Below is a list of overarching changes that apply to BMT, haematology and medical oncology protocols. Please see the history section of individual protocols for information on specific content changes.
General formatting
Essential Medicines List (EML):
EML link added to the grey bar at the top of the protocol to indicate when all anti-cancer drugs and essential supportive medicines are included on the WHO Model List of Essential Medicines (20th List March 2017)
Protocol specific calculator:
Supportive care drugs added as defaults can no longer be changed via a drop down list.
Literature search:
Literature search tab is now available from a section under the references.
Links:
Links to other regimens and relevant documents have moved to the ‘Related pages’ section above the ‘Treatment schedule’.
Treatment schedule
- New format - there is now an 'Overview' and 'Detail' tab
- The ‘treatment schedule summary’ is now called the ‘treatment overview’. It includes the:
- cycle heading with drug table below
- notes section
- drug status section.
- The detailed ‘treatment schedule’ has moved up to the top of the protocol into the ‘treatment schedule’ section. Users can toggle between the treatment schedule overview and detail.
- Drug administration wording has been updated for some drugs.
- Notes directly beneath the drug table are also included in the ‘treatment overview’ under the treatment schedule where applicable.
- Information previously accessed by clicking on the drug name has been included throughout the administration section where relevant.
- Acute myeloid leukaemia (AML): addition of the cycle numbers to protocols.
- Acute lymphoblastic leukaemia (ALL): for protocols given once off, cycle number inserted and ‘frequency’ replaced with ‘duration’.
Antiemetic changes in treatment schedules:
HIGH emetogenic risk:
- Day 1: netupitant 300 mg PO + palonosetron 0.5 mg PO and dexamethasone 12 mg PO
- Day 2 to 4 (or three days post highly emetogenic drug): dexamethasone 8 mg PO daily
- Carboplatin regimens with AUC ≥4 are considered highly emetogenic and follow the management for high emetogenic risk. Carboplatin AUC<4 regimens are considered moderately emetogenic and follow the management for moderate emetogenic risk.
- Oxaliplatin regimens are still classified as moderately emetogenic, however it is recommended that the management for high emetogenic risk be followed.
- The breast anthracycline and cyclophosphamide regimens are classified as highly emetogenic and follow the management for high emetogenic risk, including dexamethasone on days 2 to 4.
MODERATE emetogenic risk:
- Day 1: palonosetron 0.25 mg IV and dexamethasone 8mg PO
- Days 2 to 3 (or two days post moderately emetogenic drug): dexamethasone 8 mg PO daily
LOW emetogenic risk: no changes
Indications and patient population
Improved formatting and wording where applicable.
Clinical information
Clinical information blocks have been reviewed and updated. Significant updates include:
- Drugs with low risk of hypersensitivity reaction have had the hypersensitivity blocks removed.
- Premedication - specific drug information removed from the blocks. See ‘treatment schedule detail’ for specific drugs.
- Emetogenicity - specific drug information removed from the blocks. See ‘treatment schedule detail’ for specific drugs.
- Blood tests reviewed and updated.
- Hepatitis B screening and prophylaxis blocks updated in the haematology, BMT and medical oncology protocols.
Dose modifications
- Links to renal impairment and hepatic impairment removed from under associated table and inserted into disclaimer where applicable.
- Tooltips for grading non-haematological toxicities replaced by links to modal windows containing relevant grading tables.
Interactions
- Netupitant added
- Prednisolone added
- Links to QTc interval renamed ‘Drugs that may prolong the QTc interval’
- Links to CYP tables moved into the document linked behind ‘References & Disclaimer’
Administration
Content reviewed, reformatted and updated including:
- Links to treatment days now display in a bar. The day in the bar changes to purple to reflect current section in view.
- Medical oncology protocols – for protocols that have a combination of oral (PO) and intravenous (IV) therapy, the administration section is divided into day (IV) and day (PO).
- Haematology protocols - where a high dose steroid is combined with a low emetogenic drug e.g. dexamethasone/bortezomib, wording “verify antiemetics taken or administered as prescribed” has been removed.
