Chemotherapy
Chemotherapy Protocols
Due to the complex nature of the disease, cancer chemotherapy is a constantly evolving science. The fact remains that the scientific and medical community still has a long way to go before the battle against cancer can be won. Due to numerous factors, including the nature of the cancer cells, the staging and grading of the cancer etc, a cancer usually requires a combination of drugs for therapy. Even in the treatment of a cancer by multiple drugs, the cancer may develop resistance to therapy.
Numerous chemotherapy regimens have evolved over time. The popularity of some of these has gained in recent times supported by large scale randomized controlled trials. As newer chemotherapy drugs are discovered, new regimens would be introduced and studied till we have the perfect cure.
| Protocol |
PBFuM
|
|
| Cancer |
Head & Neck Cancer
|
|
| Reference |
Amrein1
|
|
| PBFuM | Cisplatin | 80 mg/m2, 24 h, day 1 |
| Bleomycin | 15 U, 24 h, day 1 | |
| 5-Fluorouracil | 800 mg/m2, 24 h, day 2-6 | |
| Methotrexate | 100 mg/m2, day 16 | |
| 3/4-week cycle, 2-4 cycles | ||
| Protocol |
FuFaPB
|
|
| Cancer |
Head & Neck Cancer
|
|
| Reference |
Guaraldi2
|
|
| FuFaPB | Cisplatin | 30 mg/m2, 1 h, day 1-2 |
| Folinic acid | 200 mg/m2, 1 h, day 1-2 | |
| 5-Fluorouracil | 500 mg/m2 bolus at half-infusion of Folinic acid, day 1-2 | |
| Bleomycin | 15 U im, day 1-2 | |
| 4-week cycle, ± 3 cycles | ||
| Protocol |
ABVD
|
|
| Cancer |
Hodgkin’s lymphoma
|
|
| Reference |
Horning3
|
|
| ABVD | Doxorubicin | 25mg/m², day 1/15 |
| Bleomycin | 10 U/m², day 1/15 | |
| Vinblastine | 6 mg/m², day 1/15 | |
| Dacarbazine | 375 mg/m², days 1/15 | |
| 4-week cycle, 6 cycles | ||
| Protocol |
MOPP/ABV
|
|
| Cancer |
Hodgkin’s lymphoma
|
|
| Reference |
Glick4
|
|
| MOPP/ABV | Mechlorethamine | 6 mg/m², day 1 |
| Vincristine | 1.4 mg/m² (max. 2.4 mg), day 1 | |
| Procarbazine | 100 mg/m² po, day 1-7 | |
| Prednisone | 40 mg/m² po, day 1-14 | |
| Doxorubicin | 25 mg/m², day 8 | |
| Vinblastine | 6 mg/m², day 8 | |
| Bleomycin | 10 U/m², day 8 | |
| 4-week cycle, max. 12 cycles | ||
| Protocol |
MACOP-B
|
|
| Cancer |
Non-Hodgkin’s lymphoma
|
|
| Reference |
Bayer5
|
|
| MACOP-B | Methotrexate | 400 mg/m², day 8 (with FA rescue 100 mg bolus, than 300 mg over 4h) |
| Doxorubicine | 50 mg/m², day 1 and 15 | |
| Cyclophosphamide | 350 mg/m², day 1 and 15 | |
| Vincristine | 1.4 mg/m² (max. 2.4 mg), day 8/22 | |
| Prednisone | 75 mg po, daily for 12 weeks, than taper | |
| Bleomycin | 10 U/m² day 22 | |
| 4-week cycle, 3 cycles | ||
| Protocol |
BEP
|
|
| Cancer |
Testicular cancer
|
|
| Reference |
Lehne6
|
|
| BEP | Bleomycin | 30 U bolus, once a week |
| Etoposide | 100 mg/m² over 30 min., day 1-5 | |
| Cisplatin | 20 mg/m² over 30 min., day 1-5 | |
| 3-week cycle, 3-4 cycles | ||
References:
