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Docetaxel (75) Ver 1.1

Description: Chemotherapy Protocol BREAST CANCER DOCETAXEL (75) Regimen Breast Cancer – Docetaxel (75) Indication Treatment of locally advanced or metastatic HER2 positive breast cancer that has failed to adequately respond to an anthracycline containing therapy or when further anthracycline therapy is contra-indicated WHO Performance status 0, 1, 2 Toxicity Drug Docetaxel Adverse Effect Hypersensitivity, fluid retention, neuropathy, joint pains, nail changes, fatigue The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen FBC, U&E’s and LFT’s prior to 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 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 Prior to prescribing cycle one the following treatment criteria must be met; Version 1.1 (Oct 2014) Page 1 of 6 Breast –Docetaxel (75) Criteria Neutrophil Platelets Eligible Level equal to or more than 1.5x109/L (unless due to bone marrow impairment) equal to or more than 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 Toxicity Neutrophil Febrile Neutropenia Platelets Grade (NCI-CTC) 1 2 3 4 3 4 Greater than or equal to 100x109/L Less than 100x109/L 75mg/m2 60mg/m2 75mg/m2 Delay until grade 1 then 75mg/m2 Delay until grade 1 then 75mg/m2 Delay until grade 1 then 60mg/m2 Delay until grade 1 then 60mg/m2 Delay until grade 1 then 60mg/m2 75mg/m2 60mg/m2 Delay until grade 1 then 60mg/m2 Delay until grade 1 then 60mg/m2 Stop Stop Stop 60mg/m2 Delay until greater than or equal to 100x109/L the 60mg/m2 Stop Kidney Impairment Drug Docetaxel Creatinine Clearance (ml/min) N/A Dose (% of original dose) No dose adjustment needed Liver Impairment Drug Docetaxel Bilirubin (μmol/L) AST/ALT (units) Alk Phos (units) N/A Greater than ULN 1.5xULN or greater and/or 3.5xULN or greater and 2.5xULN or greater and 6xULN or greater Dose (% of original dose) Give 75% Not Recommended 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. Version 1.1 (Oct 2014) Page 2 of 6 Breast –Docetaxel (75) Peripheral neuropathy at NCI-CTC grade 3 should result in a dose reduction from 75mg/m2 to 60mg/m2 once the neuropathy has resolved to NCI-CTC grade 2 or below. If the NCI-CTC grade 3 neuropathy occurred at doses lower than 75mg/m2 or a NCI-CTC grade 4 toxicity develops consider stopping treatment. Excessive tearing / lacrimation are related to cumulative docetaxel doses and occur after a median of 400mg/m². Symptomatic treatment with hypromellose 0.3% eye drops four times a day may help. However, if the ocular irritation continues reduce the docetaxel dose to 80% of the original dose in the first instance. Delay the docetaxel where a NCI-CTC grade 3 cutaneous toxicity is present on day one of the cycle until it resolves to NCI-CTC grade 1 or below. The subsequent doses of docetaxel should be reduced from 75mg/m2 to 60mg/m2. If it occurs with a dose of 60mg/m2 or if there is no recovery after two weeks, docetaxel treatment should be stopped. Where a NCI-CTC grade 3 cutaneous toxicity occurs between cycles with recovery by day one then reduce the docetaxel dose as described. Docetaxel should be stopped in response to a NCI-CTC grade 4 cutaneous toxicity. Regimen Docetaxel is highly myelosuppressive and in those with poor bone marrow reserves (for example due to extensive prior treatment, bone metastasis or extensive skeletal radiation) consider a starting dose of 55mg/m² with a view to increase to 75mg/m² if well tolerated. 21 day cycle for 6 cycles Drug Docetaxel Dose 75mg/m2 Days 1 Administration Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Dose Information Docetaxel will be dose banded as per the CSCCN agreed bands Docetaxel induced fluid retention can lead to weight gain. This is not a reason to alter the doses Administration Information Hypersensitivity reactions tend to occur with the first or second infusion of docetaxel. The docetaxel infusion should not be interrupted for minor symptoms such as flushing or localised rashes. Immediately discontinue the infusion for severe reactions which include profound hypotension, bronchospasm and generalised erythema. Docetaxel doses of more than 200mg should be diluted in 500ml sodium chloride 0.9% (maximum concentration 0.74mg/ml) Extravasation Docetaxel – exfoliant Version 1.1 (Oct 2014) Page 3 of 6 Breast –Docetaxel (75) Additional Therapy Antiemetics 15-30 minutes before chemotherapy - metoclopramide 10mg oral or intravenous As take home medication - metoclopramide 10mg three times a day when required oral To prevent fluid retention and hypersensitivity reactions prescribe dexamethasone 8mg twice a day orally for three days starting 24 hours before the docetaxel administration. On the occasions where individuals attend for treatment and have forgotten to take the dexamethasone premedication administer dexamethasone 20mg, or nearest equivalent dose, once only intravenous bolus. 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 – X71.1 Delivery – X72.3 References 1. NICE (2009). Clinical Guideline CG81. Advanced breast cancer: Diagnosis and Treatment. DOH:London. Version 1.1 (Oct 2014) Page 4 of 6 Breast –Docetaxel (75) REGIMEN SUMMARY Docetaxel (75) Cycle 1, 2, 3, 4, 5 Day Minus One 1. Dexamethasone 8mg twice a day oral* Day One 2. Dexamethasone 8mg twice a day oral (from TTO)* 3. Metoclopramide 10mg oral or intravenous 4. Docetaxel 75mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Take Home Medicines 5. Dexamethasone 8mg twice a day oral for 3 days starting the day before the docetaxel infusion 6. Metoclopramide 10mg three times a day when required oral Cycle 6 Day Minus One 1. Dexamethasone 8mg twice a day oral* Day One 2. Dexamethasone 8mg twice a day oral (from TTO)* 3. Metoclopramide 10mg oral or intravenous 4. Docetaxel 75mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Take Home Medicines 5. Metoclopramide 10mg three times a day when required oral 6. Dexamethasone 8mg twice a day oral for the day after chemotherapy* * In Aria Planner the dexamethasone 8mg twice daily will appear on days 1, 2, 3 of treatment. This is the supply for the next cycle. The administration instructions reflect this. On the last cycle no dexamethasone will appear for prescribing. Version 1.1 (Oct 2014) Page 5 of 6 Breast –Docetaxel (75) DOCUMENT CONTROL Version Date Amendment Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Regimen tabulated 1.1 August 2014 Nearest equivalent dose added to dexamethasone premedication Metoclopramide dose changed to 10mg Bolus removed from intravenous bolus throughout text OPCS code updated Disclaimer added 1 Dec 2011 None Written By Donna Kimber Pharmacy Technician Anna Bunch Pharmacist Dr Debbie Wright Pharmacist Approved By Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Caroline Archer 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 1.1 (Oct 2014) Page 6 of 6 Breast –Docetaxel (75)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Docetaxel-75-Ver-11.pdf