- Treatment times are expressed in minutes if < 90 minutes and in hours if > 90 minutes. e.g. 2 hours
- Safe administration/safe handling and waste management links created for:
- monoclonal antibodies
- reproductive risk (e.g. imatinib, gefitinib).
- 'CVAD' replaced with 'CVC' or 'port' to enable links to specific individual documents for clinical procedures.
- Nurse monitoring has been updated to only be included in protocols where closer clinical assessment is required e.g. high dose MTX, cytarabine, cyclophosphamide.
- Specific instructions for Day 0 of each type of bone marrow transplant provided. Please see example below of Allogeneic Day 0 instructions:
- Order of administration for monoclonal antibodies and chemotherapy standardised for all colorectal protocols to be monoclonal antibody first followed by chemotherapy.
- Information previously accessed by clicking on the drug name has been included throughout the administration section where relevant.
- Discharge - the link to patient information removed (available from the icon at the top of the protocol) and wording amended to ‘ensure patient receives patient information sheet’
Monitoring section
This section has been removed and monitoring information is now incorporated throughout the protocol where relevant and appropriate.
Side effects
All side effects have been reviewed and updated. Below is a list of side effects which were renamed or newly created:
New
- Hypersensitivity reaction to taxanes – in protocols with paclitaxel, docetaxel, cabazitaxel
- Hypertension associated with angiogenesis inhibitors
- Hypersensitivity reaction to DMSO – added to the autologous BMT protocols and cord BMT protocols only
- Fever and chills (ATG) – in BMT protocols with ATG
- Cytarabine (Ara-C) syndrome (no paracetamol)- in protocols with imatinib and the ‘cytarabine (Ara-C) syndrome’ side effect.
- Headache (no paracetamol) - in protocols with imatinib
- Pulmonary toxicity (bleomycin) – in protocols with bleomycin
Renamed
- Hyperlacrimation → Ocular changes
- Arthralgia → Arthralgia and myalgia
- Cardiotoxicity associated with TKIs → Cardiotoxicity
- Drug induced pancreatitis → Pancreatitis (asparaginase)
- Haemorrhagic Cystitis Associated with Low Dose Cyclophosphamide → Haemorrhagic cystitis associated (cyclophosphamide and ifosfamide)
- Peripheral oedema → Fluid retention and oedema
- Pneumonitis → Pulmonary toxicity
- Pulmonary Fibrosis → Pulmonary toxicity
- Pulmonary fibrosis associated with TKIs → Pulmonary toxicity
- Vaginal atrophy → Vaginal dryness (hormonal)
References
‘Bibliography’ section added for additional references not referenced throughout the protocol.
Patient information
The content was reviewed, reformatted and updated.
- Information which was in dot points under the treatment schedule in the previous site have been moved into a new section called ‘other information about your treatment’ or incorporated into ‘side effects’.
- Oral drugs: information about missed doses inserted into treatment schedule table OR added under the table as dot points if there is more than one oral drug.
- The ‘other information about your treatment’ also includes information on dose changes or delays, blood tests and specific drug or protocol information.
- Side effects reviewed and updated.
- Recipe for sodium bicarbonate mouthwash has been updated on the new site to reflect the MASCC/ISOO 2014 guidelines. It is now '1/4 teaspoon of sodium bicarbonate in one glass of water’ site wide.
- General advice for people having cancer treatment:
- Grapefruit interaction information added to relevant protocols.
- Reference to food safety and listeria will be removed from all Medical Oncology protocols.
- Second cancers information was reviewed and modified in patient information sheets as appropriate according to the drugs listed on the International Agency for Research on Cancer (IARC) ‘Group 1: Carcinogenic to humans’ and ‘Group 2A: Probably carcinogenic to humans’ lists, and National Toxicology Program (NTP) ‘Known to be human carcinogens’ and ‘Reasonably anticipated to be human carcinogens’ lists.