1. P. C. Amrein et al., Laryngoscope 102 (1992) 901.
2. M. Guaraldini et al. Ann. Oncol. 2 (1991) 379.
3. S. J. Horning et al., J. Clin. Oncol., 12 (1994) 297.
4. J. H. Glick et al., J. Clin. Oncol., 16 (1998) 19.
5. R. A. Bayer et al. Sem. Oncol., 19 (suppl. 5) (1992) 46.
6. G. Lehne et al., Br. J. Cancer 68 (1993) 555.
| Protocol |
PC
|
|
| Cancer |
Ovarian Cancer
|
|
| Reference |
Zamagni1, Higgins2
|
|
| PC | paclitaxel | 175 mg/m² or 200 mg/m² over 3 hr, day 1 |
| carboplatin | 400 mg/m²(4) or AUC 5-6.5 over 30 min., day 1 | |
| every 3-4 weeks, 6 cycles | ||
| Protocol |
CE
|
|
| Cancer |
Small Cell Lung Cancer
|
|
| Reference |
Evans3, Okamoto4
|
|
| CE | carboplatin | 300 mg/m² in 20’-30’ or AUC5 over 1 hr 7, day 1 |
| etoposide | 100 mg/m² over 30-60 min., day 1-3 | |
| every 4 weeks, 4-6 cycles | ||
| Protocol |
CE
|
|
| Cancer |
Non Small Cell Lung Cancer
|
|
| Reference |
Helsing5
|
|
| CE | carboplatin | 300 mg/m2 day 1 |
| etoposide | 120 mg/m2 orally, day 1-5 | |
| every 4 weeks, maximum of 8 cycles | ||
| Protocol |
PC
|
|
| Cancer |
Non Small Cell Lung Cancer
|
|
| Reference |
Hainsworth6, Helsing7
|
|
| PC | paclitaxel | 200 mg/m² or 225 mg/m² over 1 hr, day 1 |
| carboplatin | AUC 5 or AUC 6 over 30-60 min., day 1 | |
| every 3-4 weeks, 6 cycles | ||
| Protocol |
M-CAVI
|
|
| Cancer |
Transitional Cell Cancer of Urothelium
|
|
| Reference |
Bellmunt8
|
|
| M-CAVI | methotrexate | 30 mg/m² in slow push, day 1, 15, 22 |
| carboplatin | AUC 5 over 30 min., day 2 | |
| vinblastine | 3 mg/m² in slow push, day 2, 15, 22 | |
| every 4 weeks | ||
| Protocol |
PC
|
|
| Cancer |
Transitional Cell Cancer of Urothelium
|
|
| Reference |
Zielinski9
|
|
| PC | paclitaxel | 175 mg/m² over 3 hrs, day 1 |
| carboplatin | AUC 5 over 1hr, day 1 | |
| every 3 weeks, 6 cycles | ||
| References: | |
| 1. C. Zamagni et al. Am. J. Clin. Oncol. 21 (1998) 491-7. | |
| 2. R.V. Higgins et al. Gynecol. Oncol. 75 (1999) 464-7. | |
| 3. W.K. Evans et al. Br. J. Cancer 58 (1988) 464-8. | |
| 4. H. Okamoto et al. J. Clin. Oncol. 17 (1999) 3540-5. | |
| 5. M. Helsing et al. Eur. J. Cancer 34 (1998) 1036-44. | |
| 6. J.D. Hainsworth et al. Eur. J. Cancer 34 (1998) 654-8. | |
| 7. M. Helsing et al. Lung Cancer 24 (1999) 107-13. | |
| 8. J. Bellmunt et al. Cancer 80 (1997) 1966-72. | |
| 9. C.C. Zielinski et al. Br. J. Cancer 78 (1998) 370-4. | |
| Protocol |
BEP
|
|
| Cancer |
Testicular Cancer
|
|
| Reference |
Einhorm1
|
|
| BEP | Bleomycin | 30 U bolus, once a week |
| Etoposide | 100 mg/m² over 30 min., day 1-5 | |
| Cisplatin | 20 mg/m² over 30 min., day 1-5 | |
| 3-week cycle, 3-4 cycles | ||
| Protocol |
VIP
|
|
| Cancer |
Recurrent Testicular Cancer
|
|
| Reference |
Harstrick2
|
|
| VIP | etoposide | 100 mg/m² over 1 hr, day 1-5 |
| ifosfamide | 1.2 g/m² over 1 hr, day 1-5 | |
| cisplatin | 20 mg/m² over 1 hr, day 1-5 | |
| every 3-4 weeks, maximal 4 cycles | ||
| Protocol |
PaP
|
|
| Cancer |
Ovarian Cancer
|
|
| Reference |
Muggia3
|
|
| PaP | paclitaxel | 135 mg/m² over 24 h, day 1 |
| cisplatin | 75 mg/m² , day 2 | |
| every 3 weeks, 6 cycles | ||
| Protocol |
M-VAC
|
|
| Cancer |
Transitional Cell Cancer of Urothelium
|
|
