You are using an outdated browser. We suggest you update your browser for a better experience. Click here for update.
Close this notification.
Skip to main content Skip to search
A - Regimen Name

CAP Regimen
Cyclophosphamide-ADRIAMYCIN ® (DOXOrubicin)-PLATINOL ® (CISplatin)


Disease Site
Lung - Thymoma

Intent
Palliative

Regimen Category
Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.


Rationale and Uses

Treatment for advanced thymoma

 
B - Drug Regimen

cyclophosphamide
500 mg /m² IV Day 1
DOXOrubicin
50 mg /m² IV Day 1
CISplatin
50 mg /m² IV Day 1

 

 

back to top
 
C - Cycle Frequency

REPEAT EVERY 21 DAYS

For up to 8 cycles, unless disease progression, unacceptable toxicity, or limited by cardiotoxicity risk

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

High

Other Supportive Care:

Standard regimens for Cisplatin premedication and hydration should be followed.

Also refer to CCO Antiemetic Summary

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated.

Dosage with toxicity

Hematologic Toxicities:  See appendix 6 for general recommendations.



Hepatic Impairment

Bilirubin Dose
If Bilirubin 1-2 x ULN REDUCE Doxorubicin to 50% dose
If Bilirubin 2-4 x ULN
REDUCE Doxorubicin to 25% dose
If Bilirubin > 4 x ULN
OMIT doses of Doxorubicin

Renal Impairment

Creatinine Clearance /
Serum Creatinine
Dose
If CrCl = 0.5 - 1 mL/sec or Serum Creatinine = 136-185µmol/L REDUCE Cisplatin* to 50% dose
If CrCl < 0.5mL/sec or
     Serum Creatinine>185µmol/L
OMIT Cisplatin dose
If CrCl < 0.3mL/sec
REDUCE Cyclophosphamide to 50% dose (suggested)
   *Upon the discretion of the prescriber, less dose reduction may be suggested. See CISPLATIN drug monograph.

 
F - Adverse Effects

Refer to cyclophosphamide, DOXOrubicin, CISplatin drug monograph(s) for additional details of adverse effects


  • Nausea and vomiting
  • Nephrotoxicity
  • Neurotoxicity (ototoxicity)
  • Myelosuppression
  • Cardiotoxicity
  • Cystitis
  • Fatigue
  • Vesicant
 
G - Interactions

Refer to cyclophosphamide, DOXOrubicin, CISplatin drug monograph(s) for additional details

 

 
H - Drug Administration and Special Precautions

Refer to cyclophosphamide, DOXOrubicin, CISplatin drug monograph(s) for additional details

 
I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

  • Clinical toxicity assessment (including stomatitis, neurotoxicity, cardiotoxicity, ototoxicity, local toxicity).
  • CBC before each cycle.  Interim counts should be done in first cycle and repeated if dose modifications necessary.
  • Baseline and regular liver and renal function tests (including electrolytes and magnesium) and urinalysis.
  • Cardiac examination especially with risk factors (including prior therapy with Epirubicin, Mitoxantrone, or other cardiotoxic drug), or a cumulative Doxorubicin dose of > 450 mg/m2
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version


back to top
 
J - Administrative Information

Approximate Patient Visit
2-3 hours
Pharmacy Workload (average time per visit)
41.813 minutes
Nursing Workload (average time per visit)
51.667 minutes
 
K - References

Loehrer PJ Sr, Kim KM, Aisner SC, et al. Cisplatin Plus Doxorubicin Plus Cyclophosphamide in Metastatic or Recurrent Thymoma: Final Results of an Intergroup Trial. J Clin Oncol 1994;12:1164-8.

November 2017 aligned disease site to qbp


back to top
 
M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.