高雄市立小港醫院 ( 委託高雄醫學大學經營 ) 常用化學處方集 目錄 乳癌 Breast Cancer... 1 肺癌 Lung Cancer 一 非小細胞肺癌 (NSCLC) 二 小細胞肺癌 (SCLC) 食道癌 Esophageal cancer

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1 高雄市立小港醫院 ( 委託財團法人私立高雄醫學大學經營 ) Kaohsiung Municipal Hsiao-Kang Hospital 106 年常用化學治療處方

2 高雄市立小港醫院 ( 委託高雄醫學大學經營 ) 常用化學處方集 目錄 乳癌 Breast Cancer... 1 肺癌 Lung Cancer 一 非小細胞肺癌 (NSCLC) 二 小細胞肺癌 (SCLC) 食道癌 Esophageal cancer 胃癌 Stomach Cancer 結腸直腸癌 Colon Cancer & Rectum Cancer 肝癌 Hepatoma 泌尿道癌 Urinary tract Cancer 一 膀胱癌 Bladder Cancer 二 前列腺癌 Prostate Cancer 淋巴癌 Hematopoietic cancer 藥物產品規格 劑量調整 常見副作用 副作用評估級數與常見處理 Alopecia( 掉髮 ) Anemia( 貧血 ) Anorexia ( 厭食 ) Constipation( 便秘 ) Chills rigors( 寒冷 寒顫 ) Cough( 咳嗽 ) Conjunctivitis( 結膜炎 ) Diarrhea( 腹瀉 ) Dyspepsia( 消化不良 ) Dizziness( 頭暈 ) Dyspnea( 呼吸困難 ) Fever( 發燒 ) Fluid retention( 體液滯留 ) Fatigue( 疲倦 ) Hand-foot syndrome( 手足症候群 ) Headache( 頭痛 ) Hematuria( 血尿 ) Hot flashes( 潮紅 ) Hyponatremia( 低血鈉 ) Hypocacelmia( 低血鈣 ) Hypotension( 低血壓 )... 61

3 Hypokalemia( 低血鉀 ) Hypomagnesemia( 低血鎂 ) Insomnia( 失眠 ) Injection site reaction( 注射部位異常反應 ) Irregular menses( 月經不規則 ) Leukopenia( 白血球低下 ) Liver dysfunction( 肝功能異常 ) LV dysfunction(lvef decreased 左心室射出率 ) Mucostitis( 口腔發炎 ) Nail disorder( 指甲變化 ) Nausea( 噁心 )/vomiting( 嘔吐 ) Neuropathy-sensory( 感覺神經病變 ) Peripheral edema( 周邊肢體水腫 ) Proteinuria( 蛋白尿 ) Pruritus( 皮膚癢 ) Pain,chest( 胸痛 ) Pain,abdominal( 腹痛 ) Phlebitis( 靜脈炎 ) Rash( 紅疹 ) Renal dysfunction( 腎功能異常 ) SIADH( 抗利尿激素不適當分泌症候群 ) Sinus bradycardia( 竇性心搏過慢 ) Thrombocytopenia( 血小板低下 ) Tachycardia( 心搏過速 ) Weakness( 虛弱無力 ) 參考文獻... 69

4 修訂日期 106 年 6 月 16 日 治療方式 乳癌 Breast Cancer Adjuvant Regimen 1. FEC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 2. FEC follow by Docetaxel (every 3wks for 6 or 8 cycles) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 3. FLC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² 處方內容 Regimen 4. FLC follow by Docetaxel ( every 3wks for 6 or 8 cycles ) 5FU: 600 mg/m² Lipo-Dox: 35 mg/m² Cyclophosphamide: 600 mg/m² Docetaxel:75/100 mg/m² Regimen 5. EC (every 3wks for 6cycles) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 6. EC + Docetaxel ( every 3wks for 6 or 8 cycles ) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 7. LC (every 3wks for 6cycles) Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 8. LC + Docetaxel ( every 3wks for 6 or 8 cycles ) 1

5 Lipo-Dox: 35 mg/m² Cyclophosphamide: 600 mg/m² Docetaxel:75/100 mg/m² ~~~Single Agents~~~ Regimen 1. T (every 3wks ) Taxotere: 75/100 mg/m² Regimen 2. P (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Regimen 3. weekly P Paclitaxel: 80 mg/m² Regimen 4. N (every 3wks ) Navelbine 25~35 mg/m² Regimen 5. Eribulin (day 1,8 cycled every 3wks) Eribulin(Halaven): 1.4 mg/m² Regimen 6. X Capecitabine(Xeloda): 800~1000mg/ m² po bid ~~~Other Combinations ~~~ Regimen 1.PG (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Gemcitabine(Gemzar):1000 mg/m² Regimen 2. weekly P+G Paclitaxel(Genetaxyl): 80 mg/m² Gemcitabine(Gemzar): 800 mg/m² Regimen 3.TC (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 4.TG (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Gemcitabine(Gemzar): 800~1000 mg/m² 2

6 Regimen 5.TCH Docetaxel (Taxotere): 60~75 mg/m² Carboplatin(Kemocarb): (Ccr+25) x AUC mg/m² Trastuzumab(Herceptin): 6mg/kg q3wk 標靶治療 處方內容 1.Herceptin: loading dose 8mg/kg,maintain dose 6mg/kg,Q21d 2.Perjeta(with Herceptin and Taxotere): loading dose 840mg,maintain dose 420mg,Q21d 3.TDM-1(Kadcyla):3.6mg/kg,Q21d 4.Avastin(with Paclitaxel) 5-10mg/kg,Q21d 5.Afinitor(Everolimus)10mg PO,QD 賀爾蒙治療 處方內容 1.Nolvadex 10mg PO,BID 2.Femara 2.5mg PO,QD 3.Exemestane (Aromasin)25mg PO,QD 治療方式 Neoadjuvant Regimen 1. FEC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² 處方內容 Regimen 2. FEC + Docetaxel ( every 3wks for 6 or 8 cycles ) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 3. FLC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 4. FLC + Docetaxel ( every 3wks for 6 or 8 cycles ) 5FU: 600 mg/m² Lipo-Dox: 35 mg/m² Cyclophosphamide: 600 mg/m² 3

7 Docetaxel:75/100 mg/m² Regimen 5. EC (every 3wks for 6cycles) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 6. EC + Docetaxel ( every 3wks for 6 or 8 cycles ) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 7. LC (every 3wks for 6cycles) Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 8. LC + Docetaxel ( every 3wks for 6 or 8 cycles ) Lipo-Dox: 35 mg/m² Cyclophosphamide: 600 mg/m² Docetaxel:75/100 mg/m² ~~~Single Agents~~~ Regimen 1. T (every 3wks ) Taxotere: 75/100 mg/m² Regimen 2. P (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Regimen 3. weekly P (every 3wks ) Paclitaxel: 80 mg/m² Regimen 4. N (every 3wks ) Navelbine 25~35 mg/m² Regimen 5. Eribulin (day 1,8 cycled every 3wks) Eribulin(Halaven): 1.4 mg/m² Regimen 6. X Capecitabine(Xeloda): 800~1000mg/ m² po bid 4

