What are the key components of a chemotherapy cheat sheet?

Comprehensive Chemotherapy Cheat Sheet

A comprehensive chemotherapy cheat sheet should include medication dosing, administration schedules, antiemetic protocols, common toxicities, and supportive care measures to optimize patient outcomes while minimizing adverse effects.

Essential Components of a Chemotherapy Cheat Sheet

1. Chemotherapy Regimens by Cancer Type

• Breast Cancer Regimens

  • Anthracyclines:

    • Doxorubicin 60-75 mg/m² IV day 1, cycled every 21 days
    • Epirubicin 60-90 mg/m² IV day 1, cycled every 21 days
    • Pegylated liposomal doxorubicin 50 mg/m² IV day 1, cycled every 28 days 1

  • Taxanes:

    • Paclitaxel 175 mg/m² IV day 1, cycled every 21 days
    • Paclitaxel 80 mg/m² IV weekly
    • Docetaxel 60-100 mg/m² IV day 1, cycled every 21 days
    • Albumin-bound paclitaxel 260 mg/m² IV, cycled every 21 days 1

  • Combination Regimens:

    • AC (doxorubicin/cyclophosphamide)
    • EC (epirubicin/cyclophosphamide)
    • CAF/FAC (cyclophosphamide/doxorubicin/fluorouracil)
    • FEC (fluorouracil/epirubicin/cyclophosphamide)
    • AT (doxorubicin/docetaxel or doxorubicin/paclitaxel) 1

• Gastric Cancer Regimens

  • ECF (epirubicin, cisplatin, and 5-FU)
  • DCF (docetaxel, cisplatin, and 5-FU)
  • FOLFOX (fluorouracil, leucovorin, oxaliplatin) 1

• Multiple Myeloma Regimens

  • Bortezomib, melphalan, and prednisone 1
  • Melphalan plus prednisone 1

2. Antiemetic Protocols Based on Emetogenic Potential

• High Emetogenic Risk Chemotherapy (HEC)

  • Day 1 (before chemotherapy):
    • 5-HT3 antagonist (choose one):
      • Palonosetron 0.25 mg IV (preferred)
      • Ondansetron 16-24 mg PO or 8-24 mg IV
      • Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1 mg) IV
    • Dexamethasone 12 mg PO or IV
    • NK1 antagonist (choose one):
      • Aprepitant 125 mg PO day 1, then 80 mg PO days 2-3
      • Fosaprepitant 150 mg IV day 1 only
    • ± Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6h PRN 1

• Moderate Emetogenic Risk Chemotherapy (MEC)

  • Day 1:
    • 5-HT3 antagonist (same options as HEC)
    • Dexamethasone 8 mg PO or IV
    • Consider NK1 antagonist for select patients (e.g., carboplatin)
  • Days 2-3:
    • Dexamethasone 8 mg PO daily or 5-HT3 antagonist 1

• Low Emetogenic Risk Chemotherapy

  • Dexamethasone 12 mg PO or IV daily
  • Or metoclopramide 10-40 mg PO or IV Q4-6h PRN
  • Or prochlorperazine 10 mg PO or IV Q4-6h PRN 1

3. Common Toxicities and Management

• Myelosuppression

  • High-risk regimens for febrile neutropenia (>20% risk):

    • TAC (docetaxel, doxorubicin, cyclophosphamide)
    • BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone)
    • RICE (rituximab, ifosfamide, carboplatin, etoposide) 1

  • Patient risk factors for febrile neutropenia:

    • Age ≥65 years
    • Previous chemotherapy or radiation
    • Preexisting neutropenia or bone marrow involvement
    • Poor performance status
    • Poor renal/liver function 1

• Gastrointestinal Toxicity

  • Nausea/vomiting: Follow antiemetic protocols based on emetogenic potential
  • Mucositis: Oral care protocols, pain management
  • Diarrhea: Loperamide, hydration 2, 3

• Neurological Toxicity

  • Peripheral neuropathy: Dose modifications, gabapentin, duloxetine
  • Cognitive effects ("chemo brain"): Cognitive rehabilitation 3

• Cardiovascular Toxicity

  • Anthracycline-induced cardiotoxicity: Monitor LVEF, consider dexrazoxane
  • Thromboembolic events: Prophylaxis in high-risk patients 3

4. Supportive Care Measures

• Hydration Protocols

  • Pre/post-hydration for nephrotoxic agents (cisplatin, high-dose methotrexate)
  • Monitoring for electrolyte imbalances 1

• Growth Factor Support

  • Primary prophylaxis with G-CSFs for high-risk regimens
  • Secondary prophylaxis for patients with previous neutropenic complications 1

• Hypersensitivity Reaction Management

  • Premedication protocols for taxanes, platinum agents
  • Emergency protocols for anaphylaxis
  • Desensitization protocols for patients with previous reactions 1

5. Administration Considerations

• Scheduling and Timing

  • Precise timing for multi-day regimens
  • Sequencing of medications (pre-meds, chemotherapy, post-meds)
  • Cycle length and treatment breaks 4

• Vascular Access

  • Peripheral vs. central line considerations
  • Vesicant administration precautions 5

• Dose Modifications

  • Criteria for dose reductions based on toxicities
  • Renal/hepatic dose adjustments 5

Implementation Tips

• Organize the cheat sheet by cancer type for quick reference 6
• Include a section for emergency management of complications 1
• Incorporate a quick reference for dose calculations and adjustments 5
• Add common drug interactions and contraindications 7
• Include monitoring parameters and laboratory test schedules 3

Common Pitfalls to Avoid

• Failure to verify dosing calculations - Always double-check BSA calculations and dose modifications 4
• Inadequate antiemetic prophylaxis - Match antiemetic regimen to the emetogenic potential of the chemotherapy 1
• Overlooking cumulative toxicities - Track lifetime doses of cardiotoxic drugs like anthracyclines 3
• Neglecting supportive care - Proactive management of side effects improves outcomes and quality of life 2
• Improper sequencing of medications - Follow protocol-specific administration sequences 4

By incorporating these key components into a chemotherapy cheat sheet, healthcare providers can optimize the safety and efficacy of chemotherapy administration while minimizing adverse effects and improving patient outcomes.