Paclitaxel and Ramucirumab Dosing Calculation for Patient
For a patient with height 174 cm and weight 85 kg, the recommended doses are: paclitaxel 80 mg/m² on days 1,8, and 15, and ramucirumab 8 mg/kg on days 1 and 15 of a 28-day cycle.
Body Surface Area and Weight-Based Calculations
Step 1: Calculate Body Surface Area (BSA)
Using the Mosteller formula (preferred for accuracy at various body sizes 1):
- BSA = √[(Height(cm) × Weight(kg))/3600]
- BSA = √[(174 × 85)/3600]
- BSA = √(14,790/3600)
- BSA = √4.1083
- BSA = 2.03 m²
Step 2: Calculate Paclitaxel Dose
- Standard dose: 80 mg/m² on days 1,8, and 15 of a 28-day cycle 2
- Calculated dose: 80 mg/m² × 2.03 m² = 162.4 mg per administration
- Round to 162 mg on days 1,8, and 15
Step 3: Calculate Ramucirumab Dose
- Standard dose: 8 mg/kg on days 1 and 15 of a 28-day cycle 2
- Calculated dose: 8 mg/kg × 85 kg = 680 mg per administration
Administration Schedule
- Paclitaxel: 162 mg IV on days 1,8, and 15 of each 28-day cycle
- Ramucirumab: 680 mg IV on days 1 and 15 of each 28-day cycle
Important Considerations
Toxicity Management
- Monitor for neutropenia, which is the most common grade 3-4 adverse event (26% incidence with this regimen) 2
- Watch for peripheral neuropathy (6% grade 3-4) and arterial hypertension (6% grade 3-4) 3
- If toxicity occurs, modify paclitaxel dose while maintaining ramucirumab dosing when possible 4
Dose Adjustments
- Paclitaxel dose can be reduced or temporarily withheld if neutropenia or neuropathy develops
- Maintaining the ramucirumab dose while adjusting paclitaxel has been shown to be effective for managing toxicity while preserving treatment efficacy 4
Monitoring Requirements
- Complete blood count before each administration
- Blood pressure monitoring
- Regular neurological assessment for signs of peripheral neuropathy
This dosing regimen has demonstrated significant survival benefits in patients with gastric and gastroesophageal junction cancers, with a median progression-free survival of 6.6 months compared to 3.5 months with other regimens 3.