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Systemic Anti Cancer Treatment Protocol
Methotrexate Vinblastine Sarcoma
PROTOCOL REF: M PHAMETVIN (Version No. _1.0)
Approved for use in: Fibromatosis
Dosage:
Drug Dosage Route Frequency 2 Methotrexate 30mg/m IV Every 7 to 14 days Vinblastine 6mg/m2 IV Every 7 to 14 days
The dose is usually fixed at methotrexate 50mg and vinblastine 10mg.
Note Vinblastine may be replaced by vinorelbine 20mg/m2 if neuropathy is problematic.
Supportive treatments: Anti-emetic risk - minimal Domperidone 10mg oral tablets, up to 3 times a day or as required
Administration:
Day Drug Dosage Route Diluent and Rate 1 Methotrexate 30mg/m2 IV IV bolus 1 Vinblastine 6mg/m2 IV In 50mL 0.9% sodium chloride over 5 to 10 minutes
Give every 7 to 14 days until progression based on response, tolerability and patient choice
Issue Date: 10th June 2016 Page 1 of 4 Protocol reference: MPHAMETVIN Authorised by: Drugs and Therapeutics Author: Anne Hines/Helen Flint Committee &Dr N Ali Version No: 1.0
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Notes: Caution with vinblastine in patients with cachexia and ulcerated skin. If persistent or troublesome neurotoxicity consider switch to vinorelbine
Extravasation risk: Vinblastine – vesicant follow trust / network extravasation policy. Methotrexate – non vesicant
Main Toxicities: Myelosuppression, nephrotoxicity, stomatitis, neurotoxicity, alopecia
Investigations and Treatment Plan
Pre Cycle 1 Cycle 2 Cycle 3 Cycle 4 Ongoing Medical X Every 6 weeks Assessment Nursing X X X X X Every cycle Assessment FBC X X X X X Every cycle
U&E & LFT X X X X X Every cycle Calculate CrCl (Cockroft and X X X X X Every cycle Gault) CT scan X Every 3 to 6 months Informed X Consent PS recorded X X Every cycle Toxicities X X X X X Every administration documented Weight X X Every 4 weeks recorded
Issue Date: 10th June 2016 Page 2 of 4 Protocol reference: MPHAMETVIN Authorised by: Drugs and Therapeutics Author: Anne Hines/Helen Flint Committee &Dr N Ali Version No: 1.0
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Dose Modifications and Toxicity Management:
Haematological toxicity
Proceed on day 1 if:- ANC ≥ 1.0 x 109/L Platelets ≥ 100 x 109/L
Delay 1 week on day 1 if:- ANC ≤ 0.9 x 109/L Platelets ≤ 99 x 109/L
If platelets or ANC still below required levels for treatment at week 2, delay treatment and book for consultant review with a view to lengthening cycle interval.
Non-haematological toxicity
Renal CrCl (mL/min) Methotrexate dose Vinblastine dose Above 50 100% 100% 20 to 50 50% 100% Below 20 Do not give Review
Hepatic ALT / AST Bilirubin Vinblastine Methotrexate (micromol/L) Dose Dose 60 to 160 26 - 51 50% 100% Above 160 Above 51 Discuss with Discuss with consultant consultant Consider 50% Consider 75%
GI toxicity For stomatitis not related to haematological toxicity - institute appropriate mouthcare measures. Check renal function and adjust methotrexate dose if necessary. Consider folinic acid (calcium folinate tablets) with subsequent cycles starting 24 hours after methotrexate injection, giving 15mg orally every 6 hours for 6 doses.
Neurotoxicity Refer to consultant if any neurotoxicity > grade 2 or if persistent troubling symptoms – may switch to vinorelbine.
Issue Date: 10th June 2016 Page 3 of 4 Protocol reference: MPHAMETVIN Authorised by: Drugs and Therapeutics Author: Anne Hines/Helen Flint Committee &Dr N Ali Version No: 1.0
THE CLATTERBRIDGE CANCER CENTRE NHS FOUNDATION TRUST
References: Azzarelli A, Gronchi A, Bertulli R, Tesoro JD, Baratti D, Pennacchioli E, et al. Low-dose chemotherapy with methotrexate and vinblastine for patients with advanced aggressive fibromatosis. Cancer. 2001;92(5):1259-64.
Weiss AJ, Horowitz S, Lackman RD. Therapy of desmoid tumors and fibromatosis using vinorelbine. American journal of clinical oncology. 1999;22(2):193-5.
Oncology Chemotherapy Guidelines and Protocols, Royal Surrey County Hospital, http://royalsurrey.staging.flipsidegroup.com/Acc-MVAC
Issue Date: 10th June 2016 Page 4 of 4 Protocol reference: MPHAMETVIN Authorised by: Drugs and Therapeutics Author: Anne Hines/Helen Flint Committee &Dr N Ali Version No: 1.0