Cyclophosphamide-Epirubicin-Paclitaxel(7 day)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE-EPIRUBICIN-PACLITAXEL (7 day) Regimen • Breast Cancer – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) Indication • Neoadjuvant / adjuvant therapy of early breast cancer • WHO Performance status 0, 1 Toxicity Drug Cyclophosphamide Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Epirubicin Paclitaxel Cardio-toxicity, urinary discolouration (red) Hypersensitivity, hypotension, bradycardia, peripheral neuropathy, myalgia and back pain on administration The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&Es and LFTs prior to each cycle. • Ensure adequate cardiac function before starting treatment with epirubicin. Baseline LVEF should be measured, particularly in patients with a history of cardiac problems or in the elderly. 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. 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. Version 1.2 (November 2020) Page 1 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) Haematological Prior to prescribing the following treatment criteria must be met on day one of treatment. Criteria Neutrophils Platelets Eligible Level equal to or more than 1x109/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 counts on day one are below these criteria for neutrophils and platelets then delay treatment for seven days. Treatment should only be re-started when these levels are reached. Treatment may be resumed at the original dose or reduce the original dose of cyclophosphamide, epirubicin or paclitaxel to 80% of the original dose where a NCI-CTC grade 3 or above haematological event has occurred. If a second episode of neutropenia and / or thrombocytopenia occurs, despite dose reduction or the time to reach the eligible level is longer than seven days consider changing or stopping therapy. Kidney Impairment Drug Cyclophosphamide Epirubicin Paclitaxel Creatinine Clearance (ml/min) Dose (% of original dose) more than 20 100 10-20 75 less than 10 50 Dose reduce in severe impairment only No dose reductions necessary Liver Impairment Drug Cyclophosphamide Epirubicin Paclitaxel Recommendation Dose reduction may not be necessary Bilirubin (umol/L) Dose (% of original) 24-51 50 50-85 25 85 or greater Contra-indicated If AST 2-4 x ULN or bilirubin 21-51μmol/L give 50% dose , if the AST greater than 4 x ULN or bilirubin greater than 51μmol/L then give 25% dose less than 26 135mg/m² 27-51 75mg/m² greater than 51 50mg/m² If bilirubin less than 1.25xULN and transaminase less than 10xULN, dose at 175mg/m2 Version 1.2 (November 2020) Page 2 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) 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. Epirubicin Discontinue epirubicin if cardiac failure develops. Paclitaxel NCI-CTC grade 2 peripheral neuropathy withhold paclitaxel only until the neuropathy recovers to NCI-CTC grade 1 then dose reduce to 75% of the original dose. Where the peripheral neuropathy is NCI-CTC grade 3 again withhold the paclitaxel until it resolves to NCI-CTC grade 1 and then reduce the dose of paclitaxel to 50% of the original dose. Paclitaxel should be discontinued if the neuropathy does not resolve to NCI-CTC grade 1. Regimen 21 day cycle for 4 cycles Drug Cyclophosphamide Dose 600mg/m2 Days Administration 1 Intravenous bolus Epirubicin 90mg/m² 1 Intravenous bolus Followed by; 21 day cycle for 4 cycles Drug Dose Paclitaxel 80mg/m² Days 1, 8, 15 Administration Intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Dose Information • Cyclophosphamide will be dose banded in accordance with the national dose bands (20PM) • Epirubicin will be dose banded in accordance with the national dose bands (2PM) • The maximum lifetime cumulative dose of epirubicin is 900mg/m2. Version 1.2 (November 2020) Page 3 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) • Paclitaxel will be dose banded in accordance with the national dose bands (6mg/ml) Administration Information • Hypersensitivity reactions tend to occur with the first or second infusion of paclitaxel. Paclitaxel infusions should be interrupted for minor symptoms such as flushing or localised rashes. If these resolve promptly (within 5 minutes) the infusion may be restarted at a lower rate with intensive monitoring. Immediately discontinue the infusion for severe reactions which include profound hypotension, bronchospasm and generalised erythema. • Paclitaxel must be administered via a non-PVC administration set containing an in-line 0.22 micron filter. Extravasation • Cyclophosphamide - neutral • Epirubicin – vesicant • Paclitaxel – vesicant Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy with cyclophosphamide and epirubicin − dexamethasone 8mg oral or intravenous − ondansetron 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 oral − ondansetron 8mg twice a day oral for 3 days 15-30 minutes prior to chemotherapy with paclitaxel − metoclopramide 10mg oral or intravenous As take home medication − metoclopramide 10mg three times a day when required oral • Premedication to reduce of risk of paclitaxel hypersensitivity reaction 30 minutes prior to chemotherapy with paclitaxel − chlorphenamine 10mg intravenous − dexamethasone 10mg intravenous − H2 antagonist according to local formulary choice and availability Version 1.2 (November 2020) Page 4 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) • Mouthwashes according to local or national policy on the treatment of mucositis • 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. Moebus V, Jackisch C, Lueck HJ et al. Intense dose dense sequential chemotherapy with epirubicin, paclitaxel and cyclophosphamide compared with conventionally scheduled chemotherapy in high risk primary breast cancer: mature results of an AGO phase III study. J Clin Oncol 2010; 28 (17): 2874-2880. Version 1.2 (November 2020) Page 5 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) REGIMEN SUMMARY Cyclophosphamide-Epirubicin-Paclitaxel (7 day) Cycle 1, 2, 3, 4 1. Dexamethasone 8mg oral or intravenous 2. Ondansetron 8mg oral or intravenous 3. Epirubicin 90mg/m² intravenous bolus over 10 minutes. 4. Cyclophosphamide 600mg/m² intravenous bolus over 10 minutes. Take Home Medicines 5. Dexamethasone 4mg twice a day oral for 3 days starting on day two of the cycle 6. Metoclopramide 10mg three times a day when required oral 7. Ondansetron 8mg twice a day oral for three days starting on the evening of day one of treatment Cycle 5, 6, 7, 8 Days 1, 8, 15 8. Chlorphenamine 10mg intravenous 9. Dexamethasone 10mg intravenous 10. 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. 11. Metoclopramide 10mg oral or intravenous 12. Paclitaxel 80mg/m² intravenous infusion in 250ml sodium chloride 0.9% over 60 minutes Take Home Medicines 13. Metoclopramide 10mg three times a day when required oral Version 1.2 (November 2020) Page 6 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day) DOCUMENT CONTROL Version Date Amendment Written By Approved By Update of premedication due to 1.2 Nov 2020 shortage of IV ranitidine. IV ranitidine changed to H2 antagonist according to local formulary choice and availability Donna Kimber Pharmacy Technician Coding removed Dose of dexamethasone pre medication for paclitaxel reduced from 20mg to 10mg. 1.1 Dec 2019 National dose band for cyclophosphamide changed to Rebecca Wills Pharmacist “20PM”. Formatting updated Dr Debbie Wright 1 Nov 2019 None Pharmacist Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Dr Sanjay Raj 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 1.2 (November 2020) Page 7 of 7 Breast – Cyclophosphamide-Epirubicin-Paclitaxel (7 day)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Cyclophosphamide-Epirubicin-Paclitaxel-7-day.pdf

Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE-EPIRUBICIN (75)- FLUOROURACIL Regimen (FE75C) • Breast Cancer – Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) Indication • Neo-adjuvant / adjuvant therapy of breast cancer • Metastatic breast cancer • WHO Performance status 0, 1, 2 Toxicity Drug Cyclophosphamide Epirubicin Fluorouracil Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Cardio-toxicity, urinary discolouration (red) Diarrhoea, stomatitis The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&E’s and LFT’s prior to each cycle. • Ensure adequate cardiac function before starting treatment. Baseline LVEF should be measured, particularly in patients with a history of cardiac problems or in the elderly. • 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. 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 1.2 (November 2020) Page 1 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) 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 Prior to prescribing the following treatment criteria must be met on day 1 of treatment. Criteria Neutrophils Platelets Eligible Level equal to or more than 1x109/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 In the adjuvant / neo-adjuvant setting, always check with the relevant consultant before delaying or reducing the dose in response to a toxicity. If counts on day one are below these criteria for neutrophil and/or platelets then delay treatment for seven days or until recovery of counts. Treatment should only be started when these levels are reached. On subsequent cycles, if the counts are below these levels on day one then delay treatment until these levels are reached and / or consider reducing the dose to 80% of the original dose. If a second episode of neutropenia / thrombocytopenia occurs or the time to reach the eligible level is longer than seven days consider changing treatment. If patients experience febrile neutropenia or treatment delay due to neutrophil of less than 0.5x109/L or platelets less than 50x109/L for more than seven days then reduce the dose to 80% of the original dose. If neutropenia or thrombocytopenia recurs, the dosage should be either further reduce to 50% of the original dose or stop treatment. Growth factors may be considered as an alternative approach particularly in the neo-adjuvant and adjuvant setting. Kidney Impairment Drug Cyclophosphamide Epirubicin Creatinine Clearance (ml/min) more than 20 10-20 Less than 10 Dose (% of original dose) 100 75 50 Dose reduce in severe impairment only Fluorouracil Consider dose reduction in severe renal impairment only Version 1.2 (November 2020) Page 2 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) Liver Impairment Drug Cyclophosphamide Epirubicin Recommendation Dose reduction may not be necessary Bilirubin (umol/L) Dose (% of original) 24-51 50 51-85 25 85 or greater Contra-indicated If AST 2-4xULN give 50% dose, if the AST greater than 4xULN then give 25% dose Drug Fluorouracil Bilirubin AST/ALT Dose µmol/L units (%of original dose) Less than 85 Less than 180 100% More than 85 or More than 180 CI In moderate hepatic impairment reduce the initial dose by one third. In severe hepatic impairment reduce initial dose by one half. These doses may be increased if no toxicity occurs 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. Epirubicin Discontinue epirubicin if cardiac failure develops. Regimen 21 day cycle for 6 cycles Drug Dose Days Administration Cyclophosphamide 600mg/m2 1 Intravenous bolus Epirubicin Fluorouracil 75mg/m² 600mg/m² 1 Intravenous bolus 1 Intravenous bolus Version 1.2 (November 2020) Page 3 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) Dose Information • Cyclophosphamide will be dose banded in accordance with the national dose bands (20mg/ml PM) • Epirubicin will be dose banded in accordance with the national dose bands (2mg/ml PM) • The maximum lifetime cumulative dose of epirubicin is 900mg/m². • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM) Extravasation • Cyclophosphamide – neutral • Epirubicin – vesicant • Fluorouracil - inflammitant Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy; - dexamethasone 8mg oral or equivalent intravenous dose - 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 - ondansetron 8mg twice a day for three days oral • Mouthwashes according to local or national policy on the treatment of mucositis • 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.Coskan U, Gunel N, Onuk E et al. Effect of different neoadjuvant chemotherapy regimens on locally advanced breast cancer. Neoplasma 2003; 50 (3): 210-216. 2.Levine MN, Bramwell VH, Pritchard KI et al. Randomised trial of intensive Cyclophosphamide, Epirubicin and fluorouracil chemotherapy compared with Cyclophosphamide, Methotrexate and fluorouracil in premenopausal women with node-positive breast cancer. J Clin Oncol 1998; 16(8):2651-2658. 3.Brufman G, Colajori E, Ghilezan N et al. Doubling Epirubicin dose intensity (100mg/m² versus 50mg/m²) in the FEC regimen significantly increases response rates. An international randomised phase III study in metastatic breast cancer. Anns of Oncol 1997; 8: 155-162. Version 1.2 (November 2020) Page 4 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) REGIMEN SUMMARY Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) Day One 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Ondansetron 8mg oral or intravenous 3. Epirubicin 75mg/m² intravenous bolus over 10 minutes 4. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 5. Cyclophosphamide 600mg/m² intravenous bolus over 10 minutes Take Home Medicines 6. Dexamethasone 4mg twice a day for 3 days oral starting on day two of the cycle 7. Metoclopramide 10mg three times a day when required oral 8. Ondansetron 8mg twice a day for three days oral starting on the evening of day one of treatment Version 1.2 (November 2020) Page 5 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) DOCUMENT CONTROL Version Date Amendment Written By Approved By Updated monitoring with DPD 1.2 Nov 2020 testing Dose banding updated Coding removed Donna Kimber Pharmacy Technician Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Hepatic impairment updated Regimen tabulated 1.1 November 2014 Metoclopramide dose changed to 10mg Bolus removed from intravenous Donna Kimber Pharmacy Technician bolus throughout text Mucositis recommendation changed OPCS codes updated Dexamethasone TTO clarified Ondansetron TTO clarified Disclaimer added 1 Aug 2011 None Anna Bunch Pharmacist Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Debbie Wright Pharmacist Dr Caroline Archer 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 Version 1.2 (November 2020) Page 6 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C) 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 (November 2020) Page 7 of 7 Breast–Cyclophosphamide-Epirubicin (75)-Fluorouracil (FE75C)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/FE75C.pdf

Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE-EPIRUBICIN (60)- FLUOROURACIL Regimen (FE60C) • Breast Cancer – Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) Indication • Metastatic breast cancer • WHO Performance status 0, 1, 2 Toxicity Drug Cyclophosphamide Epirubicin Fluorouracil Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Cardio-toxicity, urinary discolouration (red) Diarrhoea, stomatitis The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&E’s and LFT’s prior to each cycle. • Ensure adequate cardiac function before starting treatment. Baseline LVEF should be measured, particularly in patients with a history of cardiac problems or in the elderly. • 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. 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 (November 2020) Page 1 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) 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 the following treatment criteria must be met on day 1 of treatment. Criteria Neutrophils Platelets Eligible Level equal to or more than 1x109/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 counts on day one are below these criteria for neutrophil and/or platelets then delay treatment for seven days. Treatment should only be started when these levels are reached. On subsequent cycles, if the counts are below these levels on day one then delay treatment until these levels are reached and / or consider reducing the dose to 80% of the original dose. If a second episode of neutropenia / thrombocytopenia occurs or the time to reach the eligible level is longer than seven days consider changing treatment. If patients experience febrile neutropenia or treatment delay due to neutrophil less than 0.5x109/L or platelets less than 50x109/L for more than seven days, then reduce the dose to 80% of the original dose. If the neutropenia or thrombocytopenia recurs, the dosage should be either further reduce to 50% of the original dose or stop treatment. Kidney Impairment Drug Cyclophosphamide Creatinine Clearance (ml/min) more than 20 10-20 Less than 10 Dose (% of original dose) 100 75 50 Epirubicin Dose reduce in severe impairment only Fluorouracil Consider dose reduction in severe renal impairment only Version 1.2 (November 2020) Page 2 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) Liver Impairment Drug Cyclophosphamide Recommendation Dose reduction may not be necessary Epirubicin Drug Fluorouracil Bilirubin (umol/L) Dose (% of original) 24-51 50 51-85 25 85 or greater Contra-indicated If AST 2-4xULN give 50% dose, if the AST is greater than 4xULN then give 25% dose Bilirubin AST/ALT Dose µmol/L units (%of original dose) Less than 85 Less than 180 100% More than 85 or More than 180 CI In moderate hepatic impairment reduce the initial dose by one third. In severe hepatic impairment reduce initial dose by one half. These doses may be increased if no toxicity occurs 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. Epirubicin Discontinue epirubicin if cardiac failure develops. Regimen 21 day cycle for 6 cycles Drug Dose Days Administration Cyclophosphamide 600mg/m2 1 Intravenous bolus Epirubicin Fluorouracil 60mg/m² 600mg/m² 1 Intravenous bolus 1 Intravenous bolus Dose Information • Cyclophosphamide will be dose banded in accordance with the national dose bands (20mg/ml PM) • Epirubicin will be dose banded in accordance with the national dose bands (2mg/ml PM) Version 1.2 (November 2020) Page 3 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) • The maximum lifetime cumulative dose of epirubicin is 900mg/m². • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM) Extravasation • Cyclophosphamide – neutral • Epirubicin – vesicant • Fluorouracil - inflammitant Additional Therapy • Antiemetics day 1 15-30 minutes prior to chemotherapy; - dexamethasone 8mg oral or equivalent intravenous dose - 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 - ondansetron 8mg twice a day for three days oral • Mouthwashes according to local or national policy on the treatment of mucositis • 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.Coskan U, Gunel N, Onuk E et al. Effect of different neoadjuvant chemotherapy regimens on locally advanced breast cancer. Neoplasma 2003; 50 (3): 210-216. 2.Levine MN, Bramwell VH, Pritchard KI et al. Randomised trial of intensive Cyclophosphamide, Epirubicin and fluorouracil chemotherapy compared with Cyclophosphamide, Methotrexate and fluorouracil in premenopausal women with node-positive breast cancer. J Clin Oncol 1998; 16(8):2651-2658. 3.Brufman G, Colajori E, Ghilezan N et al. Doubling Epirubicin dose intensity (100mg/m² versus 50mg/m²) in the FEC regimen significantly increases response rates. An international randomised phase III study in metastatic breast cancer. Anns of Oncol 1997; 8: 155-162. Version 1.2 (November 2020) Page 4 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) REGIMEN SUMMARY Day One Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Ondansetron 8mg oral or intravenous 3. Epirubicin 60mg/m² intravenous bolus over 10 minutes 4. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 5. Cyclophosphamide 600mg/m² intravenous bolus over 10 minutes Take Home Medicines 6. Dexamethasone 4mg twice a day for 3 days oral starting on day two of the cycle 7. Metoclopramide 10mg three times a day when required oral 8. Ondansetron 8mg twice a day for three days oral starting on the evening of day one of treatment Version 1.2 (November 2020) Page 5 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C) DOCUMENT CONTROL Version Date Amendment Updated monitoring with DPD 1.2 Nov 2020 testing Dose banding updated Coding removed Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Hepatic impairment updated Regimen tabulated 1.1 November 2014 Metoclopramide dose changed to 10mg Bolus removed from intravenous bolus throughout text Mucositis recommendation changed OPCS codes updated Dexamethasone TTO clarified Ondansetron TTO clarified Disclaimer added 1 Aug 2011 None Written By Donna Kimber Pharmacy Technician Donna Kimber Pharmacy Technician Approved By Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Anna Bunch Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Debbie Wright Pharmacist Dr Caroline Archer 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 1.2 (November 2020) Page 6 of 6 Breast–Cyclophosphamide-Epirubicin (60)-Fluorouracil (FE60C)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/FE60C.pdf

Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE-EPIRUBICIN (100)- FLUOROURACIL Regimen (FE100C) • Breast Cancer – Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) Indication • Neo-adjuvant /adjuvant therapy of breast cancer • WHO Performance status 0, 1, 2 Toxicity Drug Cyclophosphamide Epirubicin Fluorouracil Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Cardio-toxicity, urinary discolouration (red) Diarrhoea, stomatitis The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&E’s and LFT’s prior to each cycle • Ensure adequate cardiac function before starting treatment. Baseline LVEF should be measured, particularly in patients with a history of cardiac problems or in the elderly. • 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. 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 (November 2020) Page 1 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) 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 the following treatment criteria must be met on day one of treatment. Criteria Neutrophils Platelets Eligible Level equal to or more than 1x109/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 In the adjuvant / neo-adjuvant setting, always check with the relevant consultant before delaying or reducing the dose in response to a toxicity. If counts on day one are below these criteria for neutrophil and/or platelets then delay treatment for seven days. Treatment should only be started when these levels are reached. On subsequent cycles, if the counts are below these levels on day one then delay treatment until these levels are reached and / or consider reducing the dose of epirubicin to 75% of the original dose. The dose intensity of fluorouracil and cyclophosphamide may be maintained. If a second episode of neutropenia / thrombocytopenia occurs or the time to reach the eligible level is longer than seven days consider changing treatment. If patients experience febrile neutropenia or treatment delay due to neutrophil less than 0.5x109/L or platelets less than 50x109/L for more than seven days then reduce the dose to 75% of the original dose. If neutropenia or thrombocytopenia recurs, the dosage should be either further reduce to 50% of the original dose or stop treatment. Kidney Impairment Drug Cyclophosphamide Creatinine Clearance (ml/min) more than 20 10-20 Less than 10 Dose (% of original dose) 100 75 50 Epirubicin Dose reduce in severe impairment only Fluorouracil Consider dose reduction in severe renal impairment only Version 1.2 (November 2020) Page 2 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) Liver Impairment Drug Cyclophosphamide Epirubicin Recommendation Dose reduction may not be necessary Bilirubin (umol/L) Dose (% of original) 24-51 50 51-85 25 85 or greater Contra-indicated If AST 2-4xULN give 50% of the dose, if the AST is greater than 4xULN then give 25% of the dose Drug Fluorouracil Bilirubin AST/ALT Dose µmol/L units (%of original dose) Less than 85 Less than 180 100% More than 85 or More than 180 CI In moderate hepatic impairment reduce the initial dose by one third. In severe hepatic impairment reduce initial dose by one half. These doses may be increased if no toxicity occurs 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. Epirubicin Discontinue epirubicin if cardiac failure develops. Regimen 21 day cycle for 6 cycles Drug Dose Days Administration Cyclophosphamide 500mg/m2 1 Intravenous bolus Epirubicin Fluorouracil 100mg/m² 500mg/m² 1 Intravenous bolus 1 Intravenous bolus Dose Information • Cyclophosphamide will be dose banded in accordance with the national dose bands (20mg/ml PM) Version 1.2 (November 2020) Page 3 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) • Epirubicin will be dose banded in accordance with the national dose bands (2mg/ml PM) • The maximum lifetime cumulative dose of epirubicin is 900mg/m² • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM) Extravasation • Cyclophosphamide – neutral • Epirubicin – vesicant • Fluorouracil - inflammitant Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy; - dexamethasone 8mg oral or equivalent intravenous dose - 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 - ondansetron 8mg twice a day for 3 days oral • Growth factor according to local formulary choice. For example; - filgrastim or bioequivalent 300microgram once a day subcutaneous for five days starting on day five of the cycle - lenograstim or bioequivalent 263microgram once a day subcutaneous for five days starting on day five of the cycle - pegfilgrastim or bioequivalent 6mg once a day subcutaneous on day two • Mouthwashes according to local or national policy on the treatment of mucositis • 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.Coskan U, Gunel N, Onuk E et al. Effect of different neoadjuvant chemotherapy regimens on locally advanced breast cancer. Neoplasma 2003; 50 (3): 210-216. 2.Levine MN, Bramwell VH, Pritchard KI et al. Randomised trial of intensive Cyclophosphamide, Epirubicin and fluorouracil chemotherapy compared with Cyclophosphamide, Methotrexate and fluorouracil in premenopausal women with node-positive breast cancer. J Clin Oncol 1998; 16(8):2651-2658. 3.Brufman G, Colajori E, Ghilezan N et al. Doubling Epirubicin dose intensity (100mg/m² versus 50mg/m²) in the FEC regimen significantly increases response rates. An international randomised phase III study in metastatic breast cancer. Anns of Oncol 1997; 8: 155-162. Version 1.2 (November 2020) Page 4 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) REGIMEN SUMMARY Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) Day One 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Ondansetron 8mg oral or intravenous 3. Epirubicin 100mg/m² intravenous bolus over 10 minutes 4. Fluorouracil 500mg/m² intravenous bolus over 10 minutes 5. Cyclophosphamide 500mg/m² intravenous bolus over 10 minutes Take Home Medicines 6. Dexamethasone 4mg twice a day for 3 days oral starting on day two of the cycle 7. Metoclopramide 10mg three times a day when required oral 8. Ondansetron 8mg twice a day for 3 days oral starting on the evening of day one of treatment 9. Growth factor according to local formulary choice. For example; - filgrastim or bioequivalent 300microgram once a day subcutaneous for five days starting on day five of the cycle - lenograstim or bioequivalent 263microgram once a day subcutaneous for five days starting on day five of the cycle - pegfilgrastim or bioequivalent 6mg once a day subcutaneous on day two Version 1.2 (November 2020) Page 5 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C) DOCUMENT CONTROL Version Date Amendment Written By Approved By Updated monitoring with DPD testing 1.2 Nov 2020 Dose banding updated Coding removed Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Hepatic impairment updated Regimen tabulated November Metoclopramide dose changed to 1.1 2014 10mg Bolus removed from intravenous bolus throughout text Mucositis recommendation changed OPCS codes updated Dexamethasone TTO clarified Ondansetron TTO clarified Disclaimer added 1 Nov 2011 None Donna Kimber Pharmacy Technician Donna Kimber Pharmacy Technician Anna Bunch Pharmacist Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Debbie Wright Pharmacist Dr Caroline Archer 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 1.2 (November 2020) Page 6 of 6 Breast–Cyclophosphamide-Epirubicin (100)-Fluorouracil (FE100C)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/FE100C.pdf

Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF PO)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE (PO)-FLUOROURACIL-METHOTREXATE (CMF-PO) Regimen • Breast Cancer – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF PO) Indication • Adjuvant treatment of early breast cancer • WHO Performance status 0, 1, 2 Toxicity Drug Cyclophosphamide Fluorouracil Methotrexate Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Diarrhoea, stomatitis Stomatitis, conjunctivitis, renal toxicity The presence of a third fluid compartment e.g. ascities or renal failure may delay methotrexate clearance hence increase toxicity. The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&E’s and LFT’s prior to each cycle. • 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. 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 (November 2020) Page 1 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) 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 the following treatment criteria must be met on day 1 of treatment. Criteria Neutrophil Platelets Eligible Level equal to or more than 1x109/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 counts on day one are below these criteria for the neutrophils and/or platelets then delay treatment for seven days. Treatment should only be re-started when these levels are reached. Treatment may be resumed at the original dose or reduce the original dose of cyclophosphamide, methotrexate and fluorouracil to 80% of the original dose depending on clinical circumstances. If a second episode of neutropenia and / or thrombocytopenia occurs or the time to reach the eligible level is longer than seven days consider stopping or changing treatment or growth factor support as per local guidelines. Day eight treatment is seldom delayed for low blood counts. Kidney Impairment Drug Cyclophosphamide (consider mesna) Fluorouracil Methotrexate Creatinine Clearance Dose (ml/min) (% of original dose) More than 20 100% 10-20 75 Less than 10 50 Consider mesna Consider dose adjustments in severe renal impairment More than 80 60 45 Less than 30 100% 65% 50% CI Version 1.2 (November 2020) Page 2 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) Liver Impairment Drug Bilirubin µmol/L AST/ALT units Dose (%of original dose) Cyclophosphamide Dose reduction may not be necessary Fluorouracil Methotrexate Less than 85 Less than 180 100% More than 85 or More than 180 CI In moderate hepatic impairment reduce the initial dose by one third. In severe hepatic impairment reduce initial dose by one half. These doses may be increased if no toxicity occurs Less than 50 and Less than 180 100% 51-85 or More than 180 75% More than 85 CI 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. Regimen 28 day cycle for 6 cycles Drug Dose Days Administration Cyclophosphamide 100mg/m2 1-14 incl Oral Fluorouracil Methotrexate 600mg/m² 40mg/m² 1,8 Intravenous bolus 1,8 Intravenous bolus Dose Information • Cyclophosphamide will be dose rounded to the nearest 50mg (up if halfway) • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM) • Methotrexate will be dose banded in accordance with the national dose bands (25mg/ml) Version 1.2 (November 2020) Page 3 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) Extravasation • Fluorouracil - inflammitant • Methotrexate - inflammitant Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy; - dexamethasone 8mg oral or equivalent intravenous dose - metoclopramide 10mg oral or intravenous As take home medication: - dexamethasone 4mg once a day for 3 days oral - metoclopramide 10mg three times a day when required oral (may not be required on day eight) • Folinic acid 15mg six hourly for 6 doses oral starting 24 hours after methotrexate administration. • Mouthwashes according to local or national policy on the treatment of mucositis. • 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. Additional Information • The National Patient Safety Agency alert NPSA/2008/RRR001 must be followed when prescribing, dispensing or administering oral chemotherapy. • It must be made clear to all staff, including those in the community, that this is a short course of oral chemotherapy that must not be continued. References 1.Coskun U, Gunel N, Onuk E et al. Effect of different neoadjuvant chemotherapy regimens on locally advanced breast cancer. Neoplasma 2003; 50 (3): 210-216. 2.Bonnadonna G, Brusamoline E, Valagussa P et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 1976; 294: 405-410. Version 1.2 (November 2020) Page 4 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) REGIMEN SUMMARY Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) Day One 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Metoclopramide 10mg oral or intravenous 3. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 4. Methotrexate 40mg/m² intravenous bolus over 10 minutes Take Home Medicines 5. Cyclophosphamide 100mg/m² once daily days 1-14 inclusive oral 6. Folinic acid 15mg six hourly for six doses oral starting 24 hours after methotrexate administration 7. Dexamethasone 4mg once a day for 3 days oral starting on the day after chemotherapy 8. Metoclopramide 10mg three times a day when required oral Day Eight 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Metoclopramide 10mg oral or intravenous 3. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 4. Methotrexate 40mg/m² intravenous bolus over 10 minutes Take Home Medicines 5. Folinic acid 15mg six hourly for six doses oral starting 24 hours after methotrexate administration. 6. Dexamethasone 4mg once a day for 3 days oral starting on the day after chemotherapy 7. Metoclopramide 10mg three times a day when required oral* *Only dispense if required Version 1.2 (November 2020) Page 5 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO) DOCUMENT CONTROL Version Date Amendment Written By Updated monitoring with 1.2 Nov 2020 DPD testing Dose banding updated Donna Kimber Pharmacy Technician Coding removed Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Regimen tabulated Metoclopramide dose 1.1 August 2014 changed to 10mg Bolus removed from intravenous bolus throughout Donna Kimber Pharmacy Technician text Mucositis recommendation changed OPCS code updated Dexamethasone TTO clarified Disclaimer added 1 June 2011 None Anna Bunch Pharmacist Dr Debbie Wright Pharmacist Approved By Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Caroline Archer 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 1.2 (November 2020) Page 6 of 6 Breast – Cyclophosphamide (PO)-Fluorouracil-Methotrexate (CMF-PO)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/CyclophosphamideFluorouracilMethotrexateCMF-PO.pdf

