This book aims to address the infusion sequence of the main protocols used in the treatment of varied solid cancers. Since an inadequate infusion sequence can compromise the patient's treatment, this work will provide support to professionals working in the field of oncology in assessing each chemotherapy infusion sequence. The introductory chapters present the definition, indication, and the risks and benefits of polypharmacy in cancer therapy, and discuss the importance of drug combination in cancer treatment. Chapter 2 focuses on the challenges and also the toxicity of combination therapy in cancer, while chapter 3 highlights the parameters that must be evaluated before defining the infusion sequence, such as pharmacodynamic and pharmacokinetic profiles, drugs’ stability when diluted or reconstituted, toxicological profile of each drug, among others. The remaining chapters are divided by type of cancer. The content is focused on solid tumors, dividing the chapters according to breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, and neurological cancers. In each chapter the epidemiological profiles, pathophysiology, therapeutic modalities, and the main chemotherapy protocols are addressed, as well as efficacy studies and data on the infusion sequence of each mentioned protocol. This work will be a valuable resource to physicians, nurses, and pharmacists, and may help to improve health service practices.
Preface
Contents
Chapter 1: Polypharmacy in Cancer Therapy
1.1 Polypharmacy: Challenges in the Treatment of Chronic Diseases
1.2 Scenario of Polypharmacy in Cancer Treatment
1.3 Drug Interactions
1.3.1 Pharmacodynamic Interactions
1.3.2 Pharmacokinetic Interactions
1.4 Advantages in Drug Association
1.5 Risks of Polypharmacy
References
Chapter 2: Combined Therapy for the Treatment of Cancer
2.1 Anticancer Therapy
2.2 Combination Therapy in Cancer
2.2.1 Challenges in Combination Therapy
2.3 Toxicity of Combination Therapy for Cancer Treatment
2.3.1 Toxicity in the Treatment of Breast Cancer
2.3.2 Toxicity in the Treatment of Lung Cancer
2.3.3 Toxicity in the Treatment of Colorectal Cancer
2.3.4 Toxicity in the Treatment of Prostate Cancer
2.3.5 Toxicity in the Treatment of Cervical Cancer
2.3.6 Toxicity in the Treatment of Head and Neck Cancer
2.3.7 Toxicity in the Treatment of Lymphomas
References
Chapter 3: Importance of the Infusion Order in the Treatment of Cancer
3.1 Drug Infusion Therapy
3.1.1 Types of Infusion According to Administration Time
3.2 Dilution of Drugs and Their Stability
3.3 Risks of Chemotherapy Infusion
3.3.1 Drug Extravasation
3.3.1.1 Irritating Antineoplastics
3.3.1.2 Vesicant Antineoplastics
3.4 Concept and Importance of Infusion Order
3.4.1 Factors That May Influence in the Order of Infusion of Antineoplastic Agents
References
Chapter 4: Chemotherapeutic Protocols for the Treatment of Breast Cancer
4.1 Breast Cancer: Epidemiology
4.2 Pathophysiology of Breast Cancer
4.3 Molecular Subtypes of Breast Cancer
4.4 Breast Cancer Treatment Modalities
4.5 Adjuvant Chemotherapy
4.5.1 AC Protocol (Doxorubicin and Cyclophosphamide)
4.5.2 ACT, T-AC, or AC-T Protocol (Doxorubicin, Cyclophosphamide, and Paclitaxel)