8 ~~~Other Combinations ~~~ Regimen 1.PG (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Gemcitabine(Gemzar):1000 mg/m² Regimen 2. weekly P+G Paclitaxel(Genetaxyl): 80 mg/m² Gemcitabine(Gemzar): 800 mg/m² Regimen 3.TC (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 4.TG (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Gemcitabine(Gemzar): 800~1000 mg/m² Regimen 5.TCH Docetaxel (Taxotere): 60~75 mg/m² Carboplatin(Kemocarb): (Ccr+25) x AUC mg/m² Trastuzumab(Herceptin): 6mg/kg q3wk 標靶治療 處方內容 1.Herceptin: loading dose 8mg/kg,maintain dose 6mg/kg,Q21d 2.Perjeta(with Herceptin and Taxotere): loading dose 840mg,maintain dose 420mg,Q21d 3.TDM-1(Kadcyla):3.6mg/kg,Q21d 4.Avastin(with Paclitaxel) 5-10mg/kg,Q21d 5.Afinitor(Everolimus)10mg PO,QD 賀爾蒙治療 處方內容 1.Nolvadex 10mg PO,BID 2.Femara 2.5mg PO,QD 3.Exemestane (Aromasin)25mg PO,QD 5

9 治療方式 Recurrent or Metastatic Regimen 1. FEC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 2. FEC + Docetaxel ( every 3wks for 6 or 8 cycles ) 5FU: 500/600 mg/m² Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 3. FLC (every 3wks for 6cycles) 5FU: 500/600 mg/m² Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² 處方內容 Regimen 4. FLC + Docetaxel ( every 3wks for 6 or 8 cycles ) 5FU: 600 mg/m² Lipo-Dox: 35 mg/m² Cyclophosphamide: 600 mg/m² Docetaxel:75/100 mg/m² Regimen 5. EC (every 3wks for 6cycles) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 6. EC + Docetaxel ( every 3wks for 6 or 8 cycles ) Epirubicin: 75/90 mg/m² Cyclophosphamide: 500/600 mg/m² Docetaxel: 75/100 mg/m² Regimen 7. LC (every 3wks for 6cycles) Lipo-Dox: 30/35 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 8. LC + Docetaxel ( every 3wks for 6 or 8 cycles ) Lipo-Dox: 35 mg/m² 6

10 Cyclophosphamide: 600 mg/m² Docetaxel:75/100 mg/m² ~~~Single Agents~~~ Regimen 1. T (every 3wks ) Taxotere: 75/100 mg/m² Regimen 2. P (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Regimen 3. weekly P (every 3wks ) Paclitaxel: 80 mg/m² Regimen 4. N (every 3wks ) Navelbine 25~35 mg/m² Regimen 5. Eribulin (day 1,8 cycled every 3wks) Eribulin(Halaven): 1.4 mg/m² Regimen 6. X Capecitabine(Xeloda): 800~1000mg/ m² po bid ~~~Other Combinations ~~~ Regimen 1.PG (every 3wks ) Paclitaxel(Genetaxyl): 175 mg/m² Gemcitabine(Gemzar):1000 mg/m² Regimen 2. weekly P+G Paclitaxel(Genetaxyl): 80 mg/m² Gemcitabine(Gemzar): 800 mg/m² Regimen 3.TC (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Cyclophosphamide: 500/600 mg/m² Regimen 4.TG (every 3wks ) Docetaxel (Taxotere): 75 mg/m² Gemcitabine(Gemzar): 800~1000 mg/m² 7

11 Regimen 5.TCH Docetaxel (Taxotere): 60~75 mg/m² Carboplatin(Kemocarb): (Ccr+25) x AUC mg/m² Trastuzumab(Herceptin): 6mg/kg q3wk 標靶治療 處方內容 1.Herceptin: loading dose 8mg/kg,maintain dose 6mg/kg,Q21d 2.Perjeta(with Herceptin and Taxotere): loading dose 840mg,maintain dose 420mg,Q21d 3.TDM-1(Kadcyla):3.6mg/kg,Q21d 4.Avastin(with Paclitaxel) 5-10mg/kg,Q21d 5.Afinitor(Everolimus)10mg PO,QD 賀爾蒙治療 處方內容 1.Nolvadex 10mg PO,BID 2.Femara 2.5mg PO,QD 3.Exemestane (Aromasin)25mg PO,QD 參考文獻 1. 全民健康保險藥品給付規定 2. 高雄醫學大學附設中心紀念醫院癌症中心化學治療處方集 3. 高雄市立小港醫院 (2016).Antineoplastic agents. 處方集 4. National Comprehensive Cancer Network. (2017). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer, version Eloy, J. O., Petrilli, R., Chesca, D. L., Saggioro, F. P., Lee, R. J., & Marchetti, J. M. (2017). Anti-HER2 immunoliposomes for co-delivery of paclitaxel and rapamycin for breast cancer therapy. European Journal of Pharmaceutics and Biopharmaceutics, 115, Jones, S., Holmes, F. A., O'Shaughnessy, J., Blum, J. L., Vukelja, S. J., McIntyre, K. J.,... & Hyman, W. J. (2009). Docetaxel with cyclophosphamide is associated with an overall survival benefit compared with doxorubicin and cyclophosphamide: 7-year follow-up of US Oncology Research Trial 9735.Journal of Clinical Oncology, 27(8), Martin, M., Pienkowski, T., Mackey, J., Pawlicki, M., Guastalla, J. P., Weaver, C.,... & Guevin, R. (2005). Adjuvant docetaxel for node-positive breast cancer.new England Journal of Medicine, 352(22), O brien, M. E. R., Wigler, N., Inbar, M. C. B. C. S. G., Rosso, R., Grischke, E., Santoro, A.,... & Orlandi, F. (2004). Reduced cardiotoxicity and comparable efficacy in a phase III trial of pegylated liposomal doxorubicin HCl (CAELYX /Doxil ) versus conventional doxorubicin for first-line treatment of metastatic breast cancer. Annals of oncology, 15(3), Roché, H., Fumoleau, P., Spielmann, M., Canon, J. L., Delozier, T., Serin, D.,... & Viens, P. (2006). 8

12 Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial. Journal of Clinical Oncology, 24(36), Romond, E. H., Perez, E. A., Bryant, J., Suman, V. J., Geyer Jr, C. E., Davidson, N. E.,... & Swain, S. M. (2005). Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. New England Journal of Medicine, 353(16), Shahriari-Ahmadi, A., Arabi, M., Payandeh, M., & Sadeghi, M. (2017). The recurrence frequency of breast cancer and its prognostic factors in Iranian patients. International Journal of Applied and Basic Medical Research, 7(1), Teshome, M., & Kuerer, H. M. (2017). Breast conserving surgery and locoregional control after neoadjuvant chemotherapy. European Journal of Surgical Oncology (EJSO). 9