Cyclophosphamide (IV)-Fluorouracil-Methotrexate (CMF IV)

Description: Chemotherapy Protocol BREAST CANCER CYCLOPHOSPHAMIDE–FLUOROURACIL-METHOTREXATE (CMF IV) Regimen • Breast Cancer – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) Indication • Adjuvant treatment of early breast cancer • WHO Performance status 0, 1, 2 Toxicity Drug Cyclophosphamide Fluorouracil Methotrexate Adverse Effect Dysuria, haemorrhagic cystitis, taste disturbances Diarrhoea, stomatitis Stomatitis, conjunctivitis, renal toxicity The presence of a third fluid compartment e.g. ascities or renal failure may delay methotrexate clearance hence increase toxicity. The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Regimen • FBC, U&E’s and LFT’s prior to each cycle. • 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. 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 (November 2020) Page 1 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) 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 the following treatment criteria must be met on day 1 of treatment. Criteria Neutrophil Platelets Eligible Level equal to or more than 1x109/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 counts on day one are below these criteria for the neutrophils and/or platelets then delay treatment for seven days. Treatment should only be re-started when these levels are reached. Treatment may be resumed at the original dose or reduce the original dose of cyclophosphamide, methotrexate and fluorouracil to 80% of the original dose depending on clinical circumstances. If a second episode of neutropenia and / or thrombocytopenia occurs or the time to reach the eligible level is longer than 7 days consider stopping or changing treatment or growth factor support as per local guidelines. Day 8 treatment is seldom delayed for low blood counts. Kidney Impairment Drug Cyclophosphamide Fluorouracil Methotrexate Creatinine Clearance Dose (ml/min) (% of original dose) More than 20 100% 10-20 75 Less than 10 50 Consider mesna Consider dose adjustments in severe renal impairment More than 80 60 45 Less than 30 100% 65% 50% CI Version 1.2 (November 2020) Page 2 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) Liver Impairment Drug Bilirubin µmol/L AST/ALT units Dose (%of original dose) Cyclophosphamide Dose reduction may not be necessary Fluorouracil Methotrexate Less than 85 Less than 180 100% More than 85 or More than 180 CI In moderate hepatic impairment reduce the initial dose by one third. In severe hepatic impairment reduce initial dose by one half. These doses may be increased if no toxicity occurs Less than 50 and Less than 180 100% 51-85 or More than 180 75% More than 85 CI 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. Regimen 28 day cycle for 6 cycles Drug Dose Days Administration Cyclophosphamide 600mg/m2 1,8 Intravenous bolus Fluorouracil Methotrexate 600mg/m² 40mg/m² 1,8 Intravenous bolus 1,8 Intravenous bolus Dose Information • Cyclophosphamide will be dose banded in accordance with the national dose bands (20mg/ml PM) • Fluorouracil will be dose banded in accordance with the national dose bands (25mg/ml PM) • Methotrexate will be dose banded in accordance with the national dose bands (25mg/ml) Version 1.2 (November 2020) Page 3 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) Extravasation • Cyclophosphamide - neutral • Fluorouracil - inflammitant • Methotrexate - inflammitant Additional Therapy • Antiemetics 15-30 minutes prior to chemotherapy on days 1 and 8; - dexamethasone 8mg oral or equivalent intravenous dose - metoclopramide 10mg oral or intravenous As take home medication: - dexamethasone 4mg once a day for 3 days oral - metoclopramide 10mg three times a day when required oral (may not be required on day 8) • Folinic acid 15mg six hourly for 6 doses oral starting 24 hours after methotrexate administration. • Mouthwashes according to local or national policy on the treatment of mucositis. • 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.Coskun U, Gunel N, Onuk E et al. Effect of different neoadjuvant chemotherapy regimens on locally advanced breast cancer. Neoplasma 2003; 50 (3): 210-216. 2.Bonnadonna G, Brusamoline E, Valagussa P et al. Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 1976; 294: 405-410. Version 1.2 (November 2020) Page 4 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) REGIMEN SUMMARY Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) Day One 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Metoclopramide 10mg oral or intravenous 3. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 4. Methotrexate 40mg/m² intravenous bolus over 10 minutes. 5. Cyclophosphamide 600mg/m² intravenous bolus over 10 minutes. Take Home Medicines 6. Dexamethasone 4mg once a day for 3 days oral starting on the day after chemotherapy 7. Metoclopramide 10mg three times a day oral when required oral 8. Folinic acid 15mg six hourly for six doses oral starting 24 hours after methotrexate administration oral Day Eight 1. Dexamethasone 8mg oral or equivalent intravenous dose 2. Metoclopramide 10mg oral or intravenous 3. Fluorouracil 600mg/m² intravenous bolus over 10 minutes 4. Methotrexate 40mg/m² intravenous bolus over 10 minutes. 5. Cyclophosphamide 600mg/m² intravenous bolus over 10 minutes. Take Home Medicines 6. Dexamethasone 4mg once a day for 3 days oral starting on the day after chemotherapy 7. Metoclopramide 10mg three times a day oral when required oral* 8. Folinic acid 15mg six hourly for six doses oral starting 24 hours after methotrexate administration oral *Only dispense if required Version 1.2 (November 2020) Page 5 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV) Document Control Version Date Amendment Written By Updated monitoring with 1.2 Nov 2020 DPD testing Dose banding updated Donna Kimber Pharmacy Technician Coding removed Header changed Toxicities removed Adverse effects tabulated ≥ removed and written in full Dose modification tabulated Regimen tabulated Metoclopramide dose 1.1 August 2014 changed to 10mg Bolus removed from intravenous bolus throughout Donna Kimber Pharmacy Technician text Mucositis recommendation changed OPCS code updated Dexamethasone TTO clarified Disclaimer added 1 June 2011 None Anna Bunch Pharmacist Approved By Rebecca Wills Pharmacist Dr Debbie Wright Pharmacist Dr Ellen Copson Consultant Medical Oncologist Dr Debbie Wright Pharmacist Dr Caroline Archer 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 1.2 (November 2020) Page 6 of 6 Breast – Cyclophosphamide IV-Fluorouracil-Methotrexate (CMF IV)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/CyclophosphamideFluorouracilMethotrexateCMF-IV.pdf

