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Echogenic lung lesion - patient information

Description
This factsheet explains what an echogenic lung lesion (ELL) is, the possible causes and what this means for you and your baby.
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/Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Echogenic-lung-lesion-3592-PIL.pdf

Having a DXA scan - patient information

Description
This factsheet explains what a DXA scan is, what the scan involves and how to prepare for your appointment.
Url
/Media/UHS-website-2019/Patientinformation/Scansandx-rays/Having-a-DXA-scan-3198-PIL.pdf

Making your advance care plan (BMT and cellular therapy) - patient information

Description
This booklet is about how to make an advance care plan. An advance care plan is a record of your thoughts and wishes about your medical treatment and care in the future.
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/Media/UHS-website-2019/Patientinformation/Cancercare/Making-your-advance-care-plan-BMT-and-cellular-therapy-3623-PIL.pdf

Welcome to the TAVI clinic - patient information

Description
Information about transcatheter aortic valve implantation (TAVI) - a procedure to replace a faulty aortic (heart) valve via a thin plastic tube.
Url
/Media/UHS-website-2019/Patientinformation/Cardiovascular-and-thoracic/Welcome-to-the-TAVI-clinic-3352-PIL.pdf

First seizure - patient information

Description
This leaflet contains important information about having a seizure for the first time.
Url
/Media/UHS-website-2019/Patientinformation/Brain-and-spine/First-seizure-1641-PIL.pdf

Radioactive seed implants for prostate cancer low dose rate brachytherapy - patient information

Description
Radioactive seed implants (low dose rate brachytherapy) are a way of using radiotherapy to treat prostate cancer that is contained within the prostate gland.
Url
/Media/UHS-website-2019/Patientinformation/Cancercare/Radioactive-seed-implants-for-prostate-cancer-low-dose-rate-brachytherapy-954-PIL.pdf

