause significant tissue damage; avoid extravasation.
- Refer to UpToDate topic on "Extravasation injury from chemotherapy and other non-antineoplastic vesicants".
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Infection prophylaxis | - Primary prophylaxis with G-CSF is not justified (incidence of neutropenic fever <1%[1]).
- Refer to UpToDate topic on "Use of granulocyte colony stimulating factors in adult patients with chemotherapy-induced neutropenia and conditions other than acute leukemia, myelodysplastic syndrome, and hematopoietic cell transplantation".
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Dose adjustment for baseline liver or renal dysfunction | - A lower starting dose of paclitaxel may be needed for liver impairment.[2] Carboplatin dose is calculated based upon renal function by use of the Calvert formula.Δ[3]
- Refer to UpToDate topics on "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Conventional cytotoxic agents" and "Chemotherapy hepatotoxicity and dose modification in patients with liver disease: Molecularly targeted agents" and "Dosing of anticancer agents in adults".
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Monitoring parameters: |
- CBC with differential and platelet count weekly during treatment.
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- Assess electrolytes, renal, and liver function weekly during treatment.
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- Assess changes in neurologic function weekly during treatment.
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Suggested dose modifications for toxicity: |
Myelotoxicity/neurologic toxicity | - Weekly doses of paclitaxel and carboplatin should not be repeated unless the ANC is at least 1500/microL and the platelet count is at least 100,000/microL. Reduce paclitaxel dose by 20% for ANC <500/microL for a week or longer, or severe peripheral neuropathy.[2]
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Renal toxicity | - Alterations in renal function during therapy require a recalculation of the carboplatin dose.
- Refer to UpToDate topic on "Dosing of anticancer agents in adults".
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If there is a change in body weight of at least 10%, doses should be recalculated. |