13 一 非小細胞肺癌 (NSCLC) 治療方式 肺癌 Lung Cancer 修訂日期 106 年 5 月 19 日 藥物種類 劑量 間隔 治療時間 備註 *Gemcitabine (Gemzar ) Gemcitabine (Gemzar ) 1000mg/ m2 D1,D8,D15 Q28days 4-6 cycles Gemcitabine (Gemzar ) 1000mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr 60 +Cisplatin 60-75mg/ m2 D1 Gemcitabine (Gemzar )1000mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr<60 +Carboplatin (AUC=5) D1 *Vinorelbine (Navelbine ) Vinorelbine (Navelbine ) 20-25mg/ m2 D1,D8,D15 Q28days 4-6 cycles Vinorelbine (Navelbine ) 20-25mg/ m2 D1,D8,or Q28days 4-6 cycles CCr 60 D15+Cisplatin 60-75mg/ m2 D1 Vinorelbine (Navelbine ) 20-25mg/ m2 D1,D8,or Q28days 4-6 cycles CCr<60 D15+Carboplatin (AUC=5) D1 Vinorelbine (Navelbine ) ORAL 20mg Q3W 前三次依體表面積每週給藥 60mg/m 2 一次, 第四次開始增加每週 80mg/m 2 一次 Navelbine 25mg/m2 D1 D8 21Days 4-6cycle 第 Ⅱ ⅢA 期根治性手術後輔助治療 ( 配合放療 )+Cisplatin/carboplatin *Paclitaxel (Genetaxyl ) Paclitaxel mg/ m2 D1,D8,D15 Q28days 4-6 cycles Paclitaxel mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr 60 +Cisplatin 60-75mg/ m2 D1 Paclitaxel mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr<60 +Carboplatin (AUC=5) D1 *Docetaxel (Taxotere ) Docetaxel (Taxotere ) 30-35mg/ m2 D1,D8,D15 Q28days 4-6 cycles Docetaxel (Taxotere ) 30-35mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr 60 +Cisplatin 60-75mg/ m2 D1 Docetaxel (Taxotere ) 30-35mg/ m2 D1,D8,D15 Q28days 4-6 cycles CCr<60 +Carboplatin (AUC=5) D1 Docetaxel (Taxotere ) 60-75mg/ m 2 D1 Q21days 4-6 cycles Docetaxel (Taxotere ) 60-75mg/ m 2 D1 +Cisplatin 60-75mg/ m2 D1 Q28days 4-6 cycles CCr 60 Docetaxel (Taxotere ) 60-75mg/ m 2 D1 +Carboplatin (AUC=5) D1 Q28days 4-6 cycles CCr<60 10

14 藥物種類 劑量 間隔 治療時間 備註 *Pemetrexed (Alimta ) Pemetrexed (Alimta ) 500mg/ m 2 D1 Q21days 4-6 cycles Pemetrexed (Alimta ) 500mg/ m 2 D1 Q21days 4-6 cycles +Cisplatin 60-75mg/ m2 D1 Pemetrexed (Alimta ) 500mg/ m 2 D1 Q21days 4-6 cycles +Carboplatin (AUC=5) D1 CCr 60 需經健保事前審查核准後使用 CCr<60 需經健保事前審查核准後使用 Gefitinib (Iressa ) 250 mg QD 需經健保事前審查核准後使用 Erlotinib (Tarceva ) 150 mg QD 需經健保事前審查核准後使用 Afatinib (Giotrif ) 40 mg QD 需經健保事前審查核准後使用 Osimertinib(Tagrisso)80mg QD T790M EGFR 突變 ( 自費 ) Crizotinib(Xalkori)250mg Bid ALK 陽性 Ceritinib(zykadia)150mg QD( 最高劑量 750mg) 需經健保事前審查核准後使用 *UFUR mg QD or 200 mg BID Indication: Adeno, pt2 and tumor size > 3 cm 2 years 11

15 二 小細胞肺癌 (SCLC) 治療方式 Adjuvant 藥物種類 劑量 間隔 治療時間 備註 Etoposide(VP-16) 100 mg/m2 D1-D3 Q21 days 6 cycles Ccr 60 +Cisplatin 60-75mg/m2 D1 Etoposide(VP-16) 100 mg/m2 D1-D3 Q21 days 6 cycles Ccr<60 +Carboplatin (AUC=5) D1 Topotecan 1.5mg/m 2 D1-D5 Q21 days 4-6 cycles 參考文獻 1.Guilbault, C., Garant, A., Faria, S., Owen, S., Ofiara, L., Duclos, M.,... & Kopek, N. (2017). Long-term outcomes of induction carboplatin and gemcitabine followed by concurrent radiotherapy with low-dose paclitaxel and gemcitabine for stage III non-small cell lung cancer. Clinical Lung Cancer. 2.Miyawaki, M., Naoki, K., Yoda, S., Nakayama, S., Satomi, R., Sato, T.,... & Namkoong, H. (2017). Erlotinib as second-or third-line treatment in elderly patients with advanced non-small cell lung cancer: Keio Lung Oncology Group Study 001 (KLOG001). Molecular and Clinical Oncology, 6(3), Palka, M., Sanchez, A., Córdoba, M., Díaz Nuevo, G., Varela De Ugarte, A., Cantos, B.,... & Provencio, M. (2017). Cisplatin plus vinorelbine as induction treatment in stage IIIA non-small cell lung cancer. Oncology Letters, 13(3), Pirker, R. (2017). Milestones in the systemic treatment of lung cancer. memo-magazine of European Medical Oncology, 10(1),

16 修訂日期 106 年 4 月 18 日 食道癌 Esophageal cancer 治療方式 Adjuvant 1 st line : C/T alone High dose [5-FU 2000 mg/m 2 + LV 150 mg/m 2 + N/S 250ml keep 24 hrs] Q1Week +[ Cisplatin 30 mg/m 2 + N/S 500ml keep 2hrs] Q1Week (if CCr < 60 ml/min, Cisplatin 改為 [Carboplatin ((CCr+25)x3~5mg) + N/S 500ml keep 2hrs] Q3Week ) Low dose [5-FU (200mg/m 2 /day x1~5days) + N/S 250ml keep1~5days + Bloodlet(Calcium folinate15mg) 2# PO Bid 1~5days] Q1Week +[Cisplatin 25mg/m 2 + N/S 500ml keep 2hrs] Q1Week (if CCr < 60 ml/min, Cisplatin 改為 [Carboplatin ((CCr+25)x3~5mg) + N/S 500ml keep 2hrs] Q3Week ) 處方內容 Taxane-based Taxotere (75 mg/m 2 ) + N/S 500ml keep 2hrs Q3Week Paclitaxol (60~100mg/m 2 ) + N/S 500ml keep 2hrs Q1Week Combined with Platium/5FU [Taxotere ( 40 mg/m 2 ) + N/S 250ml keep 2hrs ] + [Cisplatin (30 mg/m 2 ) + N/S 500ml keep 2hrs ] + [5-FU (2000 mg/m 2 ) + LV 150 mg/ m 2 + N/S 250mlkeep 24hrs ] Q2Week [Paclitaxol(70 mg/m 2 ) + N/S 250ml keep 2hrs ] + [Cisplatin (30 mg/m 2 ) + N/S 500ml keep 2hrs ] + [5-FU (2000 mg/m 2 ) + LV 150 mg/ m 2 + N/S 250ml keep 24hrs ] Q2Week (if CCr < 60 ml/min, Cisplatin 改為 [Carboplatin ((CCr+25)x2~3mg) + N/S 250ml keep 2hrs] Q2Week ) Single Irinotecan Irinotecan (Campto) (150~180mg/ m 2 ) + N/S 250ml keep 2hrs Q2week Combine Platium [ Irinotecan (Campto) (150~180mg/m 2 ) + N/S 250ml keep 2hrs] + [Cisplatin(30 mg/m 2 ) + N/S 500ml keep 2hrs] Q2week (if CCr < 60 ml/min, Cisplatin 改為 [Carboplatin ((CCr+25)x2~3mg) + N/S 250ml keep 2hrs] Q2Week ) 13