Carboplatin-Vinorelbine Oral

Description
Chemotherapy Protocol LUNG CANCER – NON-SMALL CELL (NSCLC) CARBOPLATIN (AUC6)-VINORELBINE (Oral) Regimen  NSCLC – Carboplatin (AUC6)-Vinorelbine (Oral) Indication  First line therapy of stage III or IV NSCLC  WHO Performance status 0, 1, 2  Palliative intent Toxicity Drug Carboplatin Vinorelbine Adverse Effect Neuropathy, thrombocytopenia Neuropathy, stomatitis, transient elevation of LFTs, pain, constipation The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Disease  A baseline chest x-ray should be performed before starting treatment and up to date (ideally within 1 month) cross section imaging should also be performed Regimen  EDTA or calculated creatinine clearance before the first cycle  FBC, LFTs and U&Es prior to each cycle  A chest x-ray should be performed before each cycle 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 1.3 (May 2023) Page 1 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO 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. Haematology Prior to prescribing cycle one the following treatment criteria must be met; Criteria Neutrophil Platelets Eligible Level Greater than or equal to 1.5x109/L (unless due to bone marrow impairment) Greater than or equal to 100x109/L (unless due to bone marrow impairment 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, then in the first instance delay treatment for 7 days. If counts recover at this point continue at the initial dose. If counts remain low continue with treatment using a 20% dose reduction. If the myelosuppression recurs despite this dose reduction stop treatment. If the platelets are less than 100x109/L, then in the first instance delay treatment for 7 days. If the counts recover at this point continue at the initial dose. If the counts still fall within this range continue using a 20% dose reduction. If the platelet level falls below 50x109/L reduce the dose by 50%. Dose adjustments for day eight should be made according to local practice guidelines or procedures. Hepatic Impairment Drug Carboplatin Vinorelbine Recommendation No dose reduction necessary For the intravenous preparation consider a dose reduction to 20mg/m2 in severe liver impairment For the oral preparation consider a dose of 50mg/m2/week in moderate liver impairment Version 1.3 (May 2023) Page 2 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO Renal Impairment Drug Carboplatin Vinorelbine Dose (% of original dose) Significant changes in GFR (of more than 10%) may require dose adjustment Do not administer if the CrCl is less than 20ml/min No dose adjustment is necessary Regimen The starting dose of carboplatin AUC6 is used with calculated GFR. AUC5 may be considered with EDTA clearance, seek advice from the appropriate consultant before prescribing. The recommended maximum dose when using a calculated creatinine clearance at AUC6 is 900mg. This will be set as 890mg in ARIA to comply with national dose bands. If you have an obese patient or an individual with a calculated creatinine clearance above 125ml/min please seek advice from the relevant consultant. It should be noted that the dose of carboplatin may need to be altered if there is a change (improvement or reduction) in renal function of more than 10% from the previous cycle. The maximum dose of oral vinorelbine is 120mg for the 60mg/m2 dose and 160mg for the 80mg/m2 dose. The capsules are available in 20mg and 30mg strengths. It must be clear to all professionals and patients taking this treatment that it is a short term therapy that must not be supplied from primary care. 21 day cycle for 4 cycles Drug Dose Days Administration Carboplatin Vinorelbine AUC6 60mg/m2 (max dose 120mg) 1 Intravenous infusion in 500ml glucose 5% over 60 minutes 1, 8 Oral From cycle two onwards consider increasing the dose of vinorelbine (oral) to 80mg/m2 (maximum dose 160mg). Dose Information  Carboplatin will be dose banded in accordance with national dose bands (10mg/ml)  The maximum dose will be set at 890mg to comply with national dose bands  Vinorelbine (oral) will be rounded to the nearest 20mg (up if halfway) Version 1.3 (May 2023) Page 3 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO Administration Information Extravasation  Carboplatin – irritant Other  Oral vinorelbine capsules must be swallowed whole with food without chewing, sucking or dissolving the capsule. Additional Therapy  Antiemetics 15-30 minutes prior to chemotherapy on day one only; - ondansetron 8mg oral or intravenous - dexamethasone 8mg oral or intravenous As take home medication; - dexamethasone 4mg twice a day oral for 3 days - metoclopramide 10mg three times a day when required 15 – 30 minutes prior to chemotherapy on day eight only; - metoclopramide 10mg oral  Gastric protection with PPI or H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed  Prophylactic antibiotics can be considered if required Additional Information  The National Patient Safety Alert on oral chemotherapy (NPSA/2008/RRR001) must be followed in relation to vinorelbine. References 1.National Institute of Clinical Excellence (2005). CG24. The Diagnosis and Treatment of Lung Cancer. Methods, Evidence and Guidance. DOH: London. 