Cancer Protocol Summary for Treatment of Malignant Mesothelioma

DOSE MODIFICATIONS: 1. Hematology: For gemcitabine day 1 of each cycle ANC (x 109 /L) Platelets (x 109 /L) Dose greater than or equal to 1.0 and greater than or equal to 100 100% 0.5 to less than 1.0 or 75 to less than 100 75% less than 0.5 or less than 75 Delay* *Platinum also delayed For gemcitabine day 8 of each cycle ANC (x 109 /L) Platelets (x 109 /L) Dose** greater than or equal to 1.0 and greater than or equal to 100 100% 0.5 to less than 1.0 or 75 to less than 100 75% less than 0.5 or less than 75 Omit **Dose adjustment only for the day of treatment the CBC is drawn 2. Renal Dysfunction: Calculated Cr Clearance (mL/min) CISplatin dose Gemcitabine dose greater than or equal to 60 100% 100% 45 to less than 60 80% CISplatin or go to CARBOplatin option (same prehydration as 75 mg/m2 dose) 100% less than 45 Hold CISplatin or delay with additional IV fluids or go to CARBOplatin option 75% less than 30 Omit Omit BC Cancer Protocol Summary LUMMPG Page 2 of 4 Activated: 1 Dec 2004 Revised: 1 Jun 2019 (institutional name, contact physician, tests) Warning: The information contained in these documents are a statement of consensus of BC Cancer professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer’s terms of use available at www.bccancer.bc.ca/legal.htm 3. Other Toxicities: for gemcitabine only Grade Stomatitis Diarrhea Dose 1 Painless ulcers, erythema or mild soreness Increase of 2 to 3 stools/day 100% 2 Painful erythema, edema, or ulcers but can eat Increase of 4 to 6 stools, or nocturnal stools Omit until toxicity resolved then resume at 100% 3 Painful erythema, edema, or ulcers and cannot eat Increase of 7 to 9 stools/day or incontinence, malabsorption Omit until toxicity resolved then resume at 75% 4 Mucosal necrosis, requires parenteral support Increase of greater than or equal to 10 stools/day or grossly bloody diarrhea requiring parenteral support Omit until toxicity resolved then resume at 50% Alternatively, CARBOplatin may be used instead of CISplatin: DRUG DOSE BC Cancer Administration Guidelines CARBOplatin AUC 5 or 6 on DAY 1 Dose = AUC† x (GFR* + 25) IV in 250mL NS over 30 minutes. When CARBOplatin is used, gemcitabine dose should be reduced: gemcitabine 1000 mg/m2 /day on days 1 and 8 (total dose per cycle = 2000 mg/m²) IV in 250 mL NS over 30 min †determined at discretion of the attending medical oncologist  Repeat every 21 days x 6 cycles *GFR may be determined by nuclear renogram or estimated by the Cockcroft formula, at the discretion of the attending physician: GFR = N x (140-age in years) x wt (kg) N = 1.04 (women) or 1.23 (men) serum creatinine (micromol/L) The estimated GFR should be capped at 125 mL/min when it is used to calculate the initial CARBOplatin dose. When a nuclear renogram is available, this clearance would take precedence. PRECAUTIONS: 1. Neutropenia: Fever or other evidence of infection must be assessed promptly and treated aggressively. 2. Renal Toxicity: Nephrotoxicity is common with CISplatin. Encourage oral hydration. Avoid nephrotoxic drugs such as aminoglycoside antibiotics. Irreversible renal failure associated with hemolytic uremic syndrome may occur (rare) with gemcitabine. Use caution with preexisting renal dysfunction. 3. Pulmonary Toxicity: Acute shortnes