| Reference |
Sternberg4
|
|
| M-VAC | methotrexate | 30 mg/m², day 1, 15, 22 |
| vinblastine | 3 mg/m², day 2, 15, 22 | |
| doxorubicin | 30 mg/m², day 2 | |
| cisplatin | 70 mg/m², day 2 | |
| every 4 weeks, 4 to 7 cycles | ||
| Protocol |
EP
|
|
| Cancer |
Non Small Cell Lung Cancer
|
|
| Reference |
Klastersky5
|
|
| EP | etoposide | 100 mg/m² over 60 min., day 1-3 |
| cisplatin | 120 mg/m² over 20 min., day 1 | |
| every 3-4 weeks, minimal 3 cycles | ||
| Protocol |
PaP
|
|
| Cancer |
Non Small Cell Lung Cancer
|
|
| Reference |
Giaccone6
|
|
| PaP | paclitaxel | 175 mg/m² over 3 hrs, day 1 |
| cisplatin | 80 mg/m² day 1 | |
| every 3 weeks, 6 cycles | ||
| Protocol |
GP
|
|
| Cancer |
Non Small Cell Lung Cancer
|
|
| Reference |
Sandler7
|
|
| GP | gemcitabine | 1 g/m² over 30-60 min., days 1, 8, 15 |
| cisplatin | 100 mg/m² over 30-120 min., day 1 | |
| every 4 weeks, maximal 6 cycles | ||
| Protocol |
CF
|
|
| Cancer |
Head and Neck Cancer
|
|
| Reference |
Forastiere8
|
|
| CF | cisplatin | 100 mg/m² over 15-30 min., day 1 |
| 5-FU | 1 g/m²/day, 96-hr continuous infusion | |
| every 3 weeks, median 4 cycles | ||
| References: | |
| 1. Einhorn et al., J. Clin. Oncol. 7 (1989) 387-91. | |
| 2. Harstrick et al., J. Clin. Oncol. 9 (1991) 1549-55. | |
| 3. Muggia et al., J. Clin. Oncol. 18 (2000) 106-15. | |
| 4. Sternberg et al., J. Urol., 139 (1988) 461-9. | |
| 5. Klastersky et al., J. Clin. Oncol., 8 (1990) 1556-62. | |
| 6. Giaccone et al., J. Clin. Oncol. 16 (1998) 2133-41. | |
| 7. Sandler et al., J. Clin. Oncol. 18 (2000) 122-30. | |
| 8. Forastiere et al., J. Clin. Oncol. 10 (1992) 1245-51. | |
| Cancer | Non-Hodgkin’s lymphoma |
| Reference | Nair et al.1 |
| Chemotherapy Regimen | Doxorubicin Dose |
| MACOP-B | 50 mg/m² |
| Cancer | Soft Tissue Sarcoma |
| Reference | Pisters et al.2 |
| Chemotherapy Regimen | Doxorubicin Dose |
| doxorubicin + dacarbazine ± cyclophosphamide | 60-90 mg/m² starting dose, pre- and postoperative cycles |
| Cancer | Breast Carcinoma |
| Reference | Bontenbal et al.3 |
| Chemotherapy Regimen | Doxorubicin Dose |
| doxorubicin monotherapy | 75 mg/m², 3-week cycle |
| Cancer | Bladder Carcinoma |
| Reference | Naito et al.4 |
| Chemotherapy Regimen | Doxorubicin Dose |
| doxorubicin ± 5-FU | 30 mg/30 ml intravesically. 3 times in 1 week preoperative. 9 times in 12 weeks postoperative |
| References: | |
| 1. R. Nair et al., Cancer 82 (1998) 2282-8. | |
| 2. P.W.T. Pisters et al., J. Clin. Oncol. 15 (1997) 3481-7. | |
| 3. M. Bontenbal et al., Br. J. Cancer 77 (1998) 2257-63. | |
| 4. S. Naito et al., Int. J. Urol. 4 (1997) 352-7. | |
| Cancer | Acute Myeloid Leukemia |
| Reference | Zander et al.1 |
| Chemotherapy Regimen | Etoposide Dose |
| busulfan, etoposide, cyclophosphamide | 30-60 mg/kg 4 days before ABMT |
| Condition | PBPC mobilization |
| Reference | Kanfer et al.2 |
| Chemotherapy Regimen | Etoposide Dose |
| high-dose etoposide + G-CSF | 1.6-2.0 g/m² over 10 hr |
| Cancer | SCLC/NHL |
| Reference | Higa et al.3 |
| Chemotherapy Regimen | Etoposide Dose |
| etoposide prolonged infusion | 25 mg/m² for 35 days |
| Cancer | SCLC |
| Reference | Gridelli et al.4 |