2.Schiller JH, Harrington D, Belani CP et al. Comparison of four chemotherapy regimens for advanced non-small cell lung cancer. N Engl J Med 2002; 346 (2): 92-98. 3.Helbekkmo N, Sundstrom SH, Aasebo U et al. Vinorelbine/carboplatin vs gemcitabine/carboplatin in advanced NSCLC, similar efficacy but different impact on toxicity. Br J Cancer 2007; 97 (3): 283-289. 4.Jensen LH, Osterlind K, Rytter C et al. Randomised cross over study of patient preference for oral or intravenous vinorelbine in combination with carboplatinin the treatment of advanced non-small cell lung cancer. Lung Cancer 2008; 62 (1): 85-91. Version 1.3 (May 2023) Page 4 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO REGIMEN SUMMARY Carboplatin (AUC6)-Vinorelbine PO Day One 1. Dexamethasone 8mg oral or intravenous Administration Instructions Administer 15-30 minutes prior to SACT. Administer dexamethasone 8mg intravenous or equivalent if required 2. Ondansetron 8mg oral or intravenous Administration Instructions Administer 15-30 minutes prior to SACT. Administer ondansetron 8mg intravenous if required 2. Carboplatin AUC6 intravenous infusion in 500ml glucose 5% over 60 minutes Administration instructions: The dose of carboplatin is capped at a creatinine clearance of 125ml/min. The internationally recommended maximum dose of carboplatin for AUC 6 is 900mg. The national dose bands do not contain this dose so the cap has been set at 890mg in ARIA. Please check this dose is appropriate for your patient. 4. Vinorelbine 60mg/m2 oral Administration instructions: Vinorelbine capsules should be taken with or after food, swallowed whole, not chewed. Oral SACT Take Home Medicines 5. Dexamethasone 4mg twice a day oral for 3 days starting on day two of the cycle Administration Instructions Take 4mg twice a day for 3 days starting on day 2 of the cycle 6. Metoclopramide 10mg three times a day when required oral Administration Instructions When required for the relief of nausea. Please supply five days or an original pack as appropriate. Day Eight 8. Metoclopramide 10mg oral Administration Instructions Administer 15-30 minutes before oral SACT 9. Vinorelbine 60mg/m2 oral Administration instructions: Vinorelbine capsules should be taken with or after food, swallowed whole, not chewed. Oral SACT Version 1.3 (May 2023) Page 5 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO DOCUMENT CONTROL Version Date Amendment Written By Approved By 1.3 May 2023 Carboplatin changed to national Alexandra Pritchard Tom Hurst dose bands Pharmacist Pharmacy Technician Administration instructions added to regimen summary Coding removed Maximum dose of carboplatin amended. 1.2 9th Jan Header changed to NHS badge Dr Deborah Wright Donna Kimber 2014 AUC6 added to name and “and” Pharmacist Pharmacy Technician replaced with dash Adverse effects put in table and toxicity removed > and < written in full Dose modification tabulated Renal and hepatic function tabulated. Vinorelbine information updated from SPC Carboplatin paragraph amended under regimen Regimen tabulated Twice daily now twice a day Bolus removed from injection Regimen name added to summary Summary re-numbered Metoclopramide dose changed to 10mg Starting on day two of the cycle added to dexamethasone Document control tabulated Hospital representation and disclaimer added 1.1 23rd Sept Font changed to Arial Dr Deborah Wright Donna Kimber 2010 Header altered to include Pharmacist Pharmacy Technician “Strength through Partnership” Drug names given capitals in regimen Extravasation moved to under Administration Information Footer changed to include regimen name and review date removed Standard paragraph added to introduction in dose modifications Dose modifications format (not Version 1.3 (May 2023) Page 6 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO information) changed Dose information added to reflect super user agreements Granisetron removed from antiemetics Coding added Summary page added 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 Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS 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 (May 2023) Page 7 of 7 NSCLC – Carboplatin (AUC 6)-Vinorelbine PO
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lung-cancer-non-small-cellNSCLC/Carboplatin-Vinorelbine-Oral.pdf

