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Panitumumab (21 day) Ver 1.1

Description
Chemotherapy Protocol COLORECTAL CANCER PANITUMUMAB (21 day) This regimen may require funding and is an unlicensed dose Regimen Colorectal Cancer
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Panitumumab21dayVer11.pdf

Panitumumab (14 day) Ver 1.2

Description
Chemotherapy Protocol COLORECTAL CANCER PANITUMUMAB (14 day) This regimen may require funding Regimen Colorectal Cancer – Panitumumab (14 day) Indication Metastatic colorectal cancer that is positive for the wild type KRAS genotype and that has progressed after failure of oxaliplatin and irinotecan based therapy or who are intolerant to these agents. WHO performance status 0, 1, 2 Toxicity Drug Adverse Effect Panitumumab Infusion related reactions, interstitial lung disease, skin reactions, electrolyte abnormalities, fatigue, abdominal pain, constipation The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs Prior to starting therapy confirm a positive wild type KRAS status FBC, LFT’s and U&E’s prior to day one of cycle one and every 6 – 8 weeks thereafter Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be reescalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.2 (May 2014) Page 1 of 5 Colorectal – Panitumumab (14) Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Prior to prescribing on day one of cycle one the following criteria must be met; Criteria Neutrophil Platelets Eligible Level equal to or more than 1.5x109/L equal to or more than 100x109/L Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL For haematological toxicity, if the neutrophil count is less than 1.5 109/L or the platelet count less than 100 109/L, delay treatment until these levels are achieved. The decision to continue treatment should be made at the consultant’s discretion. Hepatic / Renal Impairment Drug Panitumumab Hepatic No information available Renal No information available Other Allergic or hypersensitivity reactions have occurred during the administration of panitumumab. For a NCI-CTC grade 1 reaction reduce the infusion rate by 50%. For a NCI-CTC grade 2 reaction, stop the infusion and administer supportive therapies as indicated. Once the reaction has resolved to NCI-CTC grade 1 or below resume the infusion at 50% of the previous rate. For a NCI-CTC grade 3 or 4 toxicity stop the infusion immediately and disconnect the tubing from the patient. Administer appropriate supportive therapies. Once recovered, patients should not receive panitumumab again. Once the rate has been reduced it should not be increased on subsequent infusions. If a second reaction occurs on the slower infusion rate the infusion should be stopped and no further treatment given. An acniform skin rash occurs in over 90% of those receiving panitumumab. The onset is normally within three weeks of starting therapy and often resolves after week twelve. For a NCI-CTC grade 1-2 reaction use symptomatic treatments such as topical or oral antibiotics and continue with the panitumumab. For a NCI-CTC grade 3 toxicity delay treatment until the toxicity resolves to NCI-CTC grade 2 or below. Reinstate therapy using 50% of the original dose. If the reaction does not recur escalate the dose in 25% increments as tolerated until the recommended dose is reached. If the reactions do not resolve to less than NCI-CTC grade 2 after withholding up to two doses or if the skin toxicity recurs or becomes intolerable at 50% of the original dose discontinue treatment. Version 1.2 (May 2014) Page 2 of 5 Colorectal – Panitumumab (14) UV radiation may worsen skin reactions. Sun safety practices should be followed during and for up to two months after the end of treatment. Stop treatment if there is a confirmed pneumonitis. Regimen 14 day cycle until intolerance or disease progression (6 cycles will be set) Drug Panitumumab Dose Days 6mg/kg 1 Route Intravenous infusion in 100ml sodium chloride 0.9% over 60 minutes (see administration instructions) Dose Information Panitumumab will be dose banded according to the CSCCN agreed bands Administration Information Extravasation Panitumumab - neutral Other Panitumumab must be administered using a 0.22 micron in-line filter Doses of 1000mg and above must be administered over 90 minutes in 150ml sodium chloride 0.9% Additional Therapy Antiemetics As take home medication - metoclopramide 10mg three times a day when required oral (supply on day one of cycle one only and then as required) Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed Coding Procurement – X71.5 Delivery – X72.3 References 1. Van Cutsem E, Peeters M, Siena S et al. Open label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy refractory metastatic colorectal cancer. J Clin Oncol 2007; 25: 1658-1664. Version 1.2 (May 2014) Page 3 of 5 Colorectal – Panitumumab (14) REGIMEN SUMMARY Panitumumab (14 day) Day One 1. Panitumumab 6mg/kg intravenous infusion in 100ml sodium chloride 0.9% over 60 minutes* 2. Metoclopramide 10mg three times a day when required for the relief of nausea oral** *Please refer to the administration instructions **The metoclopramide will only appear on day one cycle one. If further supplies are required they should be added from the support directory of Aria as necessary. Version 1.2 (May 2014) Page 4 of 5 Colorectal – Panitumumab (14) DOCUMENT CONTROL Version Date Amendment Written By Approved By Header changed Metoclopramide dose changed to 10mg throughout 1.2 May 2014 Set in Aria removed from number of cycles Dr Debbie Wright Pharmacist Donna Kimber Pharmacy Technician Coding updated Disclaimer added Panitumumab administration instructions altered to be in 1.1 Nov 2011 100ml sodium chloride 0.9%. This change was also actioned Dr Debbie Wright Pharmacist Rebecca Wills Pharmacist in the regimen summary and dose table. 1 Sept 2011 None Dr Debbie Wright Pharmacist Dr Tim Iveson Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.2 (May 2014) Page 5 of 5 Colorectal – Panitumumab (14)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Panitumumab14dayVer12.pdf