17 參考文獻 1. van Ruler, M. A., Peters, F. P., Slingerland, M., Fiocco, M., Grootenboers, D. A., Vulink, A. J.,... & Neelis, K. J. (2017). Clinical outcomes of definitive chemoradiotherapy using carboplatin and paclitaxel in esophageal cancer. Diseases of the esophagus: official journal of the International Society for Diseases of the Esophagus, 30(4), Xia, Y., Li, Y. H., Chen, Y., Zhang, J. H., Liu, Q., Deng, J. Y.,... & Badakhshi, H. (2017). A phase II study of concurrent chemoradiotherapy combined with a weekly paclitaxel and 5-fluorouracil regimen to treat patients with advanced oesophageal carcinoma. Radiation Oncology, 12(1), Zhao, C., Lin, L., Liu, J., Liu, R., Chen, Y., Ge, F.,... & Xu, J. (2016). A phase II study of concurrent chemoradiotherapy and erlotinib for inoperable esophageal squamous cell carcinoma. Oncotarget, 7(35),

18 修訂日期 106 年 6 月 16 日 胃癌 Stomach Cancer 治療方式 Neoadjuvant 處方內容 RESECTABLE ECF Preoperative Epirubicin 50 mg/m2 iv bolus d1 q3w 3 cycles Cisplatin (Kemoplat) 60 mg/m2 iv d1 q3w 3 cycles 5-FU 200 mg/m2/d civi 24 weeks FOLFOX 4 Leucovorin 200 mg/m2 iv over 2 hrs before 5-FU, d1 and d2, q2w 12 cycles 5-FU 400 mg/m2 iv bolus and then 600 mg/m2 iv over 22 hrs, d1 and d2, q2w 12 cycles Oxaliplatin (Eloxatin) 85 mg/m2 iv d1, q2w 12 cycles Oral TS1:40-60mg/BID x 28 days, 14 days off (Q 6 weeks) 5,6 UNRESECTABLE or METASTATIC DCF Docetaxel (Taxotere) 75 mg/m2 iv d1 q3w 8 cycles Cisplatin (Kemoplat) 75 mg/m2 iv d1 q3w 8 cycles 5-FU 750 mg/m2/d civi d1-5 q3w 8 cycles ECF Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles Cisplatin (Kemoplat) 60 mg/m2 iv d1 q3w x 8 cycles 5-FU 200 mg/m2/d civi x 6 months ECX Epirubicin 50 mg/m2 iv bolus d1 q3w 8 cycles Cisplatin (Kemoplat) 60 mg/m2 iv d1 q3w 8 cycles Capecitabine (Xeloda) 625 mg/m2 po bid 6 months EOX Epirubicin 50 mg/m2 iv bolus d1 q3w 8 cycles Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w 8 cycles Capecitabine (Xeloda) 625 mg/m2 po bid 6 months FLO Oxaliplatin (Eloxatin) 85 mg/m2 iv over 2 hours d1 q2w Leucovorin 200 mg/m2 iv over 2 hours d1 q2w 5-FU 200 mg/m2 civi over 24 hours q2w Paclitaxel 80 mg/m2 Ⅳ on Days 1,8 and 15 cycled every 28 days7 FOLFOX 4 Leucovorin 200 mg/m2 iv over 2 hrs before 5-FU, d1 and d2, q2w 12 cycles 15

19 5-FU 400 mg/m2 iv bolus and then 600 mg/m2 iv over 22 hrs, d1 and d2, q2w 12 cycles Oxaliplatin (Eloxatin) 85 mg/m2 iv d1, q2w 12 cycles XELOX&XP Capecitabine (Xeloda) 1000 mg/m2 po bid 14 days q3w 8 cycles Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hrs d1 q3w 8 cycles Cisplatin 80mg/m2 iv over 4hrs d1 q3w 8 cycles UFUR 1# po bid Adjuvant RESECTABLE ECF Preoperative Epirubicin 50 mg/m 2 iv bolus d1 q3w 3 cycles Cisplatin (Kemoplat) 60 mg/m 2 iv d1 q3w 3 cycles 5-FU 200 mg/m 2 /d civi 24 weeks Adjuvant Epirubicin 50 mg/m 2 iv bolus d1 q3w 3 cycles Cisplatin (Kemoplat) 60 mg/m 2 iv d1 q3w 3 cycles 5-FU 200 mg/m 2 /d civi 24 weeks FOLFOX 4 Leucovorin 200 mg/m 2 iv over 2 hrs before 5-FU, d1 and d2, q2w 12 cycles 5-FU 400 mg/m 2 iv bolus and then 600 mg/m2 iv over 22 hrs, d1 and d2, q2w 12 cycles Oxaliplatin (Eloxatin) 85 mg/m 2 iv d1, q2w 12 cycles Oral TS1:40-60mg/BID x 28 days, 14 days off (Q 6 weeks) 5,6 處方內容 UNRESECTABLE or METASTATIC DCF Docetaxel (Taxotere) 75 mg/m 2 iv d1 q3w 8 cycles Cisplatin (Kemoplat) 75 mg/m 2 iv d1 q3w 8 cycles 5-FU 750 mg/m 2 /d civi d1-5 q3w 8 cycles ECF Epirubicin 50 mg/m 2 iv bolus d1 q3w x 8 cycles Cisplatin (Kemoplat) 60 mg/m 2 iv d1 q3w x 8 cycles 5-FU 200 mg/m 2 /d civi x 6 months ECX Epirubicin 50 mg/m 2 iv bolus d1 q3w 8 cycles Cisplatin (Kemoplat) 60 mg/m 2 iv d1 q3w 8 cycles Capecitabine (Xeloda) 625 mg/m 2 po bid 6 months EOX Epirubicin 50 mg/m 2 iv bolus d1 q3w 8 cycles Oxaliplatin (Eloxatin) 130 mg/m 2 iv over 2 hours d1 q3w 8 cycles Capecitabine (Xeloda) 625 mg/m 2 po bid 6 months 16