Carboplatin(AUC6)-Pemetrexed

Description
Chemotherapy Protocol MESOTHELIOMA CARBOPLATIN (AUC6)-PEMETREXED Regimen • Mesothelioma – Carboplatin (AUC6)-Pemetrexed Indication • First line therapy of advanced pleural mesothelioma where the disease is not suitable for surgical resection • WHO Performance status 0, 1 • Palliative intent Toxicity Drug Carboplatin Adverse Effect Neuropathy, thrombocytopenia Pemetrexed Diarrhoea, skin reactions, neuropathy The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Disease • A baseline chest x-ray should be performed before starting treatment and up to date (ideally within 1 month) cross section imaging should also be performed Regimen • FBC, LFTs and U&Es before each cycle • A chest x-ray should be performed before each cycle 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 Version 1.5 (Feb 2023) Page 1 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed 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. Haematology Prior to prescribing cycle one the following treatment criteria must be met; Criteria Neutrophil Platelets Eligible Level Greater than or equal to 1.5x109/L (unless due to bone marrow impairment) Greater than or equal to 100x109/L (unless due to bone marrow impairment Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL Subsequently if the neutrophils are less than 1.5 x109/L then in the first instance delay treatment for 7 days. If counts recover at this point continue at the initial dose. If counts remain low continue with treatment using a 20% dose reduction. If the myelosuppression recurs despite this dose reduction stop treatment. If the platelets are less than 100x109/L then in the first instance delay treatment for 7 days. If the counts recover at this point continue at the initial dose. If the counts still fall within this range continue using a 20% dose reduction. If the platelet level falls below 50x109/L reduce the dose by 50%. Hepatic Impairment Drug Carboplatin Pemetrexed Recommendation No dose reduction necessary Clinical decision Renal Impairment Drug Carboplatin Pemetrexed Dose (% of original dose) Significant changes in GFR (of more than 10%) may require dose adjustment Do not administer if the CrCl is less than 20ml/min If the creatinine clearance falls below 45ml/min consider dose reduction Version 1.5 (Feb 2023) Page 2 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed Regimen The starting dose of carboplatin AUC 6 is used with calculated GFR. AUC 5 may be considered with EDTA clearance, seek advice from the appropriate consultant before prescribing. The recommended maximum dose when using a calculated creatinine clearance at AUC5 is 900mg (creatinine clearance 125ml/min). This is not a dose included in the national dose banding table. The maximum dose has been set at 890mg in ARIA. Please check if this dose is appropriate. If you have an obese patient or an individual with a calculated creatinine clearance above 125ml/min please seek advice from the relevant consultant. It should be noted that the dose of carboplatin may need to be altered if there is a change (improvement or reduction) in renal function of more than 10% from the previous cycle 21 day cycle for 3-6 cycles (6 cycles are set in Aria) Drug Dose Days Administration Carboplatin Pemetrexed AUC6 (max 890mg dose) 500mg/m2 1 Intravenous infusion in 500ml glucose 5% over 60 minutes Intravenous infusion in 100ml 1 glucose 5% or sodium chloride 0.9% over 10 minutes Dose Information • Carboplatin will be dose banded in accordance with the national dose bands (10mg/ml) • The maximum dose of carboplatin for AUC 6 is 900mg. This will be set as 890mg in ARIA to comply with national dose bands. • It