Docetaxel / Cisplatin / Fluorouracil - East Midlands Cancer Network

Leicestershire, Northamptonshire &Rutland Cancer NetworkRegimen Name:Docetaxel / Cisplatin / FluorouracilINDICATION:Locally Advanced Unresectable Head & Neck CancerDRUG REGIMEN:Day 1: Docetaxel 75mg/m 2Cisplatin 75mg/m 2Day 1 to 4 Fluorouracil 1g/m 2 per day by continuous infusionCycle frequency: Repeat every 21 days from day 1Number of cycles: Up to 4 cycles followed by radiotherapy or surgery.ANTI EMETIC GUIDELINES:Very HighCONCURRENT MEDICATION:Pre-medication with 8mg bd dexamethasone for 3 days starting the day before chemotherapyDOSE MODIFICATIONS:Counts Give DiscussNeutrophils x 10 9 /L 1.5 2.5xULN give 75mg/m 2 , if bilirubin> 22 +/- ALT /AST3.5x ULN + ALP> 6x ULN omit.Cisplatin: No dose reduction necessary5FU:If bilirubin >85 or AST >180 clinical decision consider 50% dose reduction and increase ifno toxicity.Document Code: LNRCN/DC/0004/I/07 Date of Issue: Sept 07 Review Date: Sept 09Written By: C Elwell / C Clarke Authorised By: MMG 3 Aug 07 Page Number: 1/2Issue Number: 1Website: Check www.eastmidlandscancernetwork.nhs.uk for latestversionDocetaxel-Cisplatin-Fluorouracil

Leicestershire, Northamptonshire &Rutland Cancer NetworkOther side effects:If febrile neutropenia, or ANC < 0.5 for over a week dose should be reduced to 60mg/m 2If reactions continue either reduce to 45mg/m 2 or discontinueFor severe or cumulative cutaneous reactions, or severe peripheral neuropathy dose should bereduced to 60mg/m 2For dose modifications for gastrointestinal toxicities see table belowToxicityDosage adjustmentDiarrhoea grade 3 First episode: reduce 5-FU dose by 20%.Second episode: then reduce TAXOTERE dose by 20%.Diarrhoea grade 4 First episode: reduce TAXOTERE and 5-FU doses by 20%.Second episode: discontinue treatment.Stomatitis grade 3 First episode: reduce 5-FU dose by 20%.Second episode: stop 5-FU only, at all subsequent cycles.Stomatitis grade 4Third episode: reduce TAXOTERE dose by 20%.First episode: stop 5-FU only, at all subsequent cycles.Second episode: reduce TAXOTERE dose by 20%.If patient complains of tinnitus/hearing loss discuss with SpR or Consultant beforeadministrationINVESTIGATIONS:• FBC• Biochemistry• For medical review Assess tumour response after every 2 cycles• Consider PEG feeding• Consider PICC lineSIDE EFFECTS:Reduced immunity, with possible life-threatening infection, allergic reaction, bruising/bleeding,diarrhoea, effects on fertility, fluid retention, hair loss, lethargy, loss of appetite, sore mouth,muscle/joint pain, nail ridges, nausea, pins and needles, rashes, skin sensitivity, taste changes.REFERENCES:Vermorken JB et al, J Clin Oncol 2004;2214sPosner M The Oncologist 2005; 10(suppl 3): 11-19.Document Code: LNRCN/DC/0004/I/07 Date of Issue: Sept 07 Review Date: Sept 09Written By: C Elwell / C Clarke Authorised By: MMG 3 Aug 07 Page Number: 2/2Issue Number: 1Website: Check www.eastmidlandscancernetwork.nhs.uk for latestversionDocetaxel-Cisplatin-Fluorouracil