| Chemotherapy Regimen | Etoposide Dose |
| carboplatin, epirubicin, etoposide + G-CSF | 100-140 mg/m², days 1-3, 3-week cycles |
| Cancer | NSCLC |
| Reference | Helsing et al.5 |
| Chemotherapy Regimen | Etoposide Dose |
| carboplatin, etoposide | 120 mg/m², day 1-5, 4-week cycles |
| References: | |
| 1. A.R. Zander et al. Clin. Cancer Res. 3 (1997) 2671-5. | |
| 2. E.J. Kanfer et al., Br.J. Cancer 78 (1998) 928-32. | |
| 3. G.M. Higa et al., Pharmacother. 19 (1999) 101-7. | |
| 4. C. Gridelli et al., Am.J.Clin.Oncol. 19 (1996) 589-591. | |
| 5. M. Helsing et al., Eur.J. Cancer 34 (1998) 1036-44. | |
| Protocol |
CAV (VAC)
|
|
| Cancer |
Small Cell Lung Cancer
|
|
| CAV (VAC) | Cyclophosphamide | 750 - 1000 mg/m2 i.v, day 1 |
| Doxorubicin | 50 mg/m2 i.v. day 1 | |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. day 1 | |
| Repeat cycle every 21 days | ||
| Protocol |
CHOP
|
|
| Cancer |
Non-Hodgkin’s lymphoma
|
|
| CHOP | Cyclophosphamide | 750 mg/m2 i.v, day 1 |
| Doxorubicin | 50 mg/m2 i.v. day 1 | |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. day 1 | |
| Prednisone | 100 mg/day p.o. days 1-5 | |
| Repeat cycle every 21 days | ||
| Protocol |
COP
|
|
| Cancer |
Non-Hodgkin’s lymphoma
|
|
| COP | Cyclophosphamide | 800-1000 mg/m2 i.v, day 1 |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. day 1 | |
| Prednisone | 60 mg/m2 p.o. days 1-5 | |
| Repeat cycle every 14 days | ||
| Protocol |
MACOP-B
|
|
| Cancer |
Non-Hodgkin’s lymphoma
|
|
| MACOP-B | Methotrexate | 400 mg/m2 i.v, weeks 2, 6 & 10 |
| Leucovorin | 15 mg/m2 p.o. every 6 hours for 6 doses, beginning 24 hours after methotrexate | |
| Doxorubicin | 50 mg/m2 i.v. weeks 1, 3, 5, 7, 9 & 11 | |
| Cyclophosphamide | 350 mg/m2 i.v. weeks 1, 3, 5, 7, 9 & 11 | |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. weeks 2, 4, 6, 8, 10 & 12 | |
| Prednisone | 75 mg/day p.o. for 12 weeks, then taper over last 2 weeks | |
| Bleomycin | 10 units/m2 i.v. weeks 4, 8 & 12 | |
| Co-Trimoxazole | 1 tabl 2 times per day for 12 weeks | |
| Ketoconazole | 200 mg/day p.o. | |
| administer 1 cycle | ||
| Protocol |
MOPP
|
|
| Cancer |
Adult Hodgkin’s disease
|
|
| MOPP | Mechloretamine | 6 mg/m2 i.v. days 1 & 8 |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. days 1 & 8 | |
| Procarbazine | 100 mg/m2 p.o. days 1-14 | |
| Prednisone | 40 mg/m2 p.o. days 1-14 | |
| repeat cycle every 28 days | ||
| Protocol |
MOPP/ABV hybrid
|
|
| Cancer |
Hodgkin’s disease
|
|
| MOPP/ABV hybrid | Mechloretamine | 6 mg/m2 i.v. day 1 |
| Vincristine | 1.4 mg/m2 (max 2 mg) i.v. day 1 | |
| Procarbazine | 100 mg/m2 p.o. days 1-7 | |
| Prednisone | 40 mg/m2 p.o. days 1-14 | |
| Doxorubicin | 35 mg/m2 i.v. day 8 | |
| Bleomycin | 10 units/m2 day 8 | |
| Vinblastine | 6 mg/m2 i.v. day 8 | |
| repeat cycle every 28 days | ||
| Protocol |
VBMCP
|
|
| Cancer |
Multiple Myeloma
|
|
| VBMCP | Vincristine | 1.2 mg/m2 (max 2 mg) i.v. day 1 |
| Carmustine | 20 mg/m2 i.v. day 1 | |
| Procarbazine | 8 mg/m2 p.o. days 1-4 | |
| Prednisone | 400 mg/m2 i.v. day 1 | |
| Doxorubicin | 40 mg/m2 p.o. days 1-7 all cycles, and 20 mg/m2 p.o. days 8-14 first 3 cycles only | |
| repeat cycle every 35 days | ||