should be noted that the dose of carboplatin may need to be altered if there is a change (improvement or reduction) in renal function of more than 10% from the previous cycle. • Pemetrexed will be dose banded in accordance with the national dose bands Administration Information • Carboplatin should be administered 30 minutes after the end of the pemetrexed infusion • Pemtrexed may be administered in 100ml of either glucose 5% or sodium chloride 0.9% over 10 minutes. The choice of fluid will be dependent on the product stocked by pharmacy. The fluid and volume will not appear in the prescription but can be located in the instructions notepad Version 1.5 (Feb 2023) Page 3 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed Extravasation • Carboplatin – irritant • Pemetrexed - inflammitant Additional Therapy • Folic acid 5mg once daily starting 1 – 2 weeks prior to and continuing for three weeks after the last dose of pemetrexed. • Hydroxocobalamin intramuscular injection 1mg every three months starting 1 – 2 weeks prior to pemetrexed. • Antiemetics 15-30 minutes prior to chemotherapy; - ondansetron 8mg oral or intravenous bolus Ensure the patient has taken oral dexamethasone starting the day before pemetrexed. On the occasions where individuals attend for treatment and have forgotten to take the dexamethasone pre-medication administer an intravenous bolus dose of dexamethasone 20mg. As take home medication; - dexamethasone 4mg twice a day oral for 3 days starting the day before chemotherapy is due. - metoclopramide 10mg three times a day when required • Gastric protection with a proton pump inhibitor or H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed • Prophylactic antibiotics can be considered if required Additional Information • Consider draining pleural or peritoneal effusions prior to pemetrexed administration References 1.National Institute of Clinical Excellence (2009). TA135 Pemetrexed for the treatment of mesothelioma. London: DOH. 2.Santoro A, O’Brien ME, Stahel RA et al. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemonaive patients with malignant pleural mesothelioma: results of the International Expanded Access Programme. J Thorac Oncol 2008; 3 (7): 756 – 763. Version 1.5 (Feb 2023) Page 4 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed REGIMEN SUMMARY Carboplatin (AUC6)-Pemetrexed Cycle 1, 2, 3, 4, 5 Day Minus One 1. Dexamethasone 4mg twice a day oral* Day One 2. Dexamethsone 4mg twice a day oral (from TTO)* 3. Ondansetron 8mg oral or intravenous bolus Administration Instructions Administer 15-30 minutes prior to SACT. This may be given as ondansetron 8mg IV stat if required. 4. Pemetrexed 500mg/m2 intravenous infusion in 100ml glucose 5% or sodium chloride 0.9% over 10 minutes 5. Carboplatin AUC6 intravenous infusion in 500ml glucose 5% over 60 minutes (start 30 minutes after the end of the pemetrexed infusion) Administration Instructions Start 30 minutes after the end of the pemetrexed infusion The dose of carboplatin is capped at a creatinine clearance of 125ml/min. The internationally recommended maximum dose of carboplatin for AUC 6 is 900mg. The national dose bands do not contain this dose so the cap has been set at 890mg in ARIA. Please check this dose is appropriate for your patient. Take Home Medicines 6. Dexamethasone 4mg twice a day oral for 3 days starting the day before the pemetrexed infusion* 7. Metoclopramide 10mg three times a day when required oral Administration Instructions When required for the relief of nausea. Please supply five days or an original pack as appropriate 8. Folic acid 5mg once daily oral Cycle 6 Day Minus One 9. Dexamethasone 4mg twice a day oral* Day One 