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REVIEW ARTICLE Chemotherapy Administration Sequence

Figure Chemotherapy Sequencing Chart

Sec ond Chemotherapy Agent Sec ond Chemotherapy Agent Base Solution s ) ) l e r a n ) e e a t m d U e i s x o e a SE QUENC E F n r s i a - d m e i r o W e 5 r

a b p n g s m ( b b e i n e n i b

o h a i i e t n a u

n LEGEND e l l a L A i d c % n a t i n i ( e ( p e c e a n n n i h

n e h e n

i y i c e m s o i i e

b PD= Pha rm acodyna mic/Eff icacy 5 c i e l e n t n n m R n n s i l l n m n x n n c b t t i

r i m i i n n i n n e

n i i C x b o r b u u z i a n a e d l i e n i i a t i o t e e a u e

t o i a m a a i c e i c a u b r c n d l PK= Pha rm acokine tic r d z t e l o a u a b r l x i o c t c i c b i t x x a n z h i s s r b o y t z y i r m m t c i m l a l u i a r o e t s o v b b i a u p m i t s s m s e i a a m a l a p r t p t u

o T= Toxicity a n o u b a o e i i u r t e b r o p c h a a t u t t o c i o x e o u o r s r m x i a t m t l l t h o i i r r n a a r r e p x n a e t i u d h l o u a t i t l l l o p f c t m b u a s o o p o o o ND = No diff eren ce c s t l p r o b c d o r b e u x c c u x c a m v n d t r r i t c c n n m c s t t m p c u x r a o e t s i e i e e e n n n n a u u a x e a o a o a e e e l o t i y y e i a a i a e a e a o t p i i i e o r o a l l e x r d f S M L S T M P O D E V V V R T T D P P P P M F M M D M D L I I I I F G E D D C C C C C B B D B C Bend amustine Bend amustine Bevacizumab Bevacizumab Bleo mycin Bleo mycin T1, C2 ND ND ND ND Carboplatin T Carboplatin

Carmustine Avoid PV C DH EP Carmustine Cetuximab Cetuximab G1, C2 C1, I2 P1. C2 T1, C2 ND ND Cisplatin PD/T PD T T Cisplatin C1, P2 Cycloph osph amide T Cycloph osph amide F1,C2 Cytarabine PD Cytarabine Dacarbazine Dacarbazine Dactinomycin Dactinomycin Daun orub icin Daun orub icin Dox 1 LD1-D2 I1, D2 D1, T2 D1, V2 ND ND ND ND Docetaxel T T T PK/T PK/T Avoid PV C DH EP Docetaxel Dox 1 D1, P2 ND ND Doxorub icin T PK /T Doxorub icin LD1-D2 LD1-V2 Doxorub icin (Liposomal) T ND T Doxorub icin (Liposomal) E1, P2 ND Epirub icin PK /T Epirub icin <0.4 <0.4 <0.4 Etoposide ND ND mg/ml mg/ml mg/ml Etoposide F1,C2 Flud arabine PD Flud arabine I1, F2 L1 , F2 F1, M2 NDND Fluorouracil (5-FU) PD/T PD PD Fluorouracil (5-FU) G1, C2 P1. G 2 P1, G 2 ND ND ND Gemcitabine Gemcitabine F

t PD/T PD/T PD/T i r n s e t g

Idarub icin Idarub icin C A

h y I1, D2 e p * m

a Ifosfamide Ifosfamide o r T e t h

h C1, I2 I1, F2 t ND ND e r o Irinotecan PD PD/T Irinotecan a m p e y h

Ixabepil one Avoid PV C DH EP Ixabepil one A C

g t

L1 , F2 M1, L2 e s n r i Leucovorin PD PD Leucovorin t F Mechlorethamine Mechlorethamine For Melph alan < 1hr Melph alan Mesna * Mesna F1, M2 M1, L2 ND Methotrexate PD PD Methotrexate Mitomycin Mitomycin Mitoxantrone Mitoxantrone

Flush li ne s Flush li ne s Oxali platin ND with D5W with D5W Oxali platin P1. C2 C1, P2 D1, P2 E1, P2 P1. G 2 ND ND Pacli taxel T T PK /T PK /T PD/T Avoid PV C DH EP Pacli taxel Pacli taxel (Abraxane) ND Pacli taxel (Abraxane) Panitumumab Panitumumab P1, G 2 Pemetrexed PD/T Pemetrexed Pentostatin Pentostatin Rituximab Rituximab Streptozocin Streptozocin

Temsiroli mus Avoid PV C DH EP Temsiroli mus T1, C2 T1, C2 D1, T2 ND ND Topotecan T T PK /T Topotecan Trastuzumab Trastuzumab Vinb lastine Vinb lastine Vincristine Vincristine D1, V2 LD1-V2 Vinorelbine PK /T T Vinorelbine ) ) l e a

*Follow published guideli nes r n ) e BA SE LEGEND e m t a d U o e i s x a s F e n r i a - o d m e W SAME DRUG LINE r i e p 5 Y-SITE CO MPA TIBLE a b r i g n s m ( b b e n e i n b

THERAPEUTIC L h a o i i e t n n a u e l a ( A l

% Y-SITE i i d c n a t n i e

( p e c e a n n n i h n e

DU PLICATION e n

h i y i c 5 e m s o i i e b c i e R n l e n t n n m n n s i l l n m n x n

IN COMPATIBLE c i b t t i r i m i n i n

i n n e n i x b o r b u C u z i a n a e d i l e n i i a t o i t e e a u e c t o e i a m

a a i

Y-SITE COMPA TIBLE c i c a u d b r n l d r i z t e o l a u a b r l x o c c t i c b i t x x a n z h i

s VA RIABLE s r b o y t z y i r m m t c i m l e a l b u i a r o t s o v b i a u p i t s s s m e m a a m i a l a t p r p

Y-SITE INC OMPATIBLE o t u a n o u b a o e u i i r t u e b r o p c h a a t t t o c i o r x e o r o s m x r i a t u m t l t l h a o i i r NO T TES TED r n a r e p x n a t e u d h l o t i u a t i l l l o p f c t o m b u a s o o p o

NO T TES TED o t s l c p r o b c o d r b e u c c x c x u a m v n d t r r t c i c c m n n s t t m p c u x r a o e s t i e e e e i n n n n a u u a x a a o o a e e l e e o t i y i e a y a i a a e a e o o p t i i i e r o l l e a r x d f C L C D I E M M R L C C I C D D C D M M M I G D M O P I F E F P S S T P P P V T V D V T B D B B

Sec ond Chemotherapy Agent Sec ond Chemotherapy Agent Base Solution s

20 l Journal of Hematology Oncology Pharmacy l www.JHOPonline.com March 2011 l Vol 1, No 1 Vol 1, No 1 l March 2011 www.JHOPonline.com l Journal of Hematology Oncology Pharmacy 21