20 FLO Oxaliplatin (Eloxatin) 85 mg/m 2 iv over 2 hours d1 q2w Leucovorin 200 mg/m 2 iv over 2 hours d1 q2w 5-FU 200 mg/m 2 civi over 24 hours q2w Paclitaxel 80 mg/m 2 Ⅳ on Days 1,8 and 15 cycled every 28 days 7 FOLFOX 4 Leucovorin 200 mg/m 2 iv over 2 hrs before 5-FU, d1 and d2, q2w 12 cycles 5-FU 400 mg/m 2 iv bolus and then 600 mg/m2 iv over 22 hrs, d1 and d2, q2w 12 cycles Oxaliplatin (Eloxatin) 85 mg/m 2 iv d1, q2w 12 cycles XELOX&XP Capecitabine (Xeloda) 1000 mg/m 2 po bid 14 days q3w 8 cycles Oxaliplatin (Eloxatin) 130 mg/m 2 iv over 2 hrs d1 q3w 8 cycles Cisplatin 80mg/m 2 iv over 4hrs d1 q3w 8 cycles UFUR 1# po bid CCRT Initial 5-FU 425 mg/m 2 /d iv & Leucovorin 20 mg/m 2 /d iv, d1-5 處方內容 One month later 5-FU 400 mg/m 2 /d iv & Leucovorin 20 mg/m 2 /d iv, d1-4 and last 3 days of RT Radiotherapy 1.8 Gy/d to 45 Gy One month after completion of RT 5-FU 425 mg/m 2 /d iv, d1-5, q4w 2 cycles Leucovorin 20 mg/m 2 /d iv, d1-5, q4w 2 cycles Target therapy HER2 positive Trastuzumab 8mg/kg iv on Day 1 of cycle 1,then Trastuzumab 6mg/kg iv every 21 days 處方內容 Capecitabine 1000mg/m 2 po bid on Day 1-14 every 21 days or 5FU 800mg/m 2 iv continue infection on Day 1-5 every 21 days Cisplatin 80mg/m 2 iv on Day 1 every 21 days 17

21 參考文獻 1. Ychou, M., Boige, V., Pignon, J. P., Conroy, T., Bouché, O., Lebreton, G.,... & Genève, J. (2011). Perioperative chemotherapy compared with surgery alone for resectable gastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III trial. Journal of Clinical Oncology, 29(13), Guimbaud, R., Louvet, C., Ries, P., Ychou, M., Maillard, E., André, T.,... & Etienne, P. L. (2014). Prospective, randomized, multicenter, phase III study of fluorouracil, leucovorin, and irinotecan versus epirubicin, cisplatin, and capecitabine in advanced gastric adenocarcinoma: a French intergroup (Fédération Francophone de Cancérologie Digestive, Fédération Nationale des Centres de Lutte Contre le Cancer, and Groupe Coopérateur Multidisciplinaire en Oncologie) study. Journal of Clinical Oncology, 32(31), Sasako, M., Sakuramoto, S., Katai, H., Kinoshita, T., Furukawa, H., Yamaguchi, T.,... & Ohashi, Y. (2011). Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. Journal of Clinical Oncology, 29(33), Van Cutsem, E., Sagaert, X., Topal, B., Haustermans, K., & Prenen, H. (2016). Gastric cancer. The Lancet, 388(10060), Mihmanli, M., Ilhan, E., Idiz, U. O., Alemdar, A., & Demir, U. (2016). Recent developments and innovations in gastric cancer. World journal of gastroenterology, 22(17), Digklia, A., & Wagner, A. D. (2016). Advanced gastric cancer: Current treatment landscape and future perspectives. World journal of gastroenterology, 22(8),

22 結腸直腸癌 Colon Cancer & Rectum Cancer 修訂日期 106 年 6 月 16 日 治療方式 Neoadjuvant High Risk Stage II or Stage III regimen 1: 5FU 500 mg/ m2, Leucovorin 100 mg/ m2 D Cycle:Weekly for 6 of 8 weeks,3 cycles regimen 2: UFUR(Uracil(224mg)-Tegafur(100mg) Tegafur mg/ m2 /day bid /q28 天 /every 5 weeks,6 cycles regimen 3: 5FU(400 mg/ m2 ) + D5W 250ml ivd for 2hrs,5FU(2400 mg/ m2 ) + D5W 500ml ivd(keep 46hrs)every 2 weeks,12 cycles High Risk Stage II or Stage III,IV regimen 4: Capecitabine (Xeloda ) /mg/ m2 bid /q14 /every3 weeks,8 cycles (StageII 需自費 ) StageIII CRC,StageIV MCRC(1) 處方內容 FOLFOX 4 第一天 : (1)Oxaliplatin(85mg/m2) + D5W 250ml ivd (2)Leucovorin(200mg/m2) + D5W 250ml ivd (Oxaliplatin 和 Leucovorin 同時滴 2hrs:keep 125ml/hr) (3)5FU(400mg/m2) + N/S 250ml ivd for 2hr (4)5FU (600mg/m2) + N/S 500ml ivd(keep 23 ml/hr for 22hrs) 第二天 : (1)5FU(400mg/m2) + N/S 250ml ivd for 2hr (2)5FU (600mg/m2) + N/S 500ml ivd(keep 23 ml/hr for 22hrs) (3)Leucovorin(200mg/m2) + D5W 250ml ivd(keep 125ml/hr for 2hrs) (5Fu 與 Leucovorin 一起滴 ) Cycle Q 14 days StageIV MCRC(2) FOLFIRI (1) Irinotecan (180mg/m2) + NS 500ml ivd keep 2hrs (2) Leucovorin (400mg/m2) + D5W 250ml ivd keep 2hrs (3) 5-FU (400mg/m2) + D5W 250 ml ivd for 2hr (4) 5-FU (2400mg/m2) + D5W 500 ml ivd (keep 46 hrs, rate:11ml/hr) Cycle Q 14 days StageIV MCRC(3) 19

23 FOLFOXIRI (1)Eloxatin(85 mg.kg/m2) +5%G/W 250ml ivd 2 hrs (2)Campto(130mg.kg/m2) +N/S 500ml ivd 2 hours (3)5FU(400mg.kg/m2) + N/S 250ml ivd for 2 hrs (4)Leucovorin (200mg.kg/m2) + N/S 250ml ivd ( 5FU(3) & Leucovorin (4) 同時滴 2 hrs) (5)5FU(600mg.kg/m2) + N/S 500ml ivd (keep 23 ml/hr for 22 hrs ) StageIV MCRC (with target therapy) FOLFOX 4 or FOLFIRI Cycle:Q 2 wk Cetuximab 1st week 400mg/m 2 Cetuximab 2nd week 250mg/m 2 Q 1 wk or Cetuximab 1st week 400mg/m 2 Cetuximab 2nd week 500mg/m 2 Q 2 wk (KRAS:Wild type) or Bevacizumab 5 mg/ kg Q 2 wk or Aflibercept 4mg/kg Q 2wk mfolfox6 mfolfox6 Oxaliplatin 85 mg/m2 D5W 250ml 2hrs. 14days (Oxaliplatin 健保給付第三期結腸癌及轉移性結腸 直腸癌 ) mfolfox6 Leucovorin 400 mg/m2 D5W 250ml 2hrs. 14days mfolfox6 5-Fu 400 mg/m2 N/S 250ml iv bolus (1hr) 14days mfolfox6 5-Fu 2400 mg/m2 N/S 500ml 46-48hrs. 14days 20