4.5.3 ACTT Protocol (Doxorubicin, Cyclophosphamide, Paclitaxel, and Trastuzumab)
4.5.4 CMF Protocol (Cyclophosphamide, Methotrexate, and 5-Fluorouracil)
4.5.5 FAC Protocol (5-Fluorouracil, Doxorubicin, and Cyclophosphamide)
4.5.6 FEC Protocol (5-Fluorouracil, Epirubicin, and Cyclophosphamide)
4.5.7 FEC-D Protocol (5-Fluorouracil, Epirubicin, Cyclophosphamide, and Docetaxel)
4.5.8 FEC-DT Protocol (5-Fluorouracil, Epirubicin, Cyclophosphamide, Docetaxel, and Trastuzumab)
4.5.9 DAC (Docetaxel, Doxorubicin, and Cyclophosphamide) and DC (Docetaxel and Cyclophosphamide) Protocols
4.5.10 TDC Protocol (Trastuzumab, Docetaxel, and Cyclophosphamide)
4.5.11 DCARBT Protocol (Docetaxel, Carboplatin, and Trastuzumab)
4.6 Chemotherapy in Locally Advanced Breast Cancer
4.6.1 AC-DT Protocol (Doxorubicin, Cyclophosphamide, Docetaxel, and Trastuzumab)
4.6.2 CT-AC Protocol (Carboplatin, Paclitaxel, Doxorubicin, and Cyclophosphamide)
4.7 Chemotherapy in Advanced Breast Cancer
4.7.1 GEMD Protocol (Gemcitabine and Docetaxel)
4.7.2 GEMP Protocol (Gemcitabine and Cisplatin)
4.7.3 GEMT Protocol (Gemcitabine and Paclitaxel)
4.7.4 PTRAD Protocol (Pertuzumab, Trastuzumab, and Docetaxel)
4.7.5 PTRAT Protocol (Pertuzumab, Trastuzumab, and Paclitaxel)
4.7.6 TRVIN Protocol (Trastuzumab and Vinorelbine)
References
Chapter 5: Chemotherapeutic Protocols for the Treatment of Gastrointestinal Tract Cancer
5.1 Epidemiological Profile of Cancers of the Gastrointestinal Tract
5.2 Pathophysiology of Colorectal Cancer
5.2.1 Adjuvant Chemotherapy for the Treatment of Resectable Colorectal Cancer
5.2.1.1 CAPOX Protocol (Oxaliplatin and Capecitabine)
5.2.1.2 FL Protocol (5-Fluorouracil and Leucovorin)
5.2.1.3 FOLFOX Protocol (Oxaliplatin, Leucovorin, 5-Fluorouracil, and 5-Fluorouracil in Continuous Infusion)
5.2.1.4 RALOX Protocol (Oxaliplatin and Raltitrexed)
5.2.2 Chemotherapy for the Treatment of Advanced Unresectable Colorectal Cancer
5.2.2.1 CAPB Protocol (Capecitabine and Bevacizumab)
5.2.2.2 CETIR Protocol (Cetuximab and Irinotecan)
5.2.2.3 FOLFIRI Protocol (Irinotecan, Leucovorin, 5-Fluorouracil, and 5-Fluorouracil in Continuous Infusion)
5.2.2.4 CAPIRI Protocol (Capecitabine and Irinotecan)
5.2.2.5 CAPIRIB Protocol (Capecitabine, Irinotecan, and Bevacizumab)
5.2.2.6 CAPOXB Protocol (Oxaliplatin, Bevacizumab, and Capecitabine)
5.2.2.7 FOLFIRIB Protocol (5-Fluorouracil, 5-Fluorouracil in Continuous Infusion, Leucovorin, Irinotecan, and Bevacizumab)
5.2.2.8 FOLFIRIPAN Protocol (5-Fluorouracil, Leucovorin, Irinotecan, and Panitumumab)
5.2.2.9 FOLFOXB Protocol (Oxaliplatin, Leucovorin, 5-Fluorouracil, 5-Fluorouracil in Continuous Infusion, and Bevacizumab)
5.2.2.10 FOLFOXPAN Protocol (Oxaliplatin, 5-Fluorouracil, 5-Fluorouracil in Continuous Infusion, Leucovorin, and Panitumumab)
5.3 Pathophysiology of Esophageal and Stomach Cancers
5.3.1 Chemotherapy for the Treatment of Esophageal and Stomach Cancer
5.3.1.1 FOLFOXT Protocol (Oxaliplatin, 5-Fluorouracil, 5-Fluorouracil in Continuous Infusion, Leucovorin, and Trastuzumab)
5.3.1.2 FLOT Protocol (Oxaliplatin, 5-Fluorouracil, Leucovorin, and Docetaxel)
5.3.1.3 CTRT Protocol (Carboplatin, Paclitaxel, and Radiotherapy)