Cetuximab (14 day)

Description
Chemotherapy Protocol COLORECTAL CANCER CETUXIMAB (14 day) This regimen may require funding Regimen • Colorectal Cancer – Cetuximab (14 day) Indication • Metastatic colorectal cancer positive for the wild type KRAS genotype and that has progressed after failure of oxaliplatin and irinotecan based therapy or who are intolerant to these agents. • WHO performance status 0, 1, 2 Toxicity Drug Cetuximab Adverse Effect Infusion related reactions, interstitial lung disease, skin reactions, electrolyte abnormalities, fatigue, abdominal pain, constipation The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • Prior to starting therapy confirm a positive wild type KRAS status • FBC, LFT’s and U&E’s prior to day one of cycle one of treatment and every 6 – 8 weeks thereafter • Monitor for hypersensitivity reactions for 60 minutes after the end of the cetuximab infusion Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be reescalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.2 (October 2020) Page 1 of 6 Colorectal – Cetuximab (14 day) Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Prior to prescribing on day one of cycle one the following criteria must be met; Criteria Neutrophil Platelets Eligible Level equal to or more than 1.5x109/L equal to or more than 100x109/L Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL For haematological toxicity, if the neutrophil count is less than 1.5 109/L or the platelet count less than 100 109/L, delay treatment until these levels are achieved. The decision to continue treatment should be made at the consultant’s discretion. Hepatic / Renal Impairment Drug Cetuximab Hepatic Administer only when the transaminases are 5xULN or below and the bilirubin is 1.5xULN or below Renal Administer only where the serum creatinine is 1.5xULN or below Other Cetuximab Allergic or hypersensitivity reactions have occurred during the administration of cetuximab. For a NCI-CTC grade 1 reaction reduce the infusion rate by 50% (the total should not exceed 240 minutes). For a NCI-CTC grade 2 reaction, stop the infusion and administer supportive therapies as indicated. Once the reaction has resolved to NCI-CTC grade 1 or below resume the infusion at 50% of the previous rate. For a NCI-CTC grade 3 or 4 toxicity stop the infusion immediately and disconnect the tubing from the patient. Administer appropriate supportive therapies. Once recovered, patients should not receive cetuximab again. Once the rate has been reduced it should not be increased on subsequent infusions. If a second reaction occurs on the slower infusion rate the infusion should be stopped and no further treatment given. An acniform skin rash occurs in over 70% of those receiving cetuximab. The onset is normally within three weeks of starting therapy and often resolves after week twelve. For a NCI-CTC grade 1-2 reaction use symptomatic treatments such as topical or oral antibiotics and continue with the cetuximab. For a NCI-CTC grade 3 toxicity delay treatment until the toxicity resolves to NCI-CTC grade 2 or below. If this occurs within fourteen days resume cetuximab at the same dose. If more than fourteen days is required stop treatment. If the NCI-CTC grade 3 toxicity occurs for a second and third time the cetuximab may again be delayed for up to and including fourteen days Version 1.2 (October 2020) Page 2 of 6 Colorectal – Cetuximab (14 day) with concomitant dose reductions. Cetuximab dose reductions are permanent. The cetuximab must be discontinued if more than two consecutive infusions are withheld or a fourth episode of a NCI-CTC grade 3 skin toxicity develops or a NCI-CTC grade 4 toxicity at any time. UV radiation may worsen skin reactions. Sun safety practices should be followed during and for up to two months after the end of treatment. Stop treatment if there is a confirmed pneumonitis. Regimen 14 day cycle until intolerance or disease progression develops (6 cycles will be set in Aria) Drug Cetuximab Dose 500mg/m2 Days 1 Route Intravenous infusion over 120 minutes (see administration below) Dose Information • Cetuximab will be dose banded in accordance with the national dose bands (5mg/ml) Administration Information Extravasation • Cetuximab - neutral Other • Individuals should be monitored for hypersensitivity for sixty minutes after finishing the cetuximab infusion. Do not administer other chemotherapy during this period. • The rate of administration of cetuximab must not exceed 10mg/min. The first infusion is given over 120 minutes. If this infusion rate is well tolerated subsequent infusions may be given over 60 minutes Additional Therapy • 30 minutes prior to cetuximab infusion; - chlorphenamine 10mg intravenous - dexamethasone 8mg oral or intravenous - H2 antagonist according to local formulary choice and availability - paracetamol 1000mg oral Version 1.2 (October 2020) Page 3 of 6 Colorectal – Cetuximab (14 day) • Antiemetics As take home medication - metoclopramide 10mg three times a day when required oral (supply day one cycle one only and then as required) • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed References 1. Cunningham D, Humblett Y, Sienna S et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337-335. Version 1.2 (October 2020) Page 4 of 6 Colorectal – Cetuximab (14 day) REGIMEN SUMMARY Cetuximab (14 day) Day One 1. Chlorpheniramine 10mg intravenous 2. Dexamethasone 8mg oral or intravenous 3. Paracetamol 1000mg oral Administration Instructions Please check if the patient has taken paracetamol. The maximum dose is 4000mg in every 24 hours 4. H2 antagonist according to local formulary choice and availability Administration Instructions: Administer according to local formulary choice and availability one of the following 30 minutes prior to chemotherapy; - Ranitidine 50mg intravenous once only - Famotidine 20mg oral once only - Nizatidine 150mg oral once only - Ranitidine 150mg oral once only If there is no stock of these products due to national shortages treatment may proceed without the H2 antagonist provided there is no instruction in the ARIA journal indication the patient must have H2 antagonist treatment. All infusion related reactions must be recorded in the ARIA journal and reported to the appropriate consultant. Many Trusts do not administer an H2 antagonist from cycle three onwards. They have been left in the ARIA protocols so that decisions can be made on an individual Trust and patient basis. 5. Cetuximab 500mg/m2 over 120 minutes intravenous infusion 6. Metoclopramide 10mg three times a day when required for the relief of nausea oral* *The metoclopramide will only appear on day one cycle one. If further supplies are required they should be added from the support directory of Aria as necessary. Version 1.2 (October 2020) Page 5 of 6 Colorectal – Cetuximab (14 day) DOCUMENT CONTROL Version Date Amendment Written By Approved By Update of premedication due to shortage of IV ranitidine. 1.2 October 2020 IV ranitidine changed to H2 antagonist according to local formulary choice and availability Arum Shortland Pharmacist Dr Debbie Wright Pharmacist Coding removed Dose banding updated Header changed Toxicity removed Bolus removed from supportive 1.1 May 2014 therapies Metoclopramide dose changed Dr Debbie Wright Pharmacist Donna Kimber Pharmacy Technician to 10mg OPCS codes updated Disclaimer added 1 Feb 2012 None Dr Debbie Wright Pharmacist Dr Tim Iveson Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.2 (October 2020) Page 6 of 6 Colorectal – Cetuximab (14 day)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Cetuximab14day.pdf