10. Dexamethsone 4mg twice a day oral (from TTO)* 11. Ondansetron 8mg oral or intravenous bolus Administration Instructions Administer 15-30 minutes prior to SACT. This may be given as ondansetron 8mg IV stat if required Version 1.5 (Feb 2023) Page 5 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed 12. Pemetrexed 500mg/m2 intravenous infusion in 100ml glucose 5% or sodium chloride 0.9% over 10 minutes 13. Carboplatin AUC6 intravenous infusion in 500ml glucose 5% over 60 minutes (start 30 minutes after the end of the pemetrexed infusion) Administration Instructions Start 30 minutes after the end of the pemetrexed infusion The maximum dose of carboplatin at AUC 6 is 900mg (creatinine clearance 125ml/min). This has been set at 890mg in ARIA to comply with national dose bands Take Home Medicines 14. Metoclopramide 10mg three times a day when required oral Administration Instructions When required for the relief of nausea. Please supply five days or an original pack as appropriate 15. Folic acid 5mg once daily oral Hydroxocobalamin will not be included as part of the Aria regime and must be prescribed separately on the cycle for which it is due. * In Aria Planner the dexamethasone 4mg twice daily will appear on days 1, 2, 3 of treatment. This is the supply for the next cycle. The patient should have been given the supply for cycle one in the pre-assessment or consent clinic. The administration instructions reflect this. Version 1.5 (Feb 2023) Page 6 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed DOCUMENT CONTROL Version Date Amendment Written By Approved By 1.5 Feb 2023 Max carboplatin dose added to Alexandra Pritchard Tom Hurst regimen table Pharmacist Pharmacy Technician 1.4 Aug 2022 Carboplatin national dose bands Dr Deborah Wright Donna Kimber added Pharmacist Pharmacy Technician 1.3 Jan 2016 Pemetrexed administration Dr Deborah Wright Donna Kimber changed throughout the text Pharmacist Pharmacy Technician 1.2 Header changed to NHS badge Dr Deborah Wright Debra Robertson AUC6 added to name and “and” Pharmacist Pharmacist replaced with dash Adverse effects put in table and toxicity removed Dose modification tabulated Renal and hepatic function tabulated Carboplatin paragraph amended under regimen Clarification added on the number of cycles set in Aria Regimen tabulated Twice daily changed to twice a day Regimen name added to summary Summary re-numbered Metoclopramide dose changed to 10mg Cycle 6 added with dexamethasone pre-medication removed Document control tabulated Hospital representation and disclaimer added 1.1 Sept 2010 Font changed to Arial Dr Deborah Wright Donna Kimber Header altered to include Pharmacist Pharmacy Technician “Strength through Partnership” Drug names given capitals in regimen Extravasation moved to under Administration Information Administration Information added Footer changed to include regimen name and review date removed Standard paragraph added to Version 1.5 (Feb 2023) Page 7 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed introduction in dose modifications Dose modifications format (not information changed) Dose information added to reflect super user agreements Granisetron removed from antiemetics Coding added Summary page added Document control added 1 Jan 2010 None Dr Deborah Wright Dr Andrew Bates Pharmacist Consultant Clinical Oncologist Dr Tim Gulliford 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 Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS 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 1.5 (Feb 2023) Page 8 of 8 Mesothelioma – Carboplatin (AUC6)-Pemetrexed
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Mesothelioma/CarboplatinAUC6-Pemetrexed-Ver1.5.pdf

