ION Breast Cancer Clinical Pathways - ION Solutions

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Paraplatin (Carboplatin) Taxotere (Docetaxel) +/- Avastin (Bevacizumab)EP=Moderate; FN=10%-20%Carboplatin AUC 6 D1Docetaxel 75mg/m 2 D1+/- Bevacizumab 15mg/kg D1q 21 Day Cycle>> J Clin Oncol 21:3016-3024, 2003>> Oncologist 15:1102-1112, 2010Paraplatin (Carboplatin) Gemzar (Gemcitabine) +/- Avastin (Bevacizumab)EP=Moderate; FN> J Clin Oncol 27:3217-3224, 2009Paraplatin (Carboplatin) Alimta (Pemetrexed) +/- Avastin (Bevacizumab)EP=Moderate; FN> J Clin Oncol 27:3217-3224, 2009>> J Thorac Oncol 6:506-512, 2006Navelbine (Vinorelbine) EP=Minimal; FN> J Clin Oncol 12:360-367, 1994>> J Clin Oncol 18:2354-2362, 2000Tarceva (Erlotinib)Erlotinib 150mg PO q DNote: Erlotinib is considered for first line when EGFR mutation is documented or inappropriate clinical picture (Asian, female, never-smoker, bronchioalveolar.)>> N Engl J Med 353:123-132, 2005Xalkori (Crizotinib)Crizotinib 250mg PO BID q DNote: indicated as a first line therapy for ALK+>> J Clin Oncol 29 (suppl abstract 7507), 2011Gemzar (Gemcitabine) Navelbine (Vinorelbine) EP=Low; FN> J Clin Oncol 22:2348-2356, 2004Page 26 of 39© 2013 by ION Solutions. All rights reserved
Gemzar (Gemcitabine) Taxotere (Docetaxel) EP=Low; FN=10%-20%Gemcitabine 1100mg/m 2 D1, D8Docetaxel 100mg/m 2 D8q 21 Day Cycle>> Lancet 357:1478-1484, 2001Clinical Trial:Screen patient for clinical trial. Check www.clinicaltrials.gov for available trials.Best Supportive Care and/or Hospice:Consider supportive care options and Hospice when appropriate.Note: Continuation of Bevacizumab, Pemetrexed or Gemcitabine beyond 4-6cycles and in the absence of disease progression is considered continuationmaintenance therapy.Note: Platinol (Cisplatin) is an appropriate substitution for Paraplatin(Carboplatin) in select patients.Note: For patient to receive Bevacizumab they must NOT have any of thefollowing: squamous cell carcinoma; clinically significant hemoptysis; receivinganticoagulants.Note: Drugs approved for second line metastatic disease for patients withcomorbidities precluding combination treatment.Note: Bevacizumab used with any appropriate combination is consideredcompliant.Non-Small Cell Lung (NSCL): Switch Maintenance TherapyMaintenance Therapy:Alimta (Pemetrexed) EP=Low; FN> Lancet 374:1432-40, 2009Tarceva (Erlotinib)Erlotinib 150mg PO q D>> Lancet Oncol 11:521, 2010Clinical Trial:Screen patient for clinical trial. Check www.clinicaltrials.gov for available trials.Page 27 of 39© 2013 by ION Solutions. All rights reserved
Page 1 and 2: ION SolutionsNational Physician Net
Page 3: Best Supportive Care and/or Hospice
Page 6 and 7: Chemotherapy:Taxotere (Docetaxel) A
Page 8 and 9: Taxotere (Docetaxel) Paraplatin (Ca
Page 10 and 11: Taxotere (Docetaxel) EP=Low; FN=10%
Page 12 and 13: Herceptin (Trastuzumab) Followed by
Page 14 and 15: Herceptin (Trastuzumab) Taxotere (D
Page 16 and 17: Colon: First Line MetastaticChemoth
Page 18 and 19: 5-FU (5-Fluorouracil) Leucovorin +/
Page 20 and 21: Note: Wild Type KRAS documentation
Page 22 and 23: Camptosar (Irinotecan) Avastin (Bev
Page 24 and 25: Adjuvant Non-Small Cell Lung (NSCL)
Page 28 and 29: Best Supportive Care and/or Hospice
Page 30 and 31: Clinical Trial:Screen patient for c
Page 32 and 33: Small Cell Lung: Extensive Disease
Page 34 and 35: Paraplatin (Carboplatin) VP-16 (Eto
Page 36 and 37: Anti-EmeticsEmetogenic Risk:High Em
Page 38 and 39: Lung CancerPage 38 of 39© 2013 by

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