Tepotinib

Description
The Chemotherapy Protocol for Tepotinib, a type of non-small cell lung cancer (NSCLC).
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lung-cancer-non-small-cellNSCLC/Tepotinib.pdf

Fluorouracil-FolinicAcid(MdG)-Oxaliplatin-Panitumumab

Description
Chemotherapy Protocol COLORECTAL CANCER FLUOROURACIL, FOLINIC ACID (Modified de Gramont), OXALIPLATIN and PANITUMUMAB (FOLFOX-Panitumumab) Regimen • Colorectal Cancer– Fluorouracil, Folinic Acid (modified de Gramont), Oxaliplatin and Panitumumab (FOLFOX-Panitumumab) Indication • First metastatic colorectal cancer where the following criteria are met; - the tumour is wild type RAS - no prior exposure to either cetuximab or panitumumab • WHO Performance status 0, 1 Toxicity Drug Fluorouracil Oxaliplatin Panitumumab Adverse Effect Palmar-plantar erythrodysesthesia, diarrhoea, mucositis, chest pain Peripheral neuropathy (cumulative), acute laryngopharyngeal dysasthesia (increase duration of infusion) Infusion related reactions, interstitial lung disease, skin reactions, electrolyte abnormalities, fatigue, abdominal pain, constipation The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, LFT’s and U&E’s prior to day one of treatment. • Prior to starting therapy confirm a positive wild type RAS status • Patients with complete or partial dihydropyrimidine dehydrogenase (DPD) deficiency are at increased risk of severe and fatal toxicity during treatment with fluorouracil. All patients should be tested for DPD deficiency before initiation (cycle 1) to minimise the risk of these reactions Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. Version 1.1 (November 2020) Page 1 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) In principle all dose reductions due to adverse drug reactions should not be reescalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Consider blood transfusion or erythropoietin if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL For haematological toxicity, if the neutrophil count is less than 1.5 109/L or the platelet count is less than 75 109/L, delay treatment until these levels are achieved. Reinitiate therapy at the full dose for up to a seven day delay or, for a delay of more than seven days, with 75% of the original dose for thrombocytopenia. If neutropenia is the issue then after seven days omit the bolus fluorouracil for this and subsequent cycles. If a further delay is necessary despite omitting the bolus fluorouracil then reduce the dose of both the infusional fluorouracil and oxaliplatin to 80% of the original dose. If the delay is twenty-one days or more stop therapy. The panitumumab dose rarely needs to be reduced for haematological toxixity but may be delayed. There is no need to dose adjust the folinic acid for haematological counts. Liver Impairment Drug Fluorouracil Bilirubin μmol/L More than 85 AST/ALT units More than 180 Dose (% of original dose) Contra-indicated In moderate hepatic impairment reduce the initial dose by 33%. In severe hepatic impairment reduce the initial dose by 50%. The dose may be increased as tolerated. Oxaliplatin Limited information available but there is probably little need to adjust the dose. Panitumumab No information available Version 1.1 (November 2020) Page 2 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) Renal Impairment Drug Creatinine Clearance (ml/min) Dose (% of original dose) Fluorouracil Consider dose adjustment in sever renal impairment Oxaliplatin For moderate renal impairment, treat at normal dose, and monitor renal function. Dose adjust according to toxicity. If the CrCl is less than 20m/min then dose reduce Panitumumab No information available Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Dose limiting toxicities include diarrhoea, abdominal pain, emesis, stomatitis, palmar-plantar erythrodysesthesia and neurosensory toxicities among others. If any NCI-CTC grade 1 toxicity occurs treatment should be continued, without interruption, at the full dose. For toxicities at NCI-CTC grade 3 or above treatment should be withheld until recovery to NCI-CTC grade 1 then re-started if medically appropriate. If recovery takes 21 days or longer stop treatment. Fluorouracil Diarrhoea occurring for the first time at NCI-CTC grade 2 should be approached by withholding the fluorouracil until it has resolved to NCI-CTC grade 1. Treatment can then be re-started at full dose. Treatment should again be delayed on development of a second NCI-CTC grade 2 diarrhoea and the fluorouracil re-started at 75% of the original dose when it has resolved to NCI-CTC grade 1. After resolution of a third episode of NCI-CTC grade 2 diarrhoea to NCI-CTC grade 1 the fluorouracil should be re-started using 50% of the original dose. On appearance of a NCI-CTC grade 3 diarrhoea withhold fluorouracil until it has resolved to NCI-CTC grade 1 and re-start treatment using 75% of the original dose. After a second episode at NCI-CTC grade 3 wait until the diarrhoea has resolved to NCI-CTC grade 1 and resume the fluorouracil using 50% of the original dose. For a third appearance of NCI-CTC grade 3 diarrhoea or the development of grade 4 toxicity at ant time stop fluorouracil therapy. Version 1.1 (November 2020) Page 3 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) Oxaliplatin If the neurosensory toxicity is NCI-CTC grade 1–2 and lasts less than 7 days administer full dose oxaliplatin. If the toxicity is NCI-CTC grade 2 and persists for more than 7 days reduce the oxaliplatin dose to 75mg/m2. Oxaliplatin should be discontinued for neurosensory toxicities NCI-CTC grade 3 or above. If NCI-CTC