Lomustine-Procarbazine-Vincristine (PCV) ver 1.1

Description: Chemotherapy Protocol Central Nervous System LOMUSTINE-PROCARBAZINE-VINCRISTINE (PCV) Regimen CNS – Lomustine-Procarbazine-Vincristine (PCV) Indication Adjuvant treatment for grade III gliomas including anaplastic astrocytoma, oligodendrogliomas and oligoastrocytomas. First line treatment for grade IV tumours not eligible for concurrent chemoradiation regimen. Recurrent high grade gliomas. Performance status 0, 1, 2 Toxicity Drug Lomustine Procarbazine Vincristine Adverse Effect Myelosuppression, pulmonary fibrosis Rash, loss of appetite, flu like symptoms Peripheral neuropathy, constipation, jaw pain The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs FBC, LFT’s, U&E’s and glucose prior to day one of each cycle Clinical examination including neurological assessment, whole brain imaging prior to starting treatment. Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated 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 1.1 (Oct 2015) Page 1 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Haematological Prior to starting treatment 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 or erythropoietin according to NICE technology appraisal if the patient is symptomatic of anaemia or has a haemoglobin of less than 8g/dL. If the platelets and / or neutrophils are less than 100x109/L and 1.5x109/L respectively then delay therapy until counts recover to these levels. If more than one delay is necessary in treatment due to neutropenia or thrombocytopenia, reduce procarbazine duration from 10 days to 7 days. The haematological toxicity of lomustine may be cumulative, leading to successively lower white cell and platelet counts with successive doses of the drug Hepatic Impairment Drug Bilirubin (μmol/L) AST/ALT Dose Lomustine more than 25 and more than 180 omit or dose reduce Procarbazine more than 50 more than 85 normal 50% or more than180 omit 26-51 or 60-180 50% Vincristine more than 51 and normal 50% more than 51 and more than180 omit Version 1.1 (Oct 2015) Page 2 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) Renal Impairment Creatinine Clearance (ml/min) more than 60 Lomustine Dose 100% 45 – 60 75% 30 - 45 less than 30 50% Not recommended For procarbazine, if the serum creatinine is more than 177μmol/L, give 50% dose. Procarbazine is not recommended with severe renal failure (creatinine clearance less than 10mL/min). 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. For all other non-haematological NCI-CTC grade 2 toxicities delay treatment until the adverse effect has resolved to NCI-CTC grade 1 or below. For toxicity that is NCI-CTC grade 3 or above discontinue treatment. If the patient develops a rash, they should stop procarbazine immediately. Procarbazine should then be omitted from future cycles. Regimen 42 day cycle for 6 cycles or until tumour progression (6 cycles will be set in Aria) Drug Lomustine Procarbazine Vincristine Dose 100mg/m2 once a day 100mg/m2 once a day 1.4mg/m2 (maximum 2mg) Days 1 1-10 inclusive 1 Administration Oral Oral Intravenous bolus in 50ml sodium chloride 0.9% Dose Lomustine is available as 40mg capsules. The dose will be rounded to the nearest 40mg (up if halfway) Procarbazine is available as 50mg capsules. Doses will be rounded to the nearest 25mg. Different alternate day dosing may be required to ensure the total dose is administered. Version 1.1 (Oct 2015) Page 3 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) The maximum dose of vincristine is 2mg Administration Information Lomustine and procarbazine capsules must be swallowed whole with a glass of water and must not be opened or chewed. Additional Therapy Antiemetics 15-30 minutes prior to chemotherapy - dexamethasone 8mg oral or intravenous (omit if patient is already taking dexamethasone) - ondansetron 8mg oral or intravenous - domperidone 10mg three times a day when required for the relief of nausea Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday 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. Additional Information The National Patient Safety Alert on oral chemotherapy (NPSA/2008/RRR001) must be followed in relation to oral lomustine and procarbazine Procarbazine is a weak MAO inhibitor and therefore certain foodstuffs should be avoided. These foods include mature cheeses (including processed cheese, but cottage cheese and cream cheese are safe), yeast or meat extracts (Marmite, Oxo, Bovril), broad bean pods, pickled herring, salami sausage, flavoured textured vegetable protein, over-ripe fruit, alcoholic drinks (especially heavy red wines such as Chianti), non- alcoholic beers, lagers and wines, other foods that are not fresh, particularly if they have been fermented, pickled, smoked, “hung” (game), or “matured”, miso soup and large amounts of soy sauce. The National Patient Safety Agency report NPSA/2008/RRR04 must be followed in relation to intravenous administration of vinca alkaloids. Coding Procurement – X70.2 Delivery – X 72.3 Version 1.1 (Oct 2015) Page 4 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) References 1.Medical Research Council Brain Tumor Working Party: Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: A Medical Research Council trial. J Clin Oncol (2001); 19: 509-518 2.Levin VA, Silver P, Hannigan J et al. Superiority of post-radiotherapy adjuvant chemotherapy with CCNU, procarbazine, and vincristine (PCV) over BCNU for anaplastic gliomas: NCOG6G61 final report. Int J Radiat Oncol Biol Phys (1990); 18 (2): 321-4. Version 1.1 (Oct 2015) Page 5 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) REGIMEN SUMMARY LOMUSTINE-PROCARBAZINE-VINCRISTINE (PCV) Day 1 1. Dexamethasone 8mg oral or intravenous Administration Instructions Omit this dose if the patient is already taking dexamethasone. 2. Ondansetron 8mg oral or intravenous 3. Vincristine 1.4mg/m2 (maximum 2mg) intravenous bolus in 50ml sodium chloride 0.9% Take Home Medicines 1. Lomustine 100mg/m2 once a day for one day oral Administration Instructions Swallow whole with a full glass of water. Do not open or chew 2. Procarbazine 100mg/m2 once a day for ten days oral Administration Instructions Swallow whole with a full glass of water. Do not open or chew. Do not drink alcohol. Procarbazine is available as 50mg capsules. To facilitate alternate day dosing in Aria the dose will be rounded to the nearest 25mg (up if halfway). If the calculated dose is 125mg please dispense 150mg alternating with 100mg daily. If the calculated dose is 175mg please dispense 200mg alternating with 150mg daily. If the calculated dose is 225mg please dispense 250mg alternating with 200mg daily. 3. Domperidone 10mg three times a day when required oral 4. Co-trimoxazole 960mg once a day on Monday, Wednesday and Friday oral Administration Instructions Please supply 42 days Version 1.1 (Oct 2015) Page 6 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV) DOCUMENT CONTROL Version Date Amendment Dose rounding to 25mg added 1.1 Oct 2015 to procarbazine and administration instructions updated. 1 Oct 2015 None Written By Dr Deborah Wright Pharmacist Dr Deborah Wright Pharmacist Approved By Dr Omar Al Salihi Consultant Clinical Oncologist Dr Omar Al Salihi Consultant Clinical 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 Trust All actions have been taken to ensure these protocols are correct. However, it remains the responsibility of the prescriber to ensure the correct drugs and doses are prescribed for patients. Version 1.1 (Oct 2015) Page 7 of 7 CNS – Lomustine-Procarbazine-Vincristine (PCV)
Url: /Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/CNS/Lomustine-Procarbazine-Vincristine-PCV-ver-1.1.pdf

