Next review in 5years. Nausea and vomiting are less severe and more easily controlled. Select here forrecommended doses of alternative antiemetics. Strategies to minimise toxicity includedose attenuation,thorough patient education and vigilant monitoringfor anypotentialseptic episodes. Abnormally low levels of neutrophils in the blood. Bone pain, usually in the lower back or pelvis, associatedwith colony stimulating factors (filgrastim, lenograstim,lipegfilgrastim andpegfilgrastim). Where concurrent use of an enzyme-inducing antiepileptic cannot be avoided, monitor antiepileptic serum levels for toxicity, as well as seizure frequency for efficacy; adjust dosage as appropriate. Access Flinders Filters, a division of the Flinders Digital Health Research Centre at FlindersUniversity to read more about research solutions to searching problems. Systemic Sclerosis (Orphan) Prevention of graft-versus-host disease after allogeneic hematopoietic stem cell transplant. Sequential weekly paclitaxel x 12 -> dose dense doxorubicin and cyclophosphamide x 4 every 2 weeks with filgrastim. The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated. Select link for more information and access to the full WHO Model List of Essential Medicines. Interaction with both CYP3A4 and P-gp inhibitors/inducers. HER-2 negativity (i.e. if symptoms are mild and resolve when infusion is stopped, consider recommencing infusion after review by medical officer at a slower rate. r Modification of the carboplatin dose (eg. for severe reactions seek medical assistance immediately and do not restart infusion. For patients who previously DID NOT receive chemotherapy (untreated), a target AUC of 7 (range: 6-8) mg/mL per minute has been recommended when carboplatin is used alone. The committee was most strongly influenced by the randomised open label phase II TRYPHAENA trial by Schneeweiss et al.r. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Premedication for next cycle of chemotherapy. dCRT: paclitaxel 30 mg/m 2 twice weekly (11 doses) and carboplatin AUC 1.5 weekly (6 doses), radiation dose: 50.4 Gy; followed with consolidative chemotherapy (paclitaxel 200 mg/m 2 and carboplatin AUC 6, q21d for 2 cycles) Observational studies: Jiang et al 2021 r: No: Yes-Owens et al 2020 r: Yes: Yes-de Vos-Geelen 2020 r: Yes: Yes Transferred to new eviQ website. The side effects listed below are not a complete list of all possible side effects for this treatment. Prognostic factors were similar in the two treatment groups. Prophylaxis should be determined according to individual institutional policy. Version number changed to V.2. Irregular or absent periods, hot flushes, mood swings, sleep disturbance, night sweats, vaginal dryness, decreased libido and dyspareunia. Ensure patient receives patient information sheet. They may vary between institutions and can be substituted to reflect individual institutional policy. Link to chemotherapy-induced peripheral neuropathy screening tool, Read more about biosimilar drugs on the Biosimilar Awareness Initiative page. The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQreference committeeregarding their views of currently accepted approaches to treatment. When the daily dose is known, the amount of required solution may be derived. Side effects are categorised into the approximate onset of presentation and should only be used as a guide. 'Part 1' removed from title and treatment sequencing notes removed from treatment schedule to align with other protocols. For patients who previously DID NOT receive chemotherapy (untreated), a target AUC of 7 (range: 6-8) mg/mL per minute has been recommended when carboplatin is used alone. Low-dose: 500 mg IV every 2 weeks for 6 doses plus corticosteroids, then maintenance with mycophenolate mofetil or azathioprine. For this reason, "CBDCA" is sometimes used in the medical literature as an abbreviation referring to carboplatin. Patients suitable for cisplatin or oxaliplatin based regimen. if no previous hypersensitivity reaction administer via IV infusion over 30 to60 minutes. low sorbing IV giving set with 0.22 micron filter must be used for paclitaxel, attach a second IV line via a luer lock connector as close as possible to the site of injection. [6] The diminished reactivity limits protein-carboplatin complexes, which are excreted. The side effects listed below are not a complete list of all possible side effects for this treatment. Next review in one year. Rivaroxaban: avoid concurrent use with strong CYP3A4 and Pgp inhibitors. Prime required IV lines with sodium chloride 0.9%: Insert IV cannula or access TIVADor CVAD. 98]; log rank p = 0.038).r, Kaplan-Meier plotof estimated overall survival by treatment group and histological tumour type, Hazard ratios for all-cause mortality, according to subgroup characteristics. The project goal is the provision of a sustainable model for evidence retrieval to ensure ongoing currency of