24 Adjuvant High Risk Stage II or Stage III regimen 1: 5FU 500 mg/ m2, Leucovorin 100 mg/ m2 D Cycle:Weekly for 6 of 8 weeks,3 cycles regimen 2: UFUR(Uracil(224mg)-Tegafur(100mg) Tegafur mg/ m2 /day bid /q28 天 /every 5 weeks,6 cycles regimen 3: 5FU(400 mg/ m2 ) + D5W 250ml ivd for 2hrs,5FU(2400 mg/ m2 ) + D5W 500ml ivd(keep 46hrs)every 2 weeks,12 cycles High Risk Stage II or Stage III,IV regimen 4: Capecitabine (Xeloda ) /mg/ m2 bid /q14 /every3 weeks,8 cycles (StageII 需自費 ) StageIII CRC,StageIV MCRC(1) 處方內容 FOLFOX 4 第一天 : (1)Oxaliplatin(85mg/m2) + D5W 250ml ivd (2)Leucovorin(200mg/m2) + D5W 250ml ivd (Oxaliplatin 和 Leucovorin 同時滴 2hrs:keep 125ml/hr) (3)5FU(400mg/m2) + N/S 250ml ivd for 2hr (4)5FU (600mg/m2) + N/S 500ml ivd(keep 23 ml/hr for 22hrs) 第二天 : (1)5FU(400mg/m2) + N/S 250ml ivd for 2hr (2)5FU (600mg/m2) + N/S 500ml ivd(keep 23 ml/hr for 22hrs) (3)Leucovorin(200mg/m2) + D5W 250ml ivd(keep 125ml/hr for 2hrs) (5Fu 與 Leucovorin 一起滴 ) Cycle Q 14 days StageIV MCRC(2) FOLFIRI (5) Irinotecan (180mg/m2) + NS 500ml ivd keep 2hrs (6) Leucovorin (400mg/m2) + D5W 250ml ivd keep 2hrs (7) 5-FU (400mg/m2) + D5W 250 ml ivd for 2hr (8) 5-FU (2400mg/m2) + D5W 500 ml ivd (keep 46 hrs, rate:11ml/hr) Cycle Q 14 days StageIV MCRC(3) FOLFOXIRI (1)Eloxatin(85 mg.kg/m2) +5%G/W 250ml ivd 2 hrs (2)Campto(130mg.kg/m2) +N/S 500ml ivd 2 hours (3)5FU(400mg.kg/m2) + N/S 250ml ivd for 2 hrs (4)Leucovorin (200mg.kg/m2) + N/S 250ml ivd 21

25 ( 5FU(3) & Leucovorin (4) 同時滴 2 hrs) (5)5FU(600mg.kg/m2) + N/S 500ml ivd (keep 23 ml/hr for 22 hrs ) StageIV MCRC (with target therapy) FOLFOX 4 or FOLFIRI Cycle:Q 2 wk Cetuximab 1st week 400mg/m 2 Cetuximab 2nd week 250mg/m 2 Q 1 wk or Cetuximab 1st week 400mg/m 2 Cetuximab 2nd week 500mg/m 2 Q 2 wk (KRAS:Wild type) or Bevacizumab 5 mg/ kg Q 2 wk or Aflibercept 4mg/kg Q 2wk mfolfox6 mfolfox6 Oxaliplatin 85 mg/m2 D5W 250ml 2hrs. 14days (Oxaliplatin 健保給付第三期結腸癌及轉移性結腸 直腸癌 ) mfolfox6 Leucovorin 400 mg/m2 D5W 250ml 2hrs. 14days mfolfox6 5-Fu 400 mg/m2 N/S 250ml iv bolus (1hr) 14days mfolfox6 5-Fu 2400 mg/m2 N/S 500ml 46-48hrs. 14days CC Rectal Cancer RT 處方內容 regimen 1: 5-FU + RT 5-FU 1000 mg/m2/d civi x 5 days during the first and fifth weeks of radiotherapy Concurrent radiotherapy 50.4 Gy Surgery in 4-6 weeks 5-FU 500 mg/m2/d civi d1-5 q4w x 4 cycles 22

26 參考文獻 1. 高雄市立大同醫院癌症中心化學治療處方集 2.Lenz, H., Niedzwiecki, D., Innocenti, F., Blanke, C., Mahony, M. R., O'Neil, B. H.,... & Goldberg, R. (2014). 501ocalgb/Swog 80405: phase III trial of irinotecan/5-fu/leucovorin (folfiri) or oxaliplatin/5-fu/leucovorin (mfolfox6) with bevacizumab (bv) or cetuximab (cet) for patients (pts) with expanded Ras analyses untreated metastatic adenocarcinoma of the colon or rectum (mcrc). Annals of Oncology, 25(suppl 4), mdu Fuchs, C. S., Marshall, J., Mitchell, E., Wierzbicki, R., Ganju, V., Jeffery, M.,... & Barrueco, J. (2007). Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. Journal of Clinical Oncology, 25(30), Heinemann, V., von Weikersthal, L. F., Decker, T., Kiani, A., Vehling-Kaiser, U., Al-Batran, S. E.,... & Kullmann, F. (2014). FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. The lancet oncology, 15(10), Van Cutsem, E., Tabernero, J., Lakomy, R., Prenen, H., Prausová, J., Macarulla, T.,... & McKendrick, J. (2012). Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin-based regimen. Journal of Clinical Oncology, 30(28), of metastatic colorectal cancer. Journal of clinical oncology, 21(5), Grothey, A., Van Cutsem, E., Sobrero, A., Siena, S., Falcone, A., Ychou, M.,... & Adenis, A. (2013). Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. The Lancet, 381(9863), Douillard, J. Y., Siena, S., Cassidy, J., Tabernero, J., Burkes, R., Barugel, M.,... & Rivera, F. (2010). Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. Journal of clinical oncology, 28(31), Lin, C. Y., Chen, J. B., Chiang, F. F., Wang, H. M., Chao, T. H., Chen, C. C., & Ma, H. F. (2016). Difference between Complete Oxaliplatin Based Adjuvant Chemotherapy and Incomplete Course in Stage III Colorectal Cancer Patients in Taiwan. 中華民國大腸直腸外科醫學會雜誌, 27(2), Gustavsson, B., Carlsson, G., Machover, D., Petrelli, N., Roth, A., Schmoll, H. J.,... & Gibson, F. (2015). A review of the evolution of systemic chemotherapy in the management of colorectal cancer. Clinical colorectal cancer, 14(1), Karoui, M., Rullier, A., Luciani, A., Bonnetain, F., Auriault, M. L., Sarran, A.,... & Sobhani, I. (2015). Neoadjuvant FOLFOX 4 versus FOLFOX 4 with Cetuximab versus immediate surgery for high-risk stage II and III colon cancers: a multicentre randomised controlled phase II trial the PRODIGE 22-ECKINOXE trial. BMC cancer, 15(1), Lonardi, S., Sobrero, A., Rosati, G., Di Bartolomeo, M., Ronzoni, M., Aprile, G.,... & Marchetti, P. (2016). Phase III trial comparing 3 6 months of adjuvant FOLFOX4/XELOX in stage II III colon cancer: safety and compliance in the TOSCA trial. Annals of Oncology, 27(11),