5.3.1.4 FUC Protocol (5-Fluorouracil and Cisplatin)
5.3.1.5 CCAPRT Protocol (Cisplatin, Capecitabine, and Radiotherapy)
5.3.1.6 CCAPT Protocol (Cisplatin, Capecitabine, and Trastuzumab)
5.3.1.7 CFUT Protocol (Cisplatin, 5-Fluorouracil, and Trastuzumab)
5.3.1.8 CAPOXT Protocol (Capecitabine, Oxaliplatin, and Trastuzumab)
5.3.1.9 RAMP Protocol (Paclitaxel and Ramucirumab)
5.3.1.10 ECCAP Protocol (Epirubicin, Cisplatin, and Capecitabine)
5.4 Pathophysiology of Pancreatic, Biliary Tract, and Gallbladder Cancers
5.4.1 Chemotherapy for the Treatment of Pancreatic, Biliary Tract, and Gallbladder Cancers
5.4.1.1 GEMCIS Protocol (Gemcitabine and Cisplatin)
5.4.1.2 FOLFIRINOX Protocol (Irinotecan, Oxaliplatin, 5-Fluorouracil, 5-Fluorouracil in Continuous Infusion, and Leucovorin)
5.4.1.3 GEMCAP Protocol (Capecitabine and Gemcitabine)
5.4.1.4 GEMABR Protocol (Gemcitabine and Nab-Paclitaxel)
5.5 Pathophysiology of Liver Cancer
5.5.1 Chemotherapy for the Treatment of Liver Cancer
5.5.1.1 Nivolumab and Ipilimumab Protocol
5.5.1.2 Atezolizumab and Bevacizumab Protocol
5.6 Pathophysiology of Carcinoid and Neuroendocrine Tumors
5.6.1 Chemotherapy for the Treatment of Carcinoid and Neuroendocrine Tumors
5.6.1.1 ETCIS Protocol (Etoposide and Cisplatin)
5.6.1.2 DS Protocol (Doxorubicin and Streptozotocin)
5.7 Pathophysiology of Anal Cancer
5.7.1 Chemotherapy in the Treatment of Anal Cancer
5.7.1.1 FUMRT Protocol (5-Fluorouracil, Mitomycin C, and Radiotherapy)
5.7.1.2 CAPMRT Protocol (Capecitabine, Mitomycin C, and Radiotherapy)
References
Chapter 6: Chemotherapeutic Protocols for the Treatment of Genitourinary Cancer
6.1 Epidemiological Profile of Genitourinary Cancers
6.2 Pathophysiology of Bladder Cancer
6.2.1 Chemotherapy for the Treatment of Bladder Cancer
6.2.1.1 BCGIFN Protocol (BCG and Interferon)
6.2.1.2 GEMDOC Protocol (Gemcitabine and Docetaxel)
6.2.1.3 MVAC Protocol (Methotrexate, Vinblastine, Doxorubicin, and Cisplatin)
6.3 Pathophysiology of Prostate Cancer
6.3.1 Chemotherapy for the Treatment of Prostate Cancer
6.4 Testicular Cancer
6.4.1 Chemotherapy for the Treatment of Testicular Cancer
6.4.1.1 BEP Protocol (Bleomycin, Etoposide, and Cisplatin)
6.4.1.2 VIP Protocol (Etoposide, Cisplatin, Ifosfamide, and Mesna)
6.4.1.3 TAXGEM Protocol (Paclitaxel and Gemcitabine)
6.4.1.4 TIP Protocol (Paclitaxel, Cisplatin, Ifosfamide, and Mesna)
6.4.1.5 VEIP Protocol (Vinblastine, Cisplatin, Ifosfamide, and Mesna)
6.5 Pathophysiology of Kidney Cancer
6.5.1 Chemotherapy for the Treatment of Kidney Cancer
6.5.1.1 PEMAX Protocol (Pembrolizumab and Axitinib)
6.5.1.2 Avelumab and Axitinib Protocol
References
Chapter 7: Chemotherapeutic Protocols for the Treatment of Gynecological Cancer
7.1 Epidemiological Profile of Gynecological Cancers
7.2 Pathophysiology of Ovarian Cancer
7.2.1 Chemotherapy for the Treatment of Epithelial Ovarian Cancer
7.2.1.1 CABR Protocol (Carboplatin and Abraxane)
7.2.1.2 CAPBEV Protocol (Carboplatin, Paclitaxel, and Bevacizumab)
7.2.1.3 CISP Protocol (Cisplatin and Paclitaxel)
7.2.1.4 CISPBEV Protocol (Cisplatin, Paclitaxel, and Bevacizumab)
7.2.1.5 CAD Protocol (Carboplatin and Docetaxel)
7.2.1.6 CAG Protocol (Carboplatin and Gemcitabine)