grade 3-4 diarrhoea or stomatitis recurs despite appropriate reduction in the fluorouracil dose the oxaliplatin dose should be reduced to 75mg/m2. There are rare case reports of acute interstitial lung disease or lung fibrosis in association with oxaliplatin. Where an unexplained respiratory symptom occurs stop treatment until pulmonary investigations have been conducted to exclude an interstitial cause. Panitumumab An acniform skin rash occurs in over 90% of those receiving panitumumab. The onset is normally within three weeks of starting therapy and often resolves after week twelve. Please refer to local guidelines for the treatment of this reaction. Alternatively, for a NCI-CTC grade 1-2 reaction use symptomatic treatments such as topical or oral antibiotics and continue with the panitumumab. For a NCI-CTC grade 3 toxicity delay treatment until the toxicity resolves to NCI-CTC grade 2 or below. Re-instate therapy using 50% of the original dose. If the reaction does not recur escalate the dose in 25% increments as tolerated until the recommended dose is reached. If the reactions do not resolve to less than NCI-CTC grade 2 after withholding up to two doses or if the skin toxicity recurs or becomes intolerable at 50% of the original dose discontinue treatment. UV radiation may worsen skin reactions. Sun safety practices should be followed during and for up to two months after the end of treatment. Stop treatment if there is a confirmed pneumonitis. Regimen 14 day cycle for 6 cycles Drug Folinic Acid Oxaliplatin Fluorouracil Fluorouracil Panitumumab Dose 350mg 85mg/m2 (maximum dose 170mg) 400mg/m2 2400mg/m2 6mg/kg Days Administration 1 Intravenous infusion in 250ml glucose 5% over 120 minutes 1 Intravenous infusion in 500ml glucose 5% over 120 minutes 1 Intravenous bolus over 10 minutes 1 Intravenous infusion over 46 hours Intravenous infusion in 100ml sodium 1 chloride 0.9% over 60 minutes (see administration instructions) Version 1.1 (November 2020) Page 4 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) Dose Information • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM bolus and 50mg/ml infusion) • Oxaliplatin will be dose banded in accordance with the national dose bands (5mg/ml) • Oxaliplatin dose will be capped at 170mg. • Panitumumab will be dose banded in accordance with the national dose bands (20mg/ml NS) Administration Information Extravasation • Fluorouracil – inflammitant • Oxaliplatin – exfoliant • Panitumumab - neutral Other • Central venous access and use of an ambulatory infusion pump may be required. • Panitumumab must be administered using a 0.22 micron in-line filter • Doses of 1000mg and above must be administered over 90 minutes in 150ml sodium chloride 0.9% Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy - dexamethasone 8mg oral or intravenous - ondansetron 8mg oral or intravenous As take home medication; - dexamethasone 4mg twice a day for 3 days oral - metoclopramide 10mg three times a day when required oral • Oral loperamide 4mg after the first loose stool then 2-4mg four times a day when required for the relief of diarrhoea (maximum 16mg/24 hours). • Prophylaxis for skin rash according to local formulary choices. For example; Version 1.1 (November 2020) Page 5 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) - doxycycline 100mg twice a day for 14 days oral - lymecycline 408mg once a day for 14 days oral • Gastric protection with a proton pump inhibitor or H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed Additional Information • A glucose 5% flush should be administered before and after the oxaliplatin • The folinic acid may be replaced with calcium levofolinate 175mg intravenous infusion in 250ml glucose 5% over 120 minutes References 1. Douillard JY, Oliner KS, Siena S et al. Panitumumab-FOLFOX4 treatment and RAS mutations in colorectal cancer. N Engl J Med 2013; 369 (11): 1023-1034. Version 1.1 (November 2020) Page 6 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) REGIMEN SUMMARY Flourouracil-Folinic Acid (MdG)-Oxaliplatin-Panitumumab (FOLFOXPanitumumab) Day One 1. Panitumumab 6mg/kg intravenous infusion in 100ml sodium chloride 0.9% over 60 minutes* 2. Dexamethasone 8mg oral or intravenous 3. Ondansetron 8mg oral or intravenous 4. Oxaliplatin 85mg/m2 intravenous infusion in 500ml glucose 5% over 120 minutes 5. Folinic Acid 350mg in 250ml glucose 5% over 120 minutes intravenous infusion 6. Fluorouracil 400mg/m2 intravenous bolus over 10 minutes 7. Fluorouracil 2400mg/m2 intravenous infusion over 46 hours Take Home Medicines 7. Dexamethasone 4mg twice a day for 3 days oral starting on day two of the cycle 8. Metoclopramide 10mg three times a day when required oral 9. Skin Rash Prophylaxis Administration Instructions For the prevention of skin reactions according to local formulary choice; - doxycycline 100mg twice a day for 14 days oral - lymecycline 408mg once a day for 14 days oral *Please refer to the administration instructions Version 1.1 (November 2020) Page 7 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab) DOCUMENT CONTROL Version Date Amendment Written/ By Approved By Updated monitoring with DPD 1.1 Nov 2020 testing Dose banding updated Coding removed 1 May 2016 None Donna Kimber Pharmacy Technician Dr Deborah Wright Pharmacist Rebecca Wills Pharmacist Dr Tim Iveson Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.1 (November 2020) Page 8 of 8 Colorectal – Fluorouracil, Folinic Acid (MdG), Oxaliplatin, Panitumumab (FOLFOX-Panitumumab)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Fluorouracil-FolinicAcidMdG-Oxaliplatin-Panitumumab.pdf

