Chemotherapy (TCH) given in specific order?

[Ashish31]

My mother undergoing breast cancer treatment TCH protocol. My oncologist from Mumbai suggest the specific TCH order but my doctor during 2nd chemo at Bpl has change the order of tch and hertraz does changed from 440 to 400 mg. Is there any specific order of chemo drug (TCH). Please help with quantity also

[sumeet_shah Administrator]

Quantity is according to patient weight and tolerance. Your Oncologist will do adjustments as needed. There is no specific order as such.

[kaarenorgaard]

Take a look at

herceptin.com/hcp/treatment...

So the dosage strength is 6 mg / kg of body weight when given every 3 weeks (2 mg / kg when given weekly). So if her weight is 67 kg then 400 mg is fine. 440 mg is for 73 kg. [When given every 3 weeks].

What do you mean by switching the order of chemo therapy? Docetaxel and Carboplatin are given concomitantly, i.e. at the same time according to the guidelines.

(And by the way, Herceptin is normally given weekly while chemo therapy is given - she doesn't receive 400 mg weekly?).

Kind regards,

Kaare

[Ashish31 in reply to kaarenorgaard]

Thank you Kaare, as per my first chemo order was: 1) docetaxal 120 mg in 500 ns over 1.5 hour 2)carboplatin 450mg in 500 ns over 1.5 hours 3) hartraz 440 mg 500ns 1.5hour. But new order is 1) hartraz 400 mg 500ns 1.5hour 2) carboplatin 3) decextaxal .....so change in order of injection matter ?? Please suggest.

[kaarenorgaard in reply to Ashish31]

That infusion order doesn't matter.

Please tell me: Is it weekly? Or every 3 weeks?

And please supply height and body weight, then I can check the dosage calculation.

[Ashish31 in reply to kaarenorgaard]

Thanks Kaare, My Mon weight is 67 , age 49, height 143 cm. Chemo is given in every 3 week.

[kaarenorgaard]

OK, so the Herceptin dose is spot on: 67 corresponds to 400 mg every 3 weeks.

Docetaxel should ideally be 94 - 157 mg every 3 weeks (based on a per m2 dosis of 60 - 100 mg; and the surface area being 1.57 m2 in this case). So it's also OK with 125 mg.

Carboplatin: Sometimes a more complex formula taking into account renal function (the GFR number) is used, and if so the following is less precise. The rough calculation is this: 300 mg per m2 every 4 weeks, so given in 3 week intervals it is 225 mg / m2. The surface area of 1.57 m2 gives a dose of 353 mg. She is a little overdosed with 450 mg at first glance. Maybe your doctor takes into account that the renal function is higher, or the doctor has taken the dose of Carboplatin when given alone and not as a part of TCH (which is an error)?

[Ashish31 in reply to kaarenorgaard]

Thank you Kaare for help. I have more doubt on this .can I send you both Chemotherapy sheet with protocol .please send me ur mail I'd at [e-mail]

[kaarenorgaard]

Done

[Ashish31 in reply to kaarenorgaard]

Hi kaare, Please respond to my mail.

[kaarenorgaard in reply to Ashish31]

I did it long ago. I resent it just now...

[roxboxfox RadiationOncologist]

Ashish you need to learn to trust your oncologist. If you are not happy, you can always seek a 3rd or 4th opinion from an Oncologist.

Carboplatin is never calculated on body surface area alone. Commonly the Calverts formula is used which depends on

1. Sex (For females a correction factor of 0.85 is applied)

2. Weight

3. Height

4. Age

5. S. Creatinine

One can put those parameters in that formula : globalrph.com/carboplatin.cgi

The last thing is the AUC (called Area under curve), which will AUC = 5 or 6 which will be decided by your doctor based on patients comorbidities, ECOG Peformance status and intent of treatment, the presence or absence of other chemotherapy drugs and tolerance to chemotherapy.

The reason your Hertraz dose changed was because you need a loading dose of Herceptin 8 mg/kg body weight and then maintenance Herceptin at 6 mg/kg body weight.

Sad to see such a post by you Ashish, but glad to see that your mother is on the right treatment. I wish her all the best in her chemo journey.