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