What is a common chemotherapy protocol?

Common Chemotherapy Protocols

The most common chemotherapy protocols include multiagent regimens based on the Berlin-Frankfurt-Münster (BFM) approach for acute lymphoblastic leukemia, hyper-CVAD for lymphoblastic malignancies, and various combination regimens for solid tumors such as TAC, AC-T, and TC for breast cancer. 1

Acute Lymphoblastic Leukemia (ALL) Protocols

BFM/COG Regimen (Standard 4-drug induction)

• Vincristine 2
• Anthracycline (daunorubicin or doxorubicin) 1
• Corticosteroid (prednisone or dexamethasone) 1
• L-asparaginase 3

Hyper-CVAD Regimen

• Cycles of fractionated cyclophosphamide 1
• Vincristine 2
• Doxorubicin 1
• Dexamethasone 1
• Alternating with cycles of high-dose methotrexate and cytarabine 1
• Includes intrathecal methotrexate for CNS prophylaxis 1

Breast Cancer Protocols

TAC (Preferred Adjuvant)

• Docetaxel, 75 mg/m² IV, day 1 1
• Doxorubicin, 50 mg/m² IV, day 1 1
• Cyclophosphamide, 500 mg/m² IV, day 1 1
• Cycled every 21 days for 6 cycles (with filgrastim support) 1

Dose-dense AC followed by Paclitaxel

• Doxorubicin, 60 mg/m² IV, day 1 1
• Cyclophosphamide, 600 mg/m² IV, day 1 1
• Cycled every 14 days for 4 cycles 1
• Followed by Paclitaxel, 175 mg/m² by 3-hour IV, day 1 1, 4
• Cycled every 14 days for 4 cycles (with filgrastim support) 1

TC Chemotherapy

• Docetaxel, 75 mg/m² IV, day 1 1
• Cyclophosphamide, 600 mg/m² IV, day 1 1
• Cycled every 21 days for 4 cycles 1

Ewing Sarcoma Protocols

VDC/IE (First-line treatment)

• VDC: Vincristine, Doxorubicin, Cyclophosphamide 1
• Alternating with IE: Ifosfamide, Etoposide 1, 5
• Two-weekly interval-compressed schedule is more effective than three-weekly 1

Lymphoma Protocols

COPADM (For lymphoblastic lymphoma)

• Cyclophosphamide 1
• Vincristine 1, 2
• Prednisone 1
• Doxorubicin 1
• High-dose methotrexate 1

Medulloblastoma Protocols

For Average Risk

• Weekly vincristine with radiotherapy 1
• Followed by maintenance with cisplatin, lomustine, vincristine or cisplatin, cyclophosphamide, vincristine 1

For High Risk

• Carboplatin during radiotherapy (especially for Group 3 tumors) 1
• Maintenance with cisplatin, cyclophosphamide, and vincristine 1

Important Considerations

Dosing and Administration

• Chemotherapy dosing is typically based on body surface area (m²) 1
• Many regimens require growth factor support (filgrastim) to manage myelosuppression 1
• Etoposide must be diluted prior to use with either 5% Dextrose Injection or 0.9% Sodium Chloride Injection to a final concentration of 0.2 to 0.4 mg/mL 5

Treatment Phases for ALL

• Induction: Reduces tumor burden by clearing leukemic cells from bone marrow 1
• Consolidation: Further reduces residual disease 1
• Maintenance: Prolonged therapy to prevent relapse 1
• CNS prophylaxis: Included in all ALL regimens 1

Risk Stratification

• Treatment intensity is often based on risk factors 1
• For ALL, poor risk factors include elevated WBC count, hypodiploidy, and MLL rearrangements 1, 3
• For medulloblastoma, risk factors include M+ disease, subtotal resection, and certain molecular features 1

Common Side Effects

• Myelosuppression (most common dose-limiting toxicity) 6
• Nausea, vomiting, mucositis, hair loss 7
• Organ-specific toxicities: cardiotoxicity (anthracyclines), neurotoxicity (vincristine), ototoxicity (cisplatin) 1, 2, 7

Drug Interactions

• Metabolism of vinca alkaloids is mediated by hepatic cytochrome P450 isoenzymes in the CYP 3A subfamily 2
• Paclitaxel metabolism can be inhibited by several agents including ketoconazole, verapamil, diazepam, cyclosporin, etoposide, and vincristine 4

The selection of a specific chemotherapy protocol should be based on cancer type, stage, molecular features, patient age, and comorbidities. Treatment should be administered by healthcare teams experienced in managing chemotherapy and its associated toxicities 1.