Fluorouracil-Folinic acid(MdG)-Irinotecan-Panitumumab

Description
Chemotherapy Protocol COLORECTAL CANCER FLUOROURACIL, FOLINIC ACID (Modified de Gramont), IRINOTECAN and PANITUMUMAB (FOLFIRI-Panitumumab) This pr
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Fluorouracil-Folinic-acidMdG-Irinotecan-Panitumumab.pdf

Cetuximab-Irinotecan (14 day)

Description
Chemotherapy Protocol COLORECTAL CANCER CETUXIMAB-IRINOTECAN (14 day) This regimen may require funding Regimen • Colorectal Cancer–Cetuximab-Irinotecan (14 day) Indication • Metastatic colorectal cancer that is positive for the wild type KRAS genotype and that has progressed after failure of oxaliplatin and irinotecan based therapy. • WHO performance status 0, 1 Toxicity Drug Cetuximab Irinotecan Adverse Effect Infusion related reactions, interstitial lung disease, skin reactions, electrolyte abnormalities, fatigue, abdominal pain, constipation Acute cholinergic syndrome, diarrhoea (may be delayed) The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • Prior to starting therapy confirm a positive wild type KRAS status • FBC, LFT’s and U&E’s prior to day one of treatment • Monitor for hypersensitivity reactions for 60 minutes after the end of the cetuximab infusion Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be reescalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.3 (October 2020) Page 1 of 7 Colorectal – Cetuximab-Irinotecan (14 day) Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Prior to prescribing on day one of cycle one the following criteria must be met; Criteria Neutrophil Platelets Eligible Level equal to or more than 1.5x109/L equal to or more than 100x109/L Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL If the neutrophils are less than 1.5x109/L and/or the platelets are less than 100x109/L then delay treatment for seven days If the counts recover at this time restart the irinotecan at 80% of the original dose. If a fourteen day delay is required to allow counts to recover or there are two separate delays of seven days during treatment consider reducing the dose of irinotecan to 50% of the original dose or stopping treatment. This is one of the few regimens where asymptomatic low nadir neutrophil counts are an indication for dose modification. Where this figure is less than 0.5x109/L or where there has been an episode of febrile neutropenia the subsequent irinotecan dose should be reduced to 80% of the original dose. There is little need to adjust the dose of cetuximab for haematological toxicity. Hepatic / Renal Impairment Deteriorating liver or kidney function may be a sign of disease progression or drug toxicity. Drug Cetuximab Irinotecan Hepatic Renal Administer only when the Administer only where the serum transaminases are 5xULN or creatinine is 1.5xULN or below below and the bilirubin is 1.5xULN or below For the 350mg/m2 dose if the No adjustments are necessary bilirubin is 26 to 51umol/L although there is limited inclusive prescribe 200mg/m2. If information the bilirubin is above 51umol/L consider stopping therapy. Other Cetuximab Allergic or hypersensitivity reactions have occurred during the administration of cetuximab. For a NCI-CTC grade 1 reactions reduce the infusion rate by 50% (the total should not exceed 240 minutes). For a NCI-CTC grade 2 reaction, stop the infusion and administer supportive therapies as indicated. Once the reaction has Version 1.3 (October 2020) Page 2 of 7 Colorectal – Cetuximab-Irinotecan (14 day) resolved to NCI-CTC grade 1 or below then resume the infusion at 50% of the previous rate. For a NCI-CTC grade 3 or 4 toxicity stop the infusion immediately and disconnect the tubing from the patient. Administer appropriate supportive therapies. Once recovered, patients should not receive cetuximab again. Once the rate has been reduced it should not be increased on subsequent infusions. If a second reaction occurs on the slower infusion rate the infusion should be stopped and no further treatment given. An acniform skin rash occurs in over 70% of those receiving cetuximab. The onset is normally within three weeks of starting therapy and often resolves after week twelve. For a NCI-CTC grade 1-2 reaction use symptomatic treatments such as topical or oral antibiotics and continue with the cetuximab. For a NCI-CTC grade 3 toxicity delay treatment until the toxicity resolves to NCI-CTC grade 2 or below. If this occurs within fourteen days resume cetuximab at the same dose. If more than fourteen days is required stop treatment. If the NCI-CTC grade 3 toxicity occurs for a second and third time the cetuximab may again be delayed for up to and including fourteen days with concomitant dose reductions. Cetuximab dose reductions are permanent. The cetuximab must be discontinued if more than two consecutive infusions are withheld or a fourth episode of NCI-CTC grade 3 skin toxicity develops or a NCI-CTC grade 4 toxicity at any time. UV radiation may worsen skin reactions. Sun safety practices should be followed during and for up to two months after the end of treatment. Stop treatment if there is a confirmed pneumonitis. Irinotecan Irinotecan is associated with a number of toxic reactions. The next cycle of treatment should not be administered until all toxicities have resolved to 0 or 1 of the National Cancer Institute Common Toxicity Criteria scale (NCI-CTC) within fourteen days. Diarrhoea must have resolved completely. Where a NCI-CTC grade 2 to 4 nonhaematological event has occurred the irinotecan dose must be reduced to 200mg/m2 in the first instance. If a second episode occurs despite this dose reduction delay until the symptoms have resolved and re-start the irinotecan at 150mg/m2. Stop treatment for a third episode. Regimen 