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A - Regimen Name

CRBPVNCR Regimen
CARBOplatin-VinCRIStine


Disease Site
Central Nervous System

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

For the treatment of recurrent malignant glioma and progressive low grade glioma.

 
B - Drug Regimen

CARBOplatin
AUC 5 or 6 IV Day 1

Adjust Carboplatin dose to AUC target (using Calvert formula) as outlined in "Other Notes" section.

vinCRIStine
1.5 mg /m² IV Days 1, 8 and 15
(maximum dose of 2mg)
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C - Cycle Frequency

REPEAT EVERY 28 DAYS

Until evidence of disease progression or limited by drug toxicity

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate + NK1 antagonist (Carboplatin AUC ≥ 5) (D1)
Minimal (D8, 15)

Other Supportive Care:

Also refer to CCO Antiemetic Recommendations.

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.

Dosage with toxicity

Hematologic Toxicities:  Refer to general recommendations.
 

Dosage for neuropathy:

Symptom Vincristine (% usual dose)
Areflexia only 100%
Abnormal buttoning, writing 67%
Moderate motor neuropathy (± cranial) Hold until recovery then reduce dose by 50%
Severe motor neuropathy Omit



Hepatic Impairment

Bilirubin

Vincristine (% usual dose)

> 1 – 2.5 x ULN

50%

> 2.5 x ULN

25%


Renal Impairment

Creatinine Clearance (ml/sec)

Carboplatin

(% previous dose)

 

0.4-0.6

REDUCE Carboplatin dose by 50mg/m2

 

0.2-0.4 REDUCE Carboplatin dose by 100mg/m2

< 0.2

OMIT Carboplatin

 

Carboplatin: See "Other Notes" section for Calvert Formula


 
F - Adverse Effects

Refer to CARBOplatin, vinCRIStine drug monograph(s) for additional details of adverse effects


Most Common Side Effects 

Less Common Side Effects, but may be
Severe or Life-Threatening

  • Myelosuppression +/- infection, bleeding
  • Nausea, vomiting
  • ↑ LFTs
  • Nephrotoxicity
  • Neurotoxicity (including ototoxicity; may be severe)
  • Abnormal electrolytes
  • Alopecia
  • Constipation
  • Hypersensitivity
  • Arterial thromboembolism
  • Venous thromboembolism
  • GI perforation
  • Hemolytic uremic syndrome
  • Tumour lysis syndrome
  • Seizures
 
G - Interactions

Refer to CARBOplatin, vinCRIStine drug monograph(s) for additional details

 
H - Drug Administration and Special Precautions

Refer to CARBOplatin, vinCRIStine drug monograph(s) for additional details

 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

  • CBC; baseline and before each cycle
  • Liver function tests; baseline and regular
  • Renal function tests, including electrolytes; baseline and regular
  • Clinical toxicity assessment for neurotoxicity, hypersensitivity, bleeding, infection, nausea and vomiting; regular
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

INR; baseline and as clinically indicated
 


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J - Administrative Information

Approximate Patient Visit

Day 1:  1 to 1.5 hours
Days 8, 15:  0.5 hour

Pharmacy Workload (average time per visit)
11.563 minutes
Nursing Workload (average time per visit)
54.167 minutes
 
K - References

Carboplatin and vincristine drug monographs, Cancer Care Ontario.

Packer RJ, Ater J, Allen J et al. Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas. J Neurosurg. 1997 May; 86(5): 747-54.

July 2019 Updated hyperlink to vincristine drug monograph


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L - Other Notes
Calvert Formula
                    DOSE (mg) = target AUC X (GFR + 25)
  • AUC = product of serum concentration (mg/mL) and time (min)
  • GFR (glomerular filtration rate) expressed as measured Creatinine Clearance or estimated from Serum Creatinine (by Cockcroft and Gault method or Jelliffe method)
(Calvert AH, Newell DR, Gumbrell LA, et al, Carboplatin dosage: Prospective evaluation of a simple formula based on renal function. J Clin Oncol, 1989; 7: 1748-1756)
 
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.