content. A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding. Version change to V.4. The cost includes anti-cancer drugs only (not antiemetics, supportive medications or consumables), unless otherwise indicated. These are defaults only and may be substituted to reflect individual institutional policy. Ensure that patients also have sufficient antiemetics for breakthrough emesis: Metoclopramide 10 mg three times a day when necessary (maximum of 30 mg/24 hours, up to 5 days) OR. Although in nonrandomized trials, carboplatin and paclitaxel was a less toxic and highly active combination regimen, there remained concern regarding its efficacy in patients with small-volume, resected, stage III disease. Please click on this link to access thePubmedsearches. This Carboplatin AUC calculator will then retrieve you some useful indicators about the kidney function, the GFR value, the ideal weight and the total dosage required in the used case. Haematological dose modifications updated as per consensus of the expert clinician group. Review in 2 years. by IV bolus via a side port of a freely flowing IV infusion, ensure vein is patent and monitor for signs of extravasation throughout administration, flush with ~150 mL of sodium chloride 0.9%. Monitor digoxin serum levels; adjust digoxin dosage as appropriate. The cost of oral continuous therapy is based on a 28 day month. Verifytaxane premedication taken or administer as prescribed. Verifytaxane premedication taken or administer as prescribed. Other toxicities were relatively evenly matched. Further site-wide updates and changes will occur in due course. hypersensitivityrisk increases with number of cycles administered. Trastuzumab is incompatible with glucose solutions, ensure IV administration sets are flushed with sodium chloride 0.9% pre and post administration, observe patient for fever and chills or other infusion-related symptoms. Possibility of infant risk should be discussed with breastfeeding patients. The project goal is the provision of a sustainable model for evidence retrieval to ensure ongoing currency of content. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information sources. Read more about hand-foot syndrome associated with chemotherapy. Calcium and magnesium at baseline and as clinically indicated. High-dose: 500-1000 mg/m IV monthly for 6 doses plus corticosteroids. Suggested default antiemetics have been added to the treatment schedule, and may be substituted to reflect institutional policy. Symptoms may include eye pain, blurred vision, blepharitis, uveitis, optic neuritis, tear duct stenosis, conjunctivitis, hyperlacrimation, watery or dry eyes and photophobia. Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. Review in 2 years. Thus, we conducted a noninferiority trial of cisplatin and paclitaxel versus carboplatin and paclitaxel in this population. Diminished response to vaccines and increased risk of infection with live vaccines. Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity. increased bleeding). Guidelines: Date published/revised: Supports use Use Caution/Monitor. These include taxanes, platinum-based compounds, vinca alkaloids and some drugs used to treat multiple myeloma. For dosing carboplatin, ADDIKD recommends that: For further information refer theeviQ Factsheet around carboplatin dosing and the carboplatin drug monograph within the ADDIKD guideline. The cost displayed on the protocol is intended as rudimentary guide only for the Australian context. The drug interactions shown below are not an exhaustive list. Read more about COVID-19 vaccines and cancer. antiemetics, premedications, etc. Interactions may occur when the taxanes paclitaxel and docetaxel are given concurrently with other drugs. The anticancer drug(s) in this protocolmayhave been included in the ADDIKD guideline. We acknowledge the traditional custodians of the lands on which we work and live, and recognise their continuing connection to land, water and community. Treatment schedule notes under cycles updated to include ICON8 trial data. 509 relations. Suggested default antiemetics have been added to the treatment schedule, and may be substituted to reflect institutional policy. Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. Patients receiving HER-2 directed agents are at an increased risk of cardiotoxicity e.g. Pharmacotherapy 17(5 Pt 2):126S-132S. Read more about cognitive changes (chemo fog), A search of the literature did not find strong phase IIIevidence for use this regimen in the neoadjuvant setting. [1][failed verification] Use during pregnancy may result in harm to the baby. References & Disclaimer. The main risk factor for development is cumulative docetaxel dose. Consider escalating to, or commencing carboplatin at a dose of 6 AUC in patients with good performance status. It is important that all patients of reproductive potential use effective contraceptionwhilst on therapy and after treatment finishes. Biosimilar drug added to clinical information. The addition of carboplatin significantly increased the pCR breast rate (60% vs 46%, OR 1.76; p=0.018) as well as pCR breast/axilla (54% vs 41%, OR 1.71; p=0.0029). Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. Premedication for next cycle of chemotherapy. References & Disclaimer. Note: Bold font indicates significant difference in incidence compared with other treatment arms. Drug status and clinical information updated with PBS expanded indications for GCSF. this may be required in case of a hypersensitivity reaction. The currency of this information is guaranteed only up until the date of printing, for any updates please check: Receive email notifications of new and updated protocols. #Modification of the carboplatin dose (e.g. It is always a good idea to clear the cache regularly to ensure you are getting the most up to date search. Hair loss may occur from all parts of the body. Live vaccines (e.g. Unlike cisplatin, carboplatin may be susceptible to alternative mechanisms. via controlled IV infusion over 60 minutes, flush with ~ 100 mL of sodium chloride 0.9%, if symptoms are mild and resolve when infusion is stopped, consider recommencing infusion after review by medical officer at a slower rate, for severe reactions seek medical assistance immediately and do not restart infusion. 6, 4, 3, 2 hours, respectively every hour. Flinders Filters has partnered with eviQ tobuild reliable, robust searchfiltersto retrieve core high level evidence on topics of significance to eviQ. Apixaban: avoid concurrent use with strong CYP3A4 and Pgp inhibitors. KartTuner Pro will even show you your anticipated Center of Gravity based. 3. Read more about central venous access device line selection, High risk with carboplatin. All dose reductions are calculated as a percentage of the starting dose. [1] This includes ovarian cancer, lung cancer, head and neck cancer, brain cancer, and neuroblastoma. Clinical information updated- FBC nadir cycle 1 removed from blood tests, wording changed from 'each treatment' to 'each cycle'. Use is subject to eviQs disclaimer available at www.eviQ.org.au. 2. Version number changed to V.6. Further site-wide updates and changes will occur in due course. Common side effects include low blood cell levels, nausea, and electrolyte Use with caution in patients on non-immunosuppressive therapy. Drug interactions in eviQ protocols are under review and being updated to align with current literature. Drug interaction between carboplatin and paclitaxel removed. Monitor digoxin serum levels; adjust digoxin dosage as appropriate. Any fever or suspicion of infection should be investigated immediately and managed aggressively. This protocol is based on limited evidence; refer to the evidence section of this protocol for more information. *If estimated GFR is greater than 125 mL/min (i.e. This carboplatin calculator (carboplatin dose calculator) estimates your total carboplatin dose (in mg) using the Calvert formula). To see all protocols that comply with the WHO Essential Medicine List, Genetic testing for heritable pathogenic variants, Fertility, sex, pregnancy and breastfeeding, How you have anticancer medicine treatment, BOPA Guidance on use of H2 antagonists for hypersensitivity, Breast neoadjuvant cARBOplatin weekly and PACLitaxel weekly followed by AC (DOXOrubicin and CYCLOPHOSPHamide) dose dense overview, Breast adjuvant/neoadjuvant AC (DOXOrubicin and CYCLOPHOSPHamide) dose dense, Breast neoadjuvant cARBOplatin three weekly and PACLitaxel weekly, Anti-cancer therapy before breast cancer surgery (neoadjuvant therapy). Next review in 5 years. **Including ototoxicity, renal toxicity, cardiac toxicity and stomatitis. KartTuner Pro will even show you your anticipated Center of Gravity based. General patient assessment prior to each day of treatment. Hypersensitivity risk increases with number of cycles of carboplatin. This includes ovarian cancer, lung cancer, head and neck cancer, brain cancer, and neuroblastoma. NK1 receptor antagonist unchanged. Antiemetic change: Netupitant/palonosetron combination has replaced aprepitant and a 5HT3receptor antagonist in combination with dexamethasone for all highly emetogenic regimens. Recalculate carboplatin dose if significant change in weight and/or creatinine. No change and next review in 2 years. Use is subject to eviQs disclaimer available at www.eviQ.org.au. Searches can be used when a protocol is scheduled for review or at any time you choose. The project goal is the provision of a sustainable model for evidence retrieval to ensure ongoing currency of content. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant. Antiemetic change: A NK1 receptor antagonist and a 5HT3 receptor antagonist in combination with dexamethasone has been added as available on the PBS for primary prophylaxis of carboplatin induced nausea and vomiting. The following change made post Medical Oncology Reference Committee meeting held on 21 October 2016: link to AGITG and ANZCTR added. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.). Fluid retention will slowly resolve after cessation of treatment. Prochlorperazine 10 mg POevery 6 hours when necessary. Read more about COVID-19 vaccines and cancer. Protocol reviewed at Medical Oncology Reference Committee meeting on 3/11/2017. This may reduce the effectiveness of lumacaftor/ivacaftor. Consultation with head and neck specialists is recommended for this group of patients. Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. g [1][3], Carboplatin was patented in 1972 and approved for medical use in 1989. We acknowledge the traditional custodians of the lands on which we work and live, and recognise their continuing connection to land, water and community. hypersensitivity reactions are more common during the first 2 cycles in the first 30 minutes. Paracetamol Dosage Calculator by Weight. Recalculation of carboplatin doses at each cycle is unnecessary, except when baseline kidney function (e.g., eGFR) alters by > 20% or when there is a change in the clinical status of the patient. Carboplatin dosing - for estimated GFR > 125 mL/min, note about measuring GFR and/or dose capping added. Use Caution/Monitor. It commonly develops following chemotherapy, radiation therapy to the head, neck or oesophagus, and high dose chemotherapy followed by a blood and marrow transplant (BMT). Ozols, R. F., B. N. Bundy, et al. Link to Australian Clinical Trials website. G-CSF (short or long-acting) is available on the PBS for chemotherapy induced neutropenia depending on clinical indication and/or febrile neutropenia risk. Paclitaxel diluent changed from glucose 5% to sodium chloride 0.9%. The total body clearance, apparent volume of distribution and mean residence time for Carboplatin are 4.4 L/hour, 16 L and 3.5 hours, respectively. Remove IV cannula and/or deaccessTIVAD or CVAD. The supportive therapies (e.g. Repeat LVEF assessment within 3 weeks. Read more about cognitive changes (chemo fog), A search of the literature did not find strong phase IIIevidence for the use of this regimen in the neoadjuvant setting. The calculations are based on a person's estimated creatinine clearance level (found using the Cockcroft - Gault equation), and the targeted carboplatin AUC value. Carboplatin AUC Calculator. Biosimilar drug added to clinical information. You can rectify this by using Firefox, Safari or Google chrome. Anti-cancer drugs can damage the lining of the intestine; affecting the absorption of digoxin. bevacizumab will decrease the level or effect of paclitaxel by Other (see comment). palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.). Treatment detail and clinical information updated to reflect the change. This may be caused by Internet Explorer being unable to handle long URL's. Nil changes. Occasionally the searches may not display correctly or take too long to load (and will eventually timeout). Protocol reviewed electronically by Medical Oncology Reference Committee. ID 7 Prevention of antineoplastic induced nausea and vomiting, central venous access device line selection, premedication for prophylaxis of taxane hypersensitivity reactions, preventing anti-cancer therapyinduced nausea and vomiting, chemotherapy-induced peripheral neuropathy screening tool, hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy, Common Terminology Criteria for Adverse Events (CTCAE), Australian Medicines Handbook (AMH) interactions tab, prevention of treatmentinduced nausea and vomiting, immediate management of neutropenic fever, Gynaecological cancer: A guide to clinical practice in NSW 2019 (NSW Health), Guideline for Dosing in Kidney Dysfunction, the night before chemotherapy with or after food, in 500 mL sodium chloride 0.9% over 3 hours, in 500 mL glucose 5% over 30 to 60 minutes (note: if estimated GFR is greater than 125 mL/min (i.e. Monitor INR regularly and adjust warfarin dosage as appropriate; consider alternative anticoagulant. For dosing carboplatin, ADDIKD recommends that: For further information refer theeviQ Factsheet around carboplatin dosing and the carboplatin drug monograph within the ADDIKD guideline. Protocol reviewed at Medical Oncology Reference Committee meeting. Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au), MIMS Online and other sources. General patient assessment prior to each day of treatment. Paracetamol Dosage Calculator by Weight. Review, new dose modifications and transferred to eviQ. May be mild or severe, intermittent or constant and accompanied by inflammation. Ensure IV administration sets are flushed with 0.9% sodium chloride pre and post administration, flush with ~50 mL of sodium chloride 0.9%, observe patient for hypersensitivity reaction throughout administration. Bone pain added to side effects. If you identify any new articles that you believe should be included in the content, please use the feedback button below to inform us of the name of the article(s). Select here forrecommended doses of alternative antiemetics. cardiotoxicity), Increased effects/toxicity of dexamethasone due to inhibition of its metabolism via CYP3A4, Reduced contraceptive efficacy due to increased clearance. The side effects listed below are not a complete list of all possible side effects for this treatment. The expert reference panel supported publication of the protocol on the basis of the information summarised below. Read more about hypersensitivity reaction, Read more about premedication for prophylaxis of taxane hypersensitivity reactions, Read more about prevention of treatmentinduced nausea and vomiting. o Recommendations will be updated once the individual protocol has been evaluated by the reference committee,with this version of the protocol then being archived. Flinders Filters has partnered with eviQ to build reliable, robust search filters to retrieve core high level evidence on topics of significance to eviQ. Refer to the recommended schedule of vaccination for immunocompromised patients, as outlined in the Australian Immunisation Handbook. Live vaccines (e.g. Paclitaxel clearance is reduced when cisplatin precedes paclitaxel, although cisplatin does not affect the metabolism of paclitaxel by human liver microsomes. Common side effects include low blood cell levels, nausea, and electrolyte Additional factors that should be assessed include: previous exposure to chemotherapy or radiotherapy, and overall health status. The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many anti-cancer drugs are reimbursed on the PBS. this may be required in case of a hypersensitivity reaction. is the middle ground between sensitive and specific searches. As ID 4008 Oesophageal definitive or neoadjuvant carboplatin and paclitaxel weekly chemoradiationreplaces the existingapproved protocol ID 1642, its individual History sectionis includedbelow forconsistency in documentation. RESULTS: Seven hundred ninety-two eligible patients were enrolled onto the study. Kidney function should not be capped at 125 mL/min for use in the Calvert formula. The relative risk (RR) of progression for the carboplatin plus paclitaxel group was 0.88 (95% confidence interval [CI], 0.75 to 1.03) and the RR of death was 0.84 (95% CI, 0.70 to 1.02). Note to dexamethasone added. Anti-cancer drugs may alter the anticoagulant effect of warfarin. Approved and published on eviQ. No changes review 2 years. Dose recommendations in kidney dysfunction have yet to be updated to align with the ADDIKD guideline. {{configCtrl2.info.metaDescription}} Sign up today to receive the latest news and updates from UpToDate. restricted to retrieving randomised control trials and systematic reviews. BCG, MMR, zoster and varicella) are contraindicated in patients on immunosuppressive therapy. ID 7 Prevention of antineoplastic induced nausea and vomiting, central venous access device line selection, premedication for prophylaxis of taxane hypersensitivity reactions (infusion related reactions and anaphylaxis), preventing anti-cancer therapyinduced nausea and vomiting, chemotherapy-induced peripheral neuropathy screening tool, hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy, Common Terminology Criteria for Adverse Events (CTCAE), Australian Medicines Handbook (AMH) interactions tab, Chemotherapy before breast cancer surgery (neoadjuvant chemotherapy), premedication for prophylaxis of taxane hypersensitivity reactions, prevention of treatmentinduced nausea and vomiting, immediate management of neutropenic fever, ID 1870 Breast neoadjuvant cARBOplatin three weekly and PACLitaxel weekly followed by AC (DOXOrubicin and CYCLOPHOSPHamide) dose dense overview, Guideline for Dosing in Kidney Dysfunction, in 250 mL sodium chloride 0.9% over 60 minutes, in 500 mL glucose 5% over 30 to 60 minutes (note: If estimated GFR is greater than 125 mL/min (i.e. hypersensitivityrisk increases with number of cycles administered. for severe reactions seek medical assistance immediately and do not restart infusion. Ranitidine is included as a default premedication in eviQ protocols and alternative approaches should be considered based on assessment of individual patients, institutional policy and availability of alternative drugs [e.g. You can rectify this by using Firefox, Safari or Google chrome. antiemetics, premedications, etc. ID 1642 Oesophageal neoadjuvant carboplatin and paclitaxel weekly chemoradiation pre-operativeversion 6. Symptomatic Congestive Heart Failure (CHF). Use is subject to eviQs disclaimer available at www.eviQ.org.au. Haematological dose modifications updated as per consensus of the expert clinician group. Protocol reviewed at Medical Oncology Reference Committee meeting on 30/08/2019. Both altered antiepileptic and anti-cancer drug levels may occur, possibly leading to loss of efficacy or toxicity.
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