Carboplatin and Pemetrexed

Description
Chemotherapy Protocol LUNG CANCER – NON-SMALL CELL (NSCLC) CARBOPLATIN-PEMETREXED Regimen • NSCLC – Carboplatin-Pemetrexed Indication • First line therapy of stage IIIB or IV adenocarcinoma or large cell carcinoma of the lung • WHO Performance status 0, 1 • Palliative intent Toxicity Drug Carboplatin Adverse Effect Neuropathy, thrombocytopenia Pemetrexed Diarrhoea, skin reactions, neuropathy The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Disease • A baseline chest x-ray should be performed before starting treatment and up to date (ideally within 1 month) cross section imaging should also be performed Regimen • FBC, LFTs and U&Es before each cycle • A chest x-ray should be performed before each cycle 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 Version 1.4 (February 2023) Page 1 of 8 NSCLC – Carboplatin-Pemetrexed 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. Haematology Prior to prescribing cycle one the following treatment criteria must be met; Criteria Neutrophil Platelets Eligible Level Greater than or equal to 1.5x109/L (unless due to bone marrow impairment) Greater than or equal to 100x109/L (unless due to bone marrow impairment Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL Subsequently, if the neutrophils are less than 1.5x109/L in the first instance delay treatment for 7 days. If counts recover at this point continue at the initial dose. If counts still fall within this range continue using a 20% dose reduction. If the myelosuppression recurs despite this dose reduction then stop treatment. If the platelets are less than 100x109/L, in the first instance, delay treatment for 7 days. If the counts recover at this point continue at the initial dose. If the counts still fall within this range continue using a 20% dose reduction. If the platelet level falls below 50x109/L reduce the dose by 50%. Hepatic Impairment Drug Carboplatin Pemetrexed Recommendation No dose reduction necessary Clinical decision Renal Impairment Drug Carboplatin Pemetrexed Dose (% of original dose) Significant changes in GFR (of more than 10%) may require dose adjustment Do not administer if the CrCl is less than 20ml/min If the creatinine clearance falls below 45ml/min consider dose reduction Version 1.4 (February 2023) Page 2 of 8 NSCLC – Carboplatin-Pemetrexed Regimen The starting dose of carboplatin AUC6 is used with calculated GFR. AUC5 may be considered with EDTA clearance, seek advice from the appropriate consultant before prescribing. The recommended maximum dose when using a calculated creatinine clearance at AUC6 is 900mg. This will be set as 890mg in ARIA to comply with national dose bands. If you have an obese patient or an individual with a calculated creatinine clearance above 125ml/min please seek advice from the relevant consultant. It should be noted that the dose of carboplatin may need to be altered if there is a change (improvement or reduction) in renal function of more than 10% from the previous cycle. 21 day cycle for 4 cycles Drug Dose Days Administration Carboplatin Pemetrexed AUC6 500mg/m2 1 Intravenous infusion in 500ml glucose 5% over 60 minutes Intravenous infusion in 100ml 1 glucose 5% or sodium chloride 0.9% over 10 minutes Dose Information • Carboplatin will be dose banded according to the national dose band (10mg/ml) • The maximum dose will be set at 890mg to comply with national dose bands • Pemetrexed will be dose banded in accordance with the national dose bands Administration Information • Carboplatin should be administered 30 minutes after the end of the pemetrexed infusion • Pemtrexed may be administered in 100ml of either glucose 5% or sodium chloride 0.9% over 10 minutes. The choice of fluid will be dependant on the product stocked by pharmacy. The fluid and volume will not appear in the prescription but can be located in the instructions notepad. Extravasation • Carboplatin – irritant • Pemetrexed - inflammitant Additional Therapy Version 1.4 (February 2023) Page 3 of 8 NSCLC – Carboplatin-Pemetrexed • Folic acid 5mg once daily starting 1 – 2 weeks prior to and continuing for three weeks after the last dose of pemetrexed. • Hydroxocobalamin intramuscular injection 1mg every three months starting 1 – 2 weeks prior to pemetrexed. • Antiemetics 15-30 minutes prior to chemotherapy; - ondansetron 8mg oral or intravenous Ensure the patient has taken the oral dexamethasone starting the day before pemetrexed. On the occasions where individuals attend for treatment and have forgotten to take the dexamethasone pre-medication administer dexamethasone 20mg intravenous 15-30 minutes before chemotherapy. As take home medication; - dexamethasone 4mg twice a day oral for 3 days starting the day before chemotherapy is due. - metoclopramide 10mg three times a day when 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 • Prophylactic antibiotics can be considered if required Additional Information • Consideration should be given to draining pleural or peritoneal effusions prior to pemetrexed administration References 1.National Institute of Clinical Excellence (2009). TA181 Pemetrexed for the first line treatment of non-small cell lung cancer. London: DOH. 2.Gronberg BH, Bremnes RM, Flotten O et al. Phase