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Docetaxel 75 / Cisplatin 75, Non-Small Cell Lung Carcinoma

Protocol-ID: 144 V1.1 (Complete), DOCE75/CISP75, NSCLC

Indication(s)

  • Lung Carcinoma, Non-Small Cell; ICD-10 C34.-

Protocol classification

  • Classification: current standard
  • Intensity: Standard dose
  • Therapy mode: First line
  • Therapy intention: palliative

Cycles

Cycle length 21 days, recommended cycles: 6

Risks

  • Emetogenicity (MASCC/ESMO): high (>90%)
  • Neutropenia: very high (>41%)
  • Febrile Neutropenia: intermediate (10-20%)
  • Thrombocytopenia below 50 000/µl: low (<10%)
  • Anemia Hb below 8g/dl: moderate (6-15%)
  • Cardiotoxicity: low (<10%)

Therapy

AP
Allergy prophylaxis: Docetaxel allergy prophylaxis, Dexamethasone
Access: - none -
Docetaxel SmPC
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
-1 Dexamethasone 8 mg  p.o. 1-0-1-0 
From day before therapy with Docetaxel, antihistamine therapy not provided for in summary of product characteristics.
HYD
Hydration: Hydration to Cisplatin (from 50 mg/m²)
Access: peripheral venous
Modified from Crona DJ et al 2017 and Hamroun A et al 2019.
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
1 Balanced Crystalloid Solution 3000 ml   i.v.6 h60 min before Docetaxel (d1) 
Parallel to cisplatin and beyond. 20 mmol KCl and 4 mmol (10 ml) MgSO4 added to 1000 ml balanced crystalloid solution
1 Potassium chloride 60 mmol none  i.v.6 h60 min before Docetaxel (d1) 
1 Magnesium sulfate 12 mmol none  i.v.6 h60 min before Docetaxel (d1) 
AE
Antiemesis: Emetogenicity high, FOSAP, GRAN i.v., DEXA i.v.
Access: peripheral venous
DGHO 2016, DKG 2016, MASCC/ESMO 2016
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
1 Fosaprepitant 150 mg NaCl 0.9% 150 ml i.v.20 min30 min before Docetaxel (d1) 
1 Dexamethasone 12 mg NaCl 0.9% 50 ml i.v.5 min30 min before Docetaxel (d1) 
1 Granisetron 1 mg NaCl 0.9% 50 ml i.v.5 min15 min before Docetaxel (d1) 
or other 5-HT3 receptor antagonist
2-4 Dexamethasone 8 mg  p.o. 1-0-0-0 
alternatively 4 mg 1-0-1
CTX
Medical tumor therapy: CISP75/DOCE75
Access: peripheral venous
Palliative therapy in advanced NSCLC
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
1 Docetaxel 75 mg/m² BSA NaCl 0.9% 250 ml i.v.60 minSequence 
Give docetaxel concurrently with hydration before cisplatin.
1 Cisplatin 75 mg/m² BSA NaCl 0.9% 500 ml i.v.60 minSequence 
HW
Hematopoietic growth factors: FN risk 10-20%, G-CSF long-acting, pegylated
Access: - none -
Risk of febrile neutropenia (FN) 10-20% and 1 risk factor: age > 65 y, laboratory parameters (anemia, lymphocytopenia < 700/µl, hypalbuminemia, hyperbilirubinemia) previous chemotherapy, comorbidities, low performance status, advanced symptomatic tumor disease (DKG 2016)
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
2 Pegfilgrastim 6 mg   subcBolus24 h after Cisplatin (d1) 
Use at risk: FN 10-20% and 1 risk factor, other long-acting G-CSF possible.
SUP
Supportive therapy: Magnesium p.o.
Access: - none -
For magnesium substitution in cisplatin therapies from 50mg/m².
DaySubstanceDosageSolutionAppl.Inf. timeProcedure
1-3 Magnesium 150 mg  p.o. 1-0-1-0 
For Cisplatin-containing therapies, 150 mg Magnesium corresponds to about 6.2 mmol.