14 day cycle for 6 cycles Drug Cetuximab Irinotecan Dose 500mg/m2 250mg/m2 Days 1 1 Route Intravenous infusion over 120 minutes (see administration) Intravenous infusion in 250ml sodium chloride 0.9% over 90 minutes Version 1.3 (October 2020) Page 3 of 7 Colorectal – Cetuximab-Irinotecan (14 day) Dose Information • Cetuximab will be dose banded in accordance with the national dose bands (5mg/ml) • Irinotecan will be dose banded in accordance with the national dose bands (20mg/ml) • The maximum daily dose of irinotecan is 700mg Administration Information Extravasation • Cetuximab – neutral • Irinotecan – irritant Other • Individuals should be monitored for hypersensitivity for sixty minutes after finishing the cetuximab infusion. Do not administer other chemotherapy during this period. • The rate of administration of cetuximab must not exceed 10mg/min. The first infusion is given over 120 minutes. If this infusion rate is well tolerated subsequent infusions may be given over 60 minutes • Irinotecan may be administered over 30-90 minutes Additional Therapy • 30 minutes prior to cetuximab infusion; - chlorphenamine 10mg intravenous - dexamethasone 8mg oral or intravenous - H2 antagonist according to local formulary choice and availability - paracetamol 1000mg oral • Antiemetics 15-30 minutes prior to chemotherapy on day one only - ondansetron 8mg oral or intravenous As take home medication - dexamethasone 4mg twice a day for 3 days oral - metoclopramide 10mg three times a day when required oral • Subcutaneous atropine 250microgram immediately prior to irinotecan for the prevention of acute cholinergic syndrome. A further 250microgram subcutaneous dose may be given to relieve cholinergic symptoms if they Version 1.3 (October 2020) Page 4 of 7 Colorectal – Cetuximab-Irinotecan (14 day) develop. • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed • Oral loperamide 2mg every two hours once first liquid stool appears and continue until 12 hours after the last liquid stool. Do not use for longer than 48 hours (maximum daily dose is 16mg). Please refer to the CSCCN guidelines on treatment of irinotecan related diarrhoea • Consider oral ciprofloxacin 500mg twice daily where diarrhoea continues for more than 24 hours. Review the patient before starting this treatment. Please refer to the CSCCN guidelines on treatment of irinotecan related diarrhoea References 1. Cunningham D, Humblett Y, Sienna S et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337-335. 2. Wilke H et al. Cetuximab plus irinotecan in heavily pre-treated metastatic colorectal cancer progressing on irinotecan. The MABEL study. JCO 2008; 26 (33): 5335-5343. Version 1.3 (October 2020) Page 5 of 7 Colorectal – Cetuximab-Irinotecan (14 day) REGIMEN SUMMARY Cetuximab-Irinotecan (14 day) Day One 1. Chlorphenamine 10mg intravenous 2. Dexamethasone 8mg oral or intravenous 3. Paracetamol 1000mg oral Administration Instructions Please check if the patient has taken paracetamol. The maximum dose is 4000mg in every 24 hours 4. H2 antagonist according to local formulary choice and availability Administration Instructions: Administer according to local formulary choice and availability one of the following 30 minutes prior to chemotherapy; - Ranitidine 50mg intravenous once only - Famotidine 20mg oral once only - Nizatidine 150mg oral once only - Ranitidine 150mg oral once only If there is no stock of these products due to national shortages treatment may proceed without the H2 antagonist provided there is no instruction in the ARIA journal indication the patient must have H2 antagonist treatment. All infusion related reactions must be recorded in the ARIA journal and reported to the appropriate consultant. Many Trusts do not administer an H2 antagonist from cycle three onwards. They have been left in the ARIA protocols so that decisions can be made on an individual Trust and patient basis. 5. Ondansetron 8mg oral or intravenous 6. Cetuximab 500mg/m2 over 120 minutes intravenous infusion An interval of 60 minutes should be left between administration of cetuximab and the irinotecan 7. Atropine 250microgram subcutaneous for the prevention of irinotecan associated cholinergic symptoms 8. Irinotecan 250mg/m2 intravenous infusion in 250ml sodium chloride 0.9% over 90 minutes 9. Atropine 250microgram subcutaneous when required for the treatment of irinotecan associated cholinergic symptoms Take Home Medicines 10. Dexamethasone 4mg twice a day for 3 days starting the day after chemotherapy oral 11. Metoclopramide 10mg three times a day when required for the relief of nausea oral Version 1.3 (October 2020) Page 6 of 7 Colorectal – Cetuximab-Irinotecan (14 day) DOCUMENT CONTROL Version Date Amendment Written By Approved By Update of premedication due to shortage of IV ranitidine. 1.3 October 2020 IV ranitidine changed to H2 antagonist according to local formulary choice and availability Arum Shortland Pharmacist Dr Debbie Wright Pharmacist Coding removed Dose banding updated Header changed Toxicities removed Bolus removed from intravenous bolus in supportive treatments Irinotecan administration 1.2 changed to 90 minutes May 2014 Metoclopramide dose changed to 10mg Dr Debbie Wright Pharmacist Donna Kimber Pharmacy Technician Atropine added as a standard treatment before irinotecan Coding updated Dexamethasone TTO clarified Disclaimer added 1.1 June 2012 Delivery code changed to X72.1 Dr Debbie Wright Pharmacist Liz Harrison Pharmacist 1 March 2012 None Dr Debbie Wright Pharmacist Dr Tim Iveson Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.3 (October 2020) Page 7 of 7 Colorectal – Cetuximab-Irinotecan (14 day)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Cetuximab-Irinotecan14day.pdf