27 修訂日期 106 年 5 月 9 日 治療方式 處方內容 Target therapy(adjuvant) 肝癌 Hepatoma (1) Nexavar(sorafenib) 1# - 2#/day q12h 治療方式 處方內容 Systemic Oral Chemotherapy (1) UFUR 1# - 2#/day q12h 治療方式 處方內容 Chemotherapy drugs: maybe used single or in combination(palliative) TACE (1)Epirubicin (10-30mg)/m 2 (2)Mitomycin C(2~10mg)/m 2 (3)Cisplatin(2-40mg)/m 2 Target therapy(palliative) (1) Nexavar(sorafenib) 1# - 2#/day q12h 參考文獻 1. 高雄醫學大學附設中心紀念醫院癌症中心化學治療處方集 2. Kim, J. H., Sinn, D. H., Shin, S. W., Cho, S. K., Kang, W., Gwak, G. Y.,... & Choi, M. S. (2017). The role of scheduled second TACE in early-stage hepatocellular carcinoma with complete response to initial TACE. Clinical and Molecular Hepatology, 23(1), National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers, version Siddique, O., Yoo, E. R., Perumpail, R. B., Perumpail, B. J., Liu, A., Cholankeril, G., & Ahmed, A. (2017). The importance of a multidisciplinary approach to hepatocellular carcinoma. Journal of Multidisciplinary Healthcare,10, Zhu, Y. J., Zheng, B., Wang, H. Y., & Chen, L. (2017). New knowledge of the mechanisms of sorafenib resistance in liver cancer. Acta Pharmacologica Sinica. 24

28 修訂日期 106 年 5 月 9 日 一 膀胱癌 Bladder Cancer 治療方法 Neoadjuvant 泌尿道癌 Urinary tract Cancer Systemic Regimen1:(Ccr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose) Gemcitabine (Gemzar ) 1000mg/ m2 D1, D8, D15;Cisplatin 70mg/m 2 D2 Repeat every 28days for 3-4 cycles. Regimen2: (Ccr<50) Gemcitabine (Gemzar )1000mg/m 2 D1, D8, D15;Carboplatin 300mg/m 2 D2 Repeat every 28days for 3-4 cycles. 處方內容 Regimen3: ( C Cr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose) MTX 30mg/m 2 ; Vinblastin 3mg/m 2 ; Epirubicin 30mg/m 2 ; Cisplatin 70mg/m 2 Regimen4: (Ccr<50) MTX 30mg/m 2 ; Vinblastin 3mg/m 2 ; Epirubicin 30mg/m 2 ; Carboplatin 300mg/m 2 Intravesical (IC) Regimen1: Epirubicin 30-50mg qw*6-8cycles Regimen2: Mitomycin 30mg qw*6-8cycles Regimen3: Mitomycin 30mg *1cycles Epirubicin(Pharmorubicin ) 30-50mg *1cycles Within 24 hrs after resection single use Adjuvant 處 方 內 容 Systemic Regimen1:(Ccr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose) Gemcitabine (Gemzar ) 1000mg/ m2 D1, D8, D15;Cisplatin 70mg/m 2 D2 Repeat every 28days for 3-4 cycles. Regimen2: (Ccr<50) Gemcitabine (Gemzar )1000mg/m 2 D1, D8, D15;Carboplatin 300mg/m 2 D2 Repeat every 28days for 3-4 cycles. Regimen3: ( C Cr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose) 25

29 MTX 30mg/m 2 ; Vinblastin 3mg/m 2 ; Epirubicin 30mg/m 2 ; Cisplatin 70mg/m 2 Regimen4: (Ccr<50) MTX 30mg/m 2 ; Vinblastin 3mg/m 2 ; Epirubicin 30mg/m 2 ; Carboplatin 300mg/m 2 Intravesical (IC) Regimen1: Epirubicin 30-50mg qw*6-8cycles Regimen2: Mitomycin 30mg qw*6-8cycles Regimen3: Mitomycin 30mg *1cycles Epirubicin(Pharmorubicin ) 30-50mg *1cycles Within 24 hrs after resection single use 參考文獻 1. 高雄醫學大學附設中心紀念醫院癌症中心化學治療處方集 2. 高雄市立小港醫院 (2016).Antineoplastic agents. 處方集 3. National Comprehensive Cancer Network. (2010). NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer V. 1, Wosnitzer, M. S., Hruby, G. W., Murphy, A. M., Barlow, L. J., Cordon Cardo, C., Mansukhani, M.,... & McKiernan, J. M. (2012). A comparison of the outcomes of neoadjuvant and adjuvant chemotherapy for clinical T2 T4aN0 N2M0 bladder cancer. Cancer, 118(2), von der Maase, H., Sengelov, L., Roberts, J. T., Ricci, S., Dogliotti, L., Oliver, T.,... & Arning, M. (2005). Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. Journal of Clinical Oncology, 23(21), Roberts, J. T., von der Maase, H., Sengeløv, L., Conte, P. F., Dogliotti, L., Oliver, T.,... & Arning, M. (2006). Long-term survival results of a randomized trial comparing gemcitabine/cisplatin and methotrexate/vinblastine/doxorubicin/cisplatin in patients with locally advanced and metastatic bladder cancer. Annals of oncology, 17(suppl 5), v118-v Shelley, M. D., Wilt, T. J., Court, J., Coles, B., Kynaston, H., & Mason, M. D. (2004). Intravesical bacillus Calmette Guérin is superior to mitomycin C in reducing tumour recurrence in high risk superficial bladder cancer: a meta analysis of randomized trials. BJU international, 93(4), Chang, S. S., Bochner, B. H., Chou, R., Dreicer, R., Kamat, A. M., Lerner, S. P.,... & Quale, D. Z. (2017). Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/ASTRO/SUO Guideline. The Journal of Urology. 9. Ho, P. L., Willis, D. L., Patil, J., Xiao, L., Williams, S. B., Melquist, J. J.,... & Navai, N. (2016, February). Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: The MD Anderson Cancer Center Experience. In Urologic Oncology: Seminars and Original Investigations (Vol. 34, No. 2, pp. 59-e1). Elsevier. 26

30 10. Ho, P. L., Willis, D. L., Patil, J., Xiao, L., Williams, S. B., Melquist, J. J.,... & Navai, N. (2016, February). Outcome of patients with clinically node-positive bladder cancer undergoing consolidative surgery after preoperative chemotherapy: The MD Anderson Cancer Center Experience. In Urologic Oncology: Seminars and Original Investigations (Vol. 34, No. 2, pp. 59-e1). Elsevier. 27