7.2.1.7 PLDC Protocol (Pegylated Liposomal Doxorubicin and Carboplatin)
7.2.1.8 BEVG Protocol (Bevacizumab and Gemcitabine)
7.2.1.9 BEVPLD Protocol (Bevacizumab and Pegylated Liposomal Doxorubicin)
7.2.1.10 BEVP Protocol (Bevacizumab and Paclitaxel)
7.2.2 Chemotherapy for the Treatment of Non-epithelial Ovarian Cancer
7.3 Pathophysiology of Cervical Cancer
7.3.1 Chemotherapy for the Treatment of Cervical Cancer
7.4 Pathophysiology of Endometrial Cancer
7.4.1 Chemotherapy for the Treatment of Endometrial Cancer
7.5 Pathophysiology of Gestational Trophoblastic Neoplasia
7.5.1 Chemotherapy for the Treatment of Gestational Trophoblastic Neoplasia
7.5.1.1 EMA-CO Protocol (Etoposide, Methotrexate, Actinomycin D, Leucovorin, Cyclophosphamide, and Vincristine)
7.5.1.2 DM Protocol (Actinomycin D and Methotrexate)
References
Chapter 8: Chemotherapeutic Protocols for the Treatment of Head and Neck Cancer
8.1 Epidemiological Profile of Head and Neck Cancers
8.2 Pathophysiology of Nasopharyngeal Carcinoma
8.2.1 Chemotherapy for the Treatment of Nasopharyngeal Carcinoma
8.2.1.1 FUP Protocol (5-Fluorouracil and Platinum)
8.2.1.2 EP Protocol (Etoposide and Platinum)
8.2.1.3 PG Protocol (Gemcitabine and Platinum)
8.3 Pathophysiology of Squamous Cell Carcinoma
8.3.1 Chemotherapy for the Treatment of Head and Neck Squamous Cell Carcinoma
8.3.1.1 DCF Protocol (Docetaxel, Cisplatin, and 5-Fluorouracil)
8.3.1.2 PC Protocol (Paclitaxel and Carboplatin or Cisplatin)
8.3.1.3 PCP Protocol (Paclitaxel, Carboplatin, and Pembrolizumab)
8.3.1.4 PFP Protocol (Platinum, 5-Fluorouracil, and Pembrolizumab)
8.3.1.5 PD Protocol (Platinum and Docetaxel)
8.4 Pathophysiology of Salivary Tumors
8.4.1 Chemotherapy for the Treatment of Salivary Tumors
8.4.1.1 VNC Protocol (Vinorelbine and Cisplatin)
8.4.1.2 PAC Protocol (Cisplatin, Doxorubicin, and Cyclophosphamide)
References
Chapter 9: Chemotherapeutic Protocols for the Treatment of Lung Cancer
9.1 Epidemiological Profile of Lung Cancers
9.2 Pathophysiology of Lung Cancer
9.3 Lung Cancer Treatment
9.3.1 Chemotherapy for the Treatment of Non-Small-Cell Lung Cancer
9.3.1.1 PPMB Protocol (Pemetrexed and Pembrolizumab)
9.3.1.2 PPPMB Protocol (Platinum, Pemetrexed, and Pembrolizumab)
9.3.1.3 PP Protocol (Platinum and Pemetrexed)
9.3.2 Chemotherapy for the Treatment of Small-Cell Lung Cancer
9.3.2.1 CAV Protocol (Cyclophosphamide, Doxorubicin, and Vincristine)
9.3.2.2 PI Protocol (Platinum and Irinotecan)
9.3.3 Chemotherapy for the Treatment of Malignant Mesothelioma
References
Chapter 10: Chemotherapeutic Protocols for the Treatment of Neurological Cancer
10.1 Epidemiological Profile of Neurological Cancers
10.2 Types of Neurological Cancers
10.2.1 Chemotherapy for the Treatment of Glioma
10.2.1.1 BE Protocol (Bevacizumab and Etoposide)
10.2.1.2 BL Protocol (Bevacizumab and Lomustine)
10.2.1.3 CARV Protocol (Carboplatin and Etoposide)
10.2.1.4 PCV Protocol (Procarbazine, Lomustine, and Vincristine)
10.2.1.5 TMZETO Protocol (Temozolomide and Etoposide)
10.2.2 Chemotherapy for the Treatment of Primary Neuroectodermal Tumors
10.2.2.1 CCV Protocol (Lomustine, Cisplatin, and Vincristine)
10.2.3 Treatment of Pituitary Tumor
References
Index