Cetuximab (7 day)

Description
Chemotherapy Protocol COLORECTAL CANCER CETUXIMAB (7 day) This regimen may require funding Regimen • Colorectal Cancer – Cetuximab (7 day) Indication • Metastatic colorectal cancer positive for the wild type KRAS genotype and that has progressed after failure of oxaliplatin and irinotecan based therapy or who are intolerant to these agents. • WHO performance status 0, 1, 2 Toxicity Drug Cetuximab Adverse Effect Infusion related reactions, interstitial lung disease, skin reactions, electrolyte abnormalities, fatigue, abdominal pain, constipation The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • Prior to starting therapy confirm a positive wild type KRAS status • FBC, LFT’s and U&E’s prior to day one of cycle one of treatment and every 6 – 8 weeks thereafter • Monitor for hypersensitivity reactions for 60 minutes after the end of the cetuximab infusion Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be reescalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.2 (October 2020) Page 1 of 7 Colorectal – Cetuximab (7 day) Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematological Prior to prescribing on day one of cycle one the following criteria must be met; Criteria Neutrophil Platelets Eligible Level equal to or more than 1.5x109/L equal to or more than 100x109/L Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL For haematological toxicity, if the neutrophil count is less than 1.5 109/L or the platelet count less than 100 109/L, delay treatment until these levels are achieved. The decision to continue treatment should be made at the consultant’s discretion. Hepatic / Renal Impairment Drug Cetuximab Hepatic Administer only when the transaminases are 5xULN or below and the bilirubin is 1.5xULN or below Renal Administer only where the serum creatinine is 1.5xULN or below Other Cetuximab Allergic or hypersensitivity reactions have occurred during the administration of cetuximab. For a NCI-CTC grade 1 reaction reduce the infusion rate by 50% (the total should not exceed 240 minutes). For a NCI-CTC grade 2 reaction, stop the infusion and administer supportive therapies as indicated. Once the reaction has resolved to NCI-CTC grade 1 or below resume the infusion at 50% of the previous rate. For a NCI-CTC grade 3 or 4 toxicity stop the infusion immediately and disconnect the tubing from the patient. Administer appropriate supportive therapies. Once recovered, patients should not receive cetuximab again. Once the rate has been reduced it should not be increased on subsequent infusions. If a second reaction occurs on the slower infusion rate the infusion should be stopped and no further treatment given. An acniform skin rash occurs in over 70% of those receiving cetuximab. The onset is normally within three weeks of starting therapy and often resolves after week twelve. For a NCI-CTC grade 1-2 reaction use symptomatic treatments such as topical or oral antibiotics and continue with the cetuximab. For a NCI-CTC grade 3 toxicity delay treatment until the toxicity resolves to NCI-CTC grade 2 or below. If this occurs within fourteen days resume cetuximab at the same dose. If more than fourteen days is required stop treatment. If the NCI-CTC grade 3 toxicity occurs for a second and third time the cetuximab may again be delayed for up to and including fourteen days Version 1.2 (October 2020) Page 2 of 7 Colorectal – Cetuximab (7 day) with concomitant dose reductions to 200mg/m2 and 150mg/m2 respectively. Cetuximab dose reductions are permanent. The cetuximab must be discontinued if more than two consecutive infusions are withheld or a fourth episode of a NCI-CTC grade 3 skin toxicity develops or a NCI-CTC grade 4 toxicity at any time. UV radiation may worsen skin reactions. Sun safety practices should be followed during and for up to two months after the end of treatment. Stop treatment if there is a confirmed pneumonitis. Regimen 7 day cycle until intolerance or disease progression develops (12 cycles will be set in Aria) Cycle One Drug Cetuximab Dose 400mg/m2 Days 1 Route Intravenous infusion over 120 minutes Cycle Two Onwards Drug Cetuximab Dose 250mg/m2 Days 1 Route Intravenous infusion over 60 minutes Dose Information • Cetuximab will be dose banded in accordance with the national dose bands (5mg/m) Administration Information Extravasation • Cetuximab - neutral Other • Individuals should be monitored for hypersensitivity for sixty minutes after finishing the cetuximab infusion. Do not administer other chemotherapy during this period. • The rate of administration of cetuximab must not exceed 10mg/min. The first infusion is given over 120 minutes. If this infusion rate is well tolerated subsequent infusions may be given over 60 minutes Additional Therapy • 30 minutes prior to cetuximab infusion; - chlorphenamine 10mg intravenous Version 