ANAL CANCER - Jones & Bartlett Learning

1 10/16/06 11:34 AM Page 1. ANAL CANCER . 5- fluorouracil Mitomycin Radiation Therapy (Wayne State regimen)..2. 5- fluorouracil : 1000 mg/m2/day IV continuous infusion on days 1 4 and 29 32. Mitomycin: 15 mg/m2 IV on day 1. A. Radiation therapy: 200 cGy/day on days 1 5, 8 12, and 5 19 (total dose, 3000 cGy). Chemotherapy is given concurrently with radiation therapy1,2. 5- fluorouracil Mitomycin Radiation Therapy (European Organization for Research and Treatment of CANCER [EORTC] regimen) ..3. 5- fluorouracil : 750 mg/m2/day IV continuous infusion on days 1 5 and 29 33.

2 Mitomycin: 15 mg/m2 IV on day 1. Radiation therapy: 180 cGy/day over 5-week period (total dose, 4500 cGy). Chemotherapy is given concurrently with radiation therapy. If partial or complete response occurs, a boost of 1500 2000 cGy is given1 3. 5- fluorouracil Cisplatin Radiation Therapy (MD Anderson Regimen) ..4. 5- fluorouracil : 250 mg/m2/day IV continuous infusion on days 1 5 of each week of radiation therapy Cisplatin: 4 mg/m2/day IV continuous infusion on days 1 5 of each week of radiation therapy Radiation therapy: Total dose, 5500 cGy over 6 weeks Chemotherapy is given concurrently with radiation therapy1 4.

3 Metastatic Disease and/or Salvage Chemotherapy 5- fluorouracil Cisplatin ..5. 5- fluorouracil : 1000 mg/m2/day IV continuous infusion on days 1 5. Cisplatin: 100 mg/m2 IV on day 2. Repeat cycle every 21 28 5. 1. 10/16/06 11:34 AM Page 2. 2 Anal CANCER 5-FU Mitomycin Radiation Therapy (Wayne State Regimen). Baseline laboratory tests: CBC: Chemistry and carcinoembryonic antigen (CEA). Baseline procedures or tests: Central line placement Initiate IV: sodium chloride Premedicate: 5-HT3 and dexamethasone 10 in 100 cc of normal saline (NS). Administer: fluorouracil _____mg (1000 mg/m2/day) IV continuous infusion days 1 4 and 29 32.

4 Available in solution as 50 mg/mL. No dilution required. Can be further diluted with sodium chloride or 5% dextrose and water (D5W). AND. Mitomycin _____ mg (15 mg/m2) IV on day 1. Potent vesicant Available in 5-, 20-, and 40-mg vials for IV use. Dilute with sterile water to give a final concentration of mg/mL. Reconstituted solution is stable for 14 days if refrigerated or 7 days at room temperature. Radiation therapy: 200 cGy/day on days 1 5, 8 12, and 15 19 (total dose, 3000 cGy). Chemotherapy is given concurrently with radiation therapy.

5 Major Side Effects Bone Marrow Depression: Dose limiting and cumulative toxicity, with leukopenia being more common than thrombocytopenia. Nadir counts are delayed at 4 6 weeks. Gastrointestinal Toxicities: Nausea and vomiting usually mild to moderate. Mucositis and diarrhea can be severe and dose limiting. Skin: Mitomycin causes tissue necrosis and chemical thrombophlebitos if extravasated. Local tissue irritation progressing to desquamation can occur in radiation (XRT) fields. Do not use oil-based lotions or creams in radiation field. Hyperpigmentation, photosen- sitivity, and nail changes may occur.

6 Hand-foot syndrome can be dose limiting. Ocular: Photophobia, increased lacrimation, acute and chronic conjunctivitis, blepharitis, and blurred vision. Pulmonary: Interstitial pneumonitis. Presents with dyspnea, non-productive cough, and interstitial infiltiates on CXR. Hemolytic-uremic Syndrome: Hematocrit 25%, platelets 100 103/mm3, and renal failure (serum creatinine mg/dL). Rare event ( 2%). Reproductive: Pregnancy category D. Breast feeding should be avoided. Initiate antiemetic protocol: Mild to moderately emetogenic protocol. Supportive drugs: pegfilgrastim (Neulasta) filgrastim (Neupogen).

7 Epoetin alfa (Procrit) darbepoetin alfa (Aranesp). Treatment schedule: Chair time 1 hour on days 1 and 29. Total cycle 32 days. Estimated number of visits: Five visits per treatment course. Dose Calculation by: 1. _____ 2. _____. _____ _____. Physician Date _____ _____. Patient Name ID Number _____ _____/ _____/ _____. Diagnosis Ht Wt M2. 10/16/06 11:34 AM Page 3. Anal CANCER 3. 5-FU Mitomycin Radiation Therapy (EORTC Regimen). Baseline laboratory tests: CBC: Chemistry and CEA. Baseline procedures or tests: Central line placement Initiate IV: sodium chloride Premedicate: 5-HT3 and dexamethasone 10 in 100 cc of NS.

8 Administer: fluorouracil _____mg (750 mg/m2/day) IV continuous infusion days 1 5 and 29 33. Available in solution as 50 mg/mL. No dilution required. Can be further diluted with sodium chloride or D5W. AND. Mitomycin _____ mg (15 mg/m2) IV bolus on day 1. Available in 5-, 20-, and 40-mg vials for IV use. Potent vesicant Dilute with sterile water to give a final concentration of mg/mL. Reconstituted solution stable for 14 days refrigerated or 7 days at room temperature. Radiation therapy: 180 cGy/day over 5 week period. Total dose, 4500 cGy over 5 weeks Chemotherapy is given concurrently with radiation therapy.

9 If partial or complete response seen, a boost of 1500 2000 cGy is given. Major Side Effects Bone Marrow Depression: Dose limiting, and cumulative toxicity with leukopenia more common than thrombocytopenia. Nadir counts are delayed at 4 6 weeks. Gastrointestinal (GI) Toxicities: Nausea and vomiting usually mild to moderate. Mucositis and diarrhea can be severe and dose limiting. Skin: Mitomycin causes tissue necrosis if extravasated. Local tissue irritation progressing to desquamation can occur in XRT fields. Do not use oil-based lotions or creams in radi- ation field.

10 Hyperpigmentation, photosensitivity, and nail changes may occur. Hand-foot syndrome can be dose limiting. Ocular: Photophobia, increased lacrimation, acute and chronic conjunctivitis, blepharitis, and blurred vision. Pulmonary: Interstitial pneumonitis. Presents with dyspnea, non-productive cough, and interstitial infiltiates on CXR. Hemolytic-uremic syndrome: Hematocrit 25%, platelets 100 103/mm3, and renal failure (serum creatinine mg/dL). Rare event ( 2%). Reproductive: Pregnancy category D. Breast feeding should be avoided. Initiate antiemetic protocol: Mild to moderately emetogenic protocol.