Chemotherapy Regimens and Management

Introduction to Chemotherapy Regimens

• The National Comprehensive Cancer Network recommends breast cancer regimens including anthracyclines, taxanes, and combination regimens such as AC, EC, CAF/FAC, FEC, and AT 1, 2, 3
• The National Comprehensive Cancer Network recommends gastric cancer regimens including ECF, DCF, and FOLFOX 4, 5
• The National Comprehensive Cancer Network recommends multiple myeloma regimens including bortezomib, melphalan, and prednisone, and melphalan plus prednisone 1, 5, 6

Antiemetic Protocols

• The National Comprehensive Cancer Network recommends antiemetic protocols for high emetogenic risk chemotherapy, including 5-HT3 antagonists, dexamethasone, and NK1 antagonists 7
• The National Comprehensive Cancer Network recommends antiemetic protocols for moderate emetogenic risk chemotherapy, including 5-HT3 antagonists and dexamethasone 7
• The National Comprehensive Cancer Network recommends antiemetic protocols for low emetogenic risk chemotherapy, including dexamethasone, metoclopramide, or prochlorperazine 7

Common Toxicities and Management

• The National Comprehensive Cancer Network identifies high-risk regimens for febrile neutropenia, including TAC, BEACOPP, and RICE 3, 9
• The National Comprehensive Cancer Network recommends management of myelosuppression, including growth factor support and dose modifications 1, 5, 9
• The National Comprehensive Cancer Network recommends management of gastrointestinal toxicity, including nausea/vomiting, mucositis, and diarrhea 4, 6, 7
• The National Comprehensive Cancer Network recommends management of neurological toxicity, including peripheral neuropathy and cognitive effects 1, 6

Supportive Care Measures

• The National Comprehensive Cancer Network recommends hydration protocols, including pre/post-hydration for nephrotoxic agents and monitoring for electrolyte imbalances 1
• The National Comprehensive Cancer Network recommends growth factor support, including primary and secondary prophylaxis with G-CSFs 5, 9
• The National Comprehensive Cancer Network recommends hypersensitivity reaction management, including premedication protocols and emergency protocols for anaphylaxis 1, 7

Administration Considerations

• The National Comprehensive Cancer Network recommends precise timing for multi-day regimens and sequencing of medications 1, 2, 7
• The National Comprehensive Cancer Network recommends considerations for vascular access, including peripheral vs. central line considerations 4, 9
• The National Comprehensive Cancer Network recommends dose modifications based on toxicities and renal/hepatic dose adjustments 1, 2