Your child's dermatology surgery appointment - patient information

Description: Your child’s dermatology surgery appointment Information for patients, parents and guardians Your child has been scheduled to have a minor surgical operation at: Piam Brown ward, G level, Southampton Children’s Hospital, Tremona Road, Southampton SO16 6YD. On the day of the operation, please report to the John Atwell Children's day ward on G level. The procedure will take place under local anaesthetic (meaning your child will be awake). This factsheet will help give you and your child an idea of what to expect and the preparations you should make. Planning your trip to and from Southampton Children’s Hospital We recommend that you allow plenty of time to get to the appointment. We plan our surgical appointment times carefully, but on occasion our doctors may be called away to deal with emergencies, and appointments can sometimes overrun. This could mean that you may experience a wait. We’ll always try to keep you informed about any delays that may affect your child’s appointment. If the nature and severity of your child’s medical condition means that they are unable to use private or public transport, they may be entitled to patient transport. If you think this is the case, contact your GP if they referred you for treatment, or the hospital department which has asked you to attend. We will perform the surgery near to a ward where there are children who are at risk of serious and life threatening illness if exposed to infection. We therefore ask that you telephone the department and do not attend if your child has had diarrhoea, vomiting, a temperature or if they have been unwell in the 72 hours before their appointment. Please do not attend if your child has never had chickenpox, but has been in contact with someone with chickenpox or shingles in the past three weeks. If your child has had chickenpox recently, all the chickenpox spots must have dried up for seven days before you attend your appointment. On the day of the appointment Eating and drinking On the day of the operation, we recommend that your child: • has some breakfast, even if the operation is first thing in the morning • eats normally and drinks plenty of fluids Medication • Your child should take all their regular medications as usual on the day of their surgery. • If they have been prescribed antibiotics to take before the operation, please follow the instructions about when to take them. • Please inform your child’s dermatology doctor if your child is taking any medication to thin their blood, or if they have any bleeding disorders. What to bring with you • A list of your child’s medications and any allergies. • Something which will occupy and put your child at ease during the procedure such as a toy, book, music with headphones or portable computer game. The operation itself Your child’s surgeon will explain the specific details regarding your child’s operation. The following points are a general guide: • your child must be accompanied on the day by a parent or legal guardian • the operation will be performed under local anaesthetic so your child will be awake • you can expect to stay on Piam Brown ward for one to two hours in total, depending on the complexity of the operation • a local anaesthetic cream will be applied to the skin approximately 30 minutes before surgery to help numb the area before the local anaesthetic injection • the local anaesthetic injection may be uncomfortable initially, usually for less than a minute, but sometimes longer for larger operations. Some procedures may require more than one injection. The local anaesthetic cream will reduce this discomfort and may even eliminate it • once the local anaesthetic is given, your child should not feel any pain, but some pressure or a pushing/ pulling sensation is normal • stitches will be inserted and a dressing applied, (though in some cases stitches may not be needed) After the operation When your child’s surgeon has finished the operation: • you will be given written instructions about caring for your child’s wound/s, including when and where they will need to have their stitches removed • you will be given contact details in the event of any concerns, but please ask if anything is unclear • your child may have a large bandage/dressing in place for a few days • bruising and swelling may occur initially, particularly after surgery on the face. This may include a ‘black eye’ • any surgery will leave a scar as the surgeon has cut into the skin, and possibly some numbness around the wound area, this usually improves with time • your child should continue to take all of their usual medications, unless you are advised otherwise Activities We recommend that after the operation your child: • goes home and rests – this will help to reduce the risk of any bleeding • does not swim, play sport or do heavy lifting until after their stitches have been removed. This is normally between 7 and 14 days after the operation Unexpected complications Complications which can occasionally occur include bleeding, a wound infection, or stitches coming open. You will be given written instructions about how to seek help if any of these occur. Results Your child’s results will be sent out in the post, along with details of their follow-up appointment, if one is required. This usually takes four to six weeks. Additional advice Depending on the location of the surgery, there may be some additional things to consider. If your child's surgery is: • Near the mouth: Your child will need to eat soft or ‘sloppy’ foods which require little chewing for two days after their operation. • Lower leg/foot/ankle: Your child will need to rest for up to two weeks, with their foot elevated as much as possible. It's helpful to bring a loose fitting shoe/sandal or slipper to fit over the bandages. • Face or scalp: – There may be a large bandage over your child’s head, so they may wish to wear a loose fitting hat or cap for the trip home. – Y our child will need to wear a top that opens at front, so that they don’t need to pull anything over their head. • Chest/abdomen/arms: Wearing a top that opens at the front will make dressing/undressing easier. Further information Should you have any questions or concerns, please don’t hesitate to call us for advice. Dermatology surgery bookings: 023 8054 0209 or 0759 John Atwell day ward: 023 8120 6157 Dermatology secretaries: 023 8054 0205 If you need a translation of this document, an interpreter or a version in large print, Braille or on audiotape, please telephone 023 8120 4688 for help. www.uhs.nhs.uk/childrenshospital Version 2. Published August 2019. Due for review August 2022. 1202 © 2019 University Hospital Southampton NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder.
Url: /Media/UHS-website-2019/Patientinformation/Childhealth/Your-childs-dermatology-surgery-appointment-1202-PIL.pdf

Health assessments for your baby - patient information

Description: We have written this factsheet to give you information about the different types of health assessments your baby will have shortly after they are born.
Url: /Media/UHS-website-2019/Patientinformation/Pregnancyandbirth/Health-assessments-for-your-baby.pdf

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Your child's dermatology surgery appointment - patient information

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