III study by the Norwegian lung cancer study group: pemetrexed plus carboplatin compared with gemcitabine plus carboplatin as first line chemotherapy in advanced non-small cell lung cancer. J Clin Oncol 2009; 27 (19): 3217-3224. Version 1.4 (February 2023) Page 4 of 8 NSCLC – Carboplatin-Pemetrexed REGIMEN SUMMARY Carboplatin (AUC6)-Pemetrexed Cycle 1, 2, 3 Day Minus One 1. Dexamethasone 4mg twice a day oral* Day One 2. Dexamethsone 4mg twice a day oral (from TTO)* 3. Ondansetron 8mg oral or intravenous Administration Instructions Administer 15-30 minutes prior to SACT. Administer ondansetron 8mg intravenous if required 4. Pemetrexed 500mg/m2 intravenous infusion in 100ml glucose 5% or sodium chloride 0.9% over 10 minutes 5. Carboplatin AUC 6 intravenous infusion in 500ml glucose 5% over 60 minutes Administration Instructions Start 30 minutes after the end of the pemetrexed infusion. The dose of carboplatin is capped at a creatinine clearance of 125ml/min. The internationally recommended maximum dose of carboplatin for AUC 6 is 900mg. The national dose bands do not contain this dose so the cap has been set at 890mg in ARIA. Please check this dose is appropriate for your patient. Take Home Medicines 6. Dexamethasone 4mg twice a day oral for 3 days starting the day before the pemetrexed infusion* 7. Metoclopramide 10mg three times a day when required oral Administration Instructions Please supply 28 tablets or an original pack as appropriate 8. Folic acid 5mg once daily oral Cycle 4 Day Minus One 9. Dexamethasone 4mg twice a day oral* Day One 10. Dexamethsone 4mg twice a day oral (from TTO)* Version 1.4 (February 2023) Page 5 of 8 NSCLC – Carboplatin-Pemetrexed 11. Ondansetron 8mg oral or intravenous Administration Instructions Administer 15-30 minutes prior to SACT. Administer ondansetron 8mg intravenous if required 12. Pemetrexed 500mg/m2 intravenous infusion in 100ml glucose 5% or sodium chloride 0.9% over 10 minutes 13. Carboplatin AUC 6 intravenous infusion in 500ml glucose 5% over 60 minutes Administration Instructions Start 30 minutes after the end of the pemetrexed infusion. Take Home Medicines 14. Metoclopramide 10mg three times a day when required oral Administration Instructions Please supply 28 tablets or an original pack as appropriate 15. Folic acid 5mg once daily oral Hydroxocobalamin will not be included as part of the Aria regime and must be prescribed separately on the cycle for which it is due. * In Aria Planner the dexamethasone 4mg twice daily will appear on days 1, 2, 3 of treatment. This is the supply for the next cycle. The patient should have been given the supply for cycle one in the pre-assessment or consent clinic. The administration instructions reflect this. Version 1.4 (February 2023) Page 6 of 8 NSCLC – Carboplatin-Pemetrexed DOCUMENT CONTROL Version Date Amendment Written By Approved By 1.4 Feb 2023 National dose banding for Alexandra Pritchard Tom Hurst carboplatin added Pharmacist Pharmacy Technician Maximum dose of carboplatin amended as per national dose bands Administration instructions added Coding removed 1.3 9th Jan Diluent for pemetrexed changed Dr Deborah Wright Donna Kimber 2016 throughout the text Pharmacist Pharmacy Technician 1.2 9th Jan Header changed to NHS badge Dr Deborah Wright Donna Kimber 2014 AUC6 added to name and “and” Pharmacist Pharmacy Technician replaced with dash Adverse effects put in table and toxicity removed Dose modification tabulated Renal and hepatic function tabulated Carboplatin paragraph amended under regimen Start after pemetrexed removed from carboplatin in regimen table Regimen tabulated Twice daily now twice a day Bolus removed from injection Regimen name added to summary Metoclopramide dose changed to 10mg Cycle 4 added with dexamethasone pre-medication removed Summary re-numbered Document control tabulated Hospital representation and disclaimer added 1.1 23rd Sept Font changed to Arial Dr Deborah Wright Donna Kimber 2010 Header altered to include Pharmacist Pharmacy Technician “Strength through Partnership” Drug names given capitals in regimen Extravasation moved to under Administration Information Version 1.4 (February 2023) Page 7 of 8 NSCLC – Carboplatin-Pemetrexed Administration Information added Footer changed to include regimen name and review date removed Standard paragraph added to introduction in dose modifications Dose modifications format (not information) changed Dose information added to reflect super user agreements Granisetron removed from antiemetics Coding added Summary page added Document control added 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 Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS 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 1.4 (February 2023) Page 8 of 8 NSCLC – Carboplatin-Pemetrexed
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Lung-cancer-non-small-cellNSCLC/Carboplatin-Pemetrexed-Ver1.4.pdf

Radiotherapy for pituitary tumours - patient information

Description
This booklet contains information for patients who have been recommended radiotherapy treatment for a pituitary tumour.
Url
/Media/UHS-website-2019/Patientinformation/Brain-and-spine/Radiotherapy-for-pituitary-tumours-3290-PIL.pdf
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