1.2 (October 2020) Page 3 of 7 Colorectal – Cetuximab (7 day) - dexamethasone 8mg oral or intravenous - H2 antagonist according to local formulary choice and availability - paracetamol 1000mg oral • Antiemetics As take home medication - metoclopramide 10mg three times a day when required oral (supply day one cycle one only and then as required) • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed References 1. Cunningham D, Humblett Y, Sienna S et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan refractory metastatic colorectal cancer. N Engl J Med 2004; 351: 337-335. Version 1.2 (October 2020) Page 4 of 7 Colorectal – Cetuximab (7 day) REGIMEN SUMMARY Cetuximab (7 day) Day One Cycle One 1. Chlorpheniramine 10mg intravenous 2. Dexamethasone 8mg oral or intravenous 3. Paracetamol 1000mg oral Administration Instructions Please check if the patient has taken paracetamol. The maximum dose is 4000mg in every 24 hours 4. H2 antagonist according to local formulary choice and availability Administration Instructions: Administer according to local formulary choice and availability one of the following 30 minutes prior to chemotherapy; - Ranitidine 50mg intravenous once only - Famotidine 20mg oral once only - Nizatidine 150mg oral once only - Ranitidine 150mg oral once only If there is no stock of these products due to national shortages treatment may proceed without the H2 antagonist provided there is no instruction in the ARIA journal indication the patient must have H2 antagonist treatment. All infusion related reactions must be recorded in the ARIA journal and reported to the appropriate consultant. Many Trusts do not administer an H2 antagonist from cycle three onwards. They have been left in the ARIA protocols so that decisions can be made on an individual Trust and patient basis. 5. Cetuximab 400mg/m2 over 120 minutes intravenous infusion 6. Metoclopramide 10mg three times a day when required for the relief of nausea oral* Cycle Two Onwards 1. Chlorpheniramine 10mg intravenous 2. Dexamethasone 8mg oral or intravenous 3. Paracetamol 1000mg oral Administration Instructions Please check if the patient has taken paracetamol. The maximum dose is 4000mg in every 24 hours 4. H2 antagonist according to local formulary choice and availability Administration Instructions: Administer according to local formulary choice and availability one of the following 30 minutes prior to chemotherapy; - Ranitidine 50mg intravenous once only - Famotidine 20mg oral once only - Nizatidine 150mg oral once only - Ranitidine 150mg oral once only If there is no stock of these products due to national shortages treatment may proceed without the H2 antagonist provided there is no instruction in the ARIA journal indication the patient must have H2 antagonist treatment. All infusion related reactions must be recorded in the ARIA journal and reported to the appropriate consultant. Many Trusts do not administer an H2 antagonist from cycle three onwards. They have been left in the ARIA protocols so that decisions can be made on an individual Trust and patient basis. Version 1.2 (October 2020) Page 5 of 7 Colorectal – Cetuximab (7 day) 5. Cetuximab 250mg/m2 over 60 minutes intravenous infusion *The metoclopramide will only appear on day one cycle one. If further supplies are required they should be added from the support directory of Aria as necessary. Version 1.2 (October 2020) Page 6 of 7 Colorectal – Cetuximab (7 day) DOCUMENT CONTROL Version Date Amendment Written By Approved By Update of premedication due to shortage of IV ranitidine. 1.2 October 2020 IV ranitidine changed to H2 antagonist according to local formulary choice and availability Arum Shortland Pharmacist Dr Debbie Wright Pharmacist Coding removed Dose banding updated Header changed Toxicity removed 1.1 May 2014 Bolus removed from supportive therapies Dr Debbie Wright Pharmacist Donna Kimber Pharmacy Technician Metoclopramide dose changed Disclaimer added 1 Feb 2012 None Dr Debbie Wright Pharmacist Dr Tim Iveson Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospital NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.2 (October 2020) Page 7 of 7 Colorectal – Cetuximab (7 day)
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Cetuximab7day.pdf

Meningitis trial_frequently asked questions

Description
F.A.Q.: Human nasopharyngeal colonization using a genetically modified strain of the bacteria, Neisseria lactamica This document contains informatio
Url
/Media/Southampton-Clinical-Research/Researchtrials/Meningitis-trial-frequently-asked-questions.pdf

Cetuximab-Encorafenib

Description
Chemotherapy Protocol COLORECTAL CANCER CETUXIMAB-ENCORAFENIB Regimen • Colorectal Cancer – Cetuxim
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Colorectal/Cetuximab-Encorafenib.pdf
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