Concomitant therapy supplements

Dexamethasone of allergy prophylaxis is covered by dexamethasone of antiemesis on days 1 and 2.

Notes

in case of response 4-6 cycles, maximum 6

Cycle diagram

Allergy prophylaxis: Docetaxel allergy prophylaxis, Dexamethasone

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Dexamethasone (p.o.)              

Hydration: Hydration to Cisplatin (from 50 mg/m²)

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Balanced Crystalloid Solution (i.v.)              
Potassium chloride (i.v.)              
Magnesium sulfate (i.v.)              

Antiemesis: Emetogenicity high, FOSAP, GRAN i.v., DEXA i.v.

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Fosaprepitant (i.v.)              
Dexamethasone (i.v.)              
Granisetron (i.v.)              
Dexamethasone (p.o.)              

Medical tumor therapy: CISP75/DOCE75

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Docetaxel (i.v.)              
Cisplatin (i.v.)              

Hematopoietic growth factors: FN risk 10-20%, G-CSF long-acting, pegylated

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Pegfilgrastim (subc)              

Supportive therapy: Magnesium p.o.

Week -1 / dWeek 1 / d
Substance -7-6-5-4-3-2-11234567
Magnesium (p.o.)              

Cycles

Cycle length 21 days, recommended cycles: 6

Controls:

  • Blood count: 1x weekly
  • Audiogram Ototoxicity of cisplatin
  • Echocardiography, ECG Evaluation of cardiac pump function before cisplatin therapy.
  • Day 1: Creatinine, glomerular filtration rate (GFR) Exclusion of renal insufficiency before cisplatin.
  • Day 1: GOT, GPT, GGT, Bilirubin, AP, Cholinesterase Liver function prior to Docetaxel and Cisplatin administration, ongoing liver monitoring during therapy.
  • Day 1,2: Na+, K+, Ca2+, Mg2+ Exclusion of electrolyte imbalance during cisplatin and infusion therapy.
  • Day 1-2: Weight

Original indication

Non-small cell lung Ca Std IIIb, IV or recurrence.

Original author

Joan H. Schiller (2002)

Origin

Eastern Cooperative Oncology Group

References

  • Schiller JH, Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer., N Engl J Med 2002 Jan 10;346(2):92-8 [PMID]
  • Millward MJ, Phase I trial of docetaxel and cisplatin in previously untreated patients with advanced non-small-cell lung cancer., J Clin Oncol. 1997 Feb;15(2):750-8 [PMID]
  • Fossella F, Randomized, multinational, phase III study of docetaxel plus platinum combinations versus vinorelbine plus cisplatin for advanced non-small-cell lung cancer: the TAX 326 Study Group, J Clin Oncol. 2003 Aug 15;21(16):3016-24. Epub 2003 Jul 1. [PMID]
  • Novello S, Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up., Ann Oncol 2016 Sep;27(suppl 5):v1-v27 [PMID]

Recommendations

Status

Valid since 2023-02-22, Version 1.1, last updated 2023-02-22

Last modification: V1.1: Hydration update according to Crona 2017 and Hamroun 2019. V1.0: Cato test done. Hydration modified to Cisplatin, substances of the fluid module merged for Cato export. V0.1: Run times and dosing according to Milward 1997.

Important notice

The copyrighted protocols are treatment recommendations. The information contained in this compilation on cytostatic drugs, concomitant medication and other therapeutic procedures, as well as dosage and application information, is continuously reviewed with all due care by the authors and editors involved. Nevertheless, the publishers and authors do not assume any liability for the correctness - also with regard to possible printing errors.

The protocols may not be changed in terms of content.

Diagnosis, indication for therapy and treatment of malignant diseases must be carried out in each individual case by the hematologist and oncologist on his or her own responsibility. The treating physician is obligated to this personal responsibility to weigh in each case before a diagnostic or therapeutic measure, indication, contraindications, dosage and application under consideration of the specialized information or other documents of the manufacturers. This applies in particular to rarely used preparations or preparations that are new to the market.

The publishers and authors assume no liability for the accuracy of the contents. The application is at the own responsibility of the treating physician. ©Onkopti.