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Chapter 10: Urological Cancer

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Chapter 10: Urological Cancer Chapter 10: Urological Cancer Contents Chapter 10: Urological Cancer .................................................................................. 1 Bladder Cancer - Transitional cell ........................................................................... 2 Neoadjuvant ............................................................................................................ 2 Cisplatin / gemcitabine ......................................................................................... 2 Cisplatin / gemcitabine split dose ......................................................................... 2 Concurrent Chemotherapy / Radiotherapy .............................................................. 3 Mitomycin C and fluorouracil ................................................................................ 3 Cisplatin ............................................................................................................... 3 Advanced ................................................................................................................ 4 Cisplatin / gemcitabine split dose ......................................................................... 4 Cisplatin / gemcitabine ......................................................................................... 4 Carboplatin / gemcitabine ..................................................................................... 5 Paclitaxel .............................................................................................................. 5 Renal cancer .............................................................................................................. 6 Advanced: ............................................................................................................... 6 First line ................................................................................................................... 6 Sunitinib ............................................................................................................... 6 Pazopanib ............................................................................................................ 6 *Temsirolimus....................................................................................................... 7 Second line therapy ................................................................................................. 8 *Everolimus (Afinitor®) ......................................................................................... 8 *Axitinib ................................................................................................................ 8 Prostate Cancer ....................................................................................................... 10 Docetaxel ........................................................................................................... 10 Weekly Docetaxel ............................................................................................... 10 *Abiraterone First line therapy ............................................................................ 11 Second line treatment ........................................................................................... 11 Mitoxantrone ...................................................................................................... 11 Abiraterone ......................................................................................................... 12 *Cabazitaxel ....................................................................................................... 13 Issue Date: June 2014 Page 1 of 13 Issue No: 11.10.0 Author: Helen Flint Authorised by: Dr I Syndikus Copy No: Bladder Cancer - Transitional cell Neoadjuvant Cisplatin / gemcitabine Cisplatin/gemcitabine Frequency Course length Every 21 Days 3 cycles Drug Dose Admin Day 1 Cisplatin 70mg/m2 IV infusion over 90 minutes Day 1 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Day 8 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate creatinine clearance prior to each cycle and administer cisplatin according to guidelines Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle, normal FBC limits for administration apply Cisplatin / gemcitabine split dose Cisplatin/gemcitabine Frequency Course length Every 21 Days Upto 4 cycles Drug Dose Admin Day 1 Cisplatin 35mg/m2 IV infusion over 60 minutes Day 1 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Day 8 Cisplatin 35mg/m2 IV infusion over 60 minutes Day 8 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate creatinine clearance prior to each cycle and administer cisplatin according to guidelines Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle, normal FBC limits for administration apply Issue Date: June 2014 Page 2 of 13 Issue No: 11.10.0 Author: Helen Flint Authorised by: Dr I Syndikus Copy No: Concurrent Chemotherapy / Radiotherapy Mitomycin C and fluorouracil Mitomycin C and fluorouracil Frequency Course length Five week course One course Drug Dose Admin Day 1 Mitomycin C 12mg/m2 IV bolus (maximum dose 20mg) Days 1 to 5 Fluorouracil 500mg/m2 daily IV infusion over 24 hours Days 16 to 20 Fluorouracil 500mg/m2 daily IV infusion over 24 hours Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle Normal FBC limits for administration apply Cisplatin Cisplatin Frequency Course length Every 7 Days 4 to 6 weeks, concurrent with radiotherapy Drug Dose Admin 2 IV infusion over 60 minutes Day 1 Cisplatin 30 to 40mg/m IV (maximum dose 60mg) XRT 55Gy in 20# (4 x weekly cisplatin infusions) or XRT 64Gy in 32# (6 x weekly cisplatin infusions) As possible alternative to standard mitomycin C and fluorouracil Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate creatinine clearance prior to each cycle and administer cisplatin according to guidelines Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle Normal FBC limits for administration apply Issue Date: June 2014 Page 3 of 13 Issue No: 11.10.0 Author: Helen Flint Authorised by: Dr I Syndikus Copy No: Advanced Cisplatin / gemcitabine split dose Cisplatin/gemcitabine Frequency Course length Every 21 Days Upto 4 cycles Drug Dose Admin Day 1 Cisplatin 35mg/m2 IV infusion over 60 minutes Day 1 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Day 8 Cisplatin 35mg/m2 IV infusion over 60 minutes Day 8 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate creatinine clearance prior to each cycle and administer cisplatin according to guidelines Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle Normal FBC limits for administration apply Cisplatin / gemcitabine Cisplatin/gemcitabine Frequency Course length Every 21 Days Upto 6 cycles Drug Dose Admin Day 1 Cisplatin 70mg/m2 IV infusion over 90 minutes Day 1 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Day 8 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Laboratory investigations Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate creatinine clearance prior to each cycle and administer cisplatin according to guidelines Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle Normal FBC limits for administration apply Issue Date: June 2014 Page 4 of 13 Issue No: 11.10.0 Author: Helen Flint Authorised by: Dr I Syndikus Copy No: Carboplatin / gemcitabine Carboplatin/gemcitabine Frequency Course length Every 21 Days Upto 6 cycles Drug Dose Admin Day 1 Carboplatin AUC 4 to 5 IV infusion over 60 minutes Day 1 Gemcitabine 1000mg/m2 IV infusion over 30 minutes Day 8 Gemcitabine 1000mg/m2 IV infusion over 30 minutes For patients with impaired renal function Interval between cycles can be increased to 28 days if prolonged immunosuppression Laboratory Investigation Ensure normal hepatic function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Calculate or measure creatinine clearance prior to first cycle and before subsequent cycles if clinically indicated Where renal / hepatic function are abnormal treatment is at physician discretion FBC prior to each cycle, normal FBC limits for administration apply Paclitaxel Weekly paclitaxel Frequency Course length Every 7 days Until disease progression Drug Dose Admin Day 1 Chlorphenamine 10mg IV bolus IV bolus Day 1 Dexamethasone 8mg Reducing to 4mg from week 2 Day 1 Ranitidine 50mg IV bolus Day 1 Paclitaxel 80mg/m2 IV infusion over 60 minutes Laboratory investigations Ensure normal renal function prior to cycle 1 and repeat during subsequent cycles if clinically indicated Patients with abnormal hepatic function should be treated cautiously Where renal / hepatic function
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