31 二 前列腺癌 Prostate Cancer CRPC Case 適用 (castration resistance prostate cancer) 處方內容 Systemic Regimen1: Docetaxel (Taxotere ) 75mg/m 2 + Prednisolone 1# bid 5days/ 21~ Q28d,6~8 course 參考文獻 1.Papandreou, C. N., Daliani, D. D., Thall, P. F., Tu, S. M., Wang, X., Reyes, A.,... & Logothetis, C. J. (2002). Results of a phase II study with doxorubicin, etoposide, and cisplatin in patients with fully characterized small-cell carcinoma of the prostate. Journal of clinical oncology, 20(14), Noda, K., Nishiwaki, Y., Kawahara, M., Negoro, S., Sugiura, T., Yokoyama, A.,... & Yamamoto, S. (2002). Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung cancer. New England Journal of Medicine, 346(2), Machiels, J. P., Mazzeo, F., Clausse, M., Filleul, B., Marcelis, L., Honhon, B.,... & Verhoeven, D. (2008). Prospective randomized study comparing docetaxel, estramustine, and prednisone with docetaxel and prednisone in metastatic hormone-refractory prostate cancer. Journal of clinical oncology, 26(32), Osanto, S., & Luelmo, S. A. C. (2017). Chemotherapy and Androgen Receptor-Directed Treatment of Castration Resistant Metastatic Prostate Cancer. In Management of Prostate Cancer (pp ). Springer International Publishing. 5.de Morrée, E. S., Vogelzang, N. J., Petrylak, D. P., Budnik, N., Wiechno, P. J., Sternberg, C. N.,... & Choudhury, A. (2017). Association of Survival Benefit With Docetaxel in Prostate Cancer and Total Number of Cycles Administered: A Post Hoc Analysis of the Mainsail Study. JAMA oncology, 3(1), Osanto, S., & Luelmo, S. A. C. (2017). Chemotherapy and Androgen Receptor-Directed Treatment of Castration Resistant Metastatic Prostate Cancer. In Management of Prostate Cancer (pp ). Springer International Publishing. 28

32 制定日期 106 年 5 月 9 日 淋巴癌 Hematopoietic cancer 化療藥物名稱標準劑量單位稀釋液滴注時間週期 R-CHOP 1 m2 Mabthera 375 mg/ CHOP 2 Cyclophosphamide 750 mg/ m2 Doxorubicin 50 mg/ Vincristine 1.4(max 2mg) m2 mg/ m2 N/S 500ml N/S 500ml N/S 500ml N/S 50ml keep IV pump >6hrs(D1) 2hrs(D2) 2hrs(D2) 30min(D2) Prednisolone 40 mg - TID(D2-D6) Cyclophosphamide 750 mg/m2 N/S 500ml Doxorubicin 50 mg/m2 N/S 500ml Vincristine 1.4(max 2mg) mg/m2 N/S 50ml 2hrs(D1) 2hrs(D1) 30min(D1) Prednisolone 40 mg - TID(D1-D5) R-COP 3 500ml Cyclophosphamide 750 mg/m2 N/S Mabthera 375 mg/m2 N/S 500ml Vincristine 1.4(max mg/m2 N/S 2mg) 50ml keep IV pump >6hrs(D1) 2hrs(D2) 30min(D2) Prednisolone 40 mg - TID(D2-D6) COP 3 Cyclophosphamide 750 mg/ m2 R-EPOCH 4 5 Vincristine 1.4(max 2mg) mg/m2 N/S 500ml N/S 50ml 2hrs(D1) 30min(D1) Prednisolone 40 mg - TID(D1-D5) Mabthera 375 mg/ m2 N/S 500ml keep IV pump >6hrs(D1) Etoposide 50 mg/m2 N/S 500ml 24hrs(D2-D5) Epirubicin 10 mg/m2 N/S 500ml 24hrs(D2-D5) Vincristine 0.5 mg day N/S 500ml 24hrs(D2-D5) 21 days 21 days 21 days 21 days 21 days EPOCH 4 5 Cyclophosphamide 750 mg/m2 N/S 500ml 2hrs(D7) Prednisolone 60 mg - TID(D2-D7) Etoposide 50 mg/ N/S 500ml 24hrs(D1-D4) m2 Epirubicin 10 mg/m2 N/S 500ml 24hrs(D1-D4) Vincristine 0.5 mg day N/S 500ml 24hrs(D1-D4) Cyclophosphamide 750 mg/m2 N/S 500ml 2hrs(D6) Prednisolone 60 mg - TID(D1-D6) Mabthera 375 mg/m2 N/S 500ml keep IV pump 29 >6hrs(D1) 21 days

33 R-ESHAP 6 R-ESHAP 6 Solu-medrol 500 mg total N/S 100ml 1hr(D2-D5) Etoposide 40 mg/m2 N/S 500ml 3hrs(D2-D5) 21 days Cisplatin 25 mg/m2 N/S 500ml 3hrs(D2-D5) 21 days Ara-C 2000 mg/m2 N/S 500ml 2hrs(D6) Solu-medrol 500 mg total N/S 100ml 1hr(D1-D4) ESHAP 7 Etoposide 40 mg/m2 N/S 500ml 3hrs(D1-D4) Cisplatin 25 mg/m2 N/S 500ml 3hrs(D1-D4) 21 days R-ICE 8 Ara-C 2000 mg/m2 N/S 500ml 2hrs(D5) Mabthera 375 mg/m2 N/S 500ml keep IV pump >6hrs(D1) Ifosfamide 1330 mg/m2 N/S 500ml 24hrs(D2-D4) Cisplatin or Carboplatin +Mesna (D2-D4) 25 mg/m2 N/S 500ml 2hrs(D2-D4) AUC=5 2hrs (D2) 21 days Etoposide 100 mg/m2 N/S 500ml 2hrs(D2-D4) ICE 9 Ifosfamide 1330 mg/m2 N/S 500ml 24hrs(D1-D3) Cisplatin or Carboplatin +Mesna (D1-D3) 25 mg/m2 N/S 500ml 2hrs(D1-D3) AUC=5 2hrs (D1) 21 days Etoposide 100 mg/m2 N/S 500ml 2hrs(D1-D3) 30

34 FOR HL Epirubicin 25 mg/m2 N/S 1hrs(D1) ABVD ml Bleomycin 10 mg/m2 N/S 1hrs(D1) 14 days 250ml Vinblastine 6 mg/m2 N/S 1hrs(D1) 250ml Dacarbazine 375 mg/m2 N/S 1hrs(D1) 參考文獻 1. 高雄市立大同醫院癌症中心化學治療處方集 2.Czuczman, M. S., Weaver, R., Alkuzweny, B., Berlfein, J., & Grillo-López, A. J. (2004). Prolonged clinical and molecular remission in patients with low-grade or follicular non-hodgkin's lymphoma treated with rituximab plus CHOP chemotherapy: 9-year follow-up. Journal of clinical oncology, 22(23), Dunleavy, K., Pittaluga, S., Maeda, L. S., Advani, R., Chen, C. C., Hessler, J.,... & Staudt, L. M. (2013). Dose-adjusted EPOCH-rituximab therapy in primary mediastinal B-cell lymphoma. New England Journal of Medicine, 368(15), Eich, H. T., Diehl, V., Görgen, H., Pabst, T., Markova, J., Debus, J.,... & Wiegel, T. (2010). Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin's lymphoma: final analysis of the German Hodgkin Study Group HD11 trial. Journal of Clinical Oncology, 28(27), Jermann, M., Jost, L. M., Taverna, C. H., Jacky, E., Honegger, H. P., Betticher, D. C.,... & Stahel, R. A. (2004). Rituximab EPOCH, an effective salvage therapy for relapsed, refractory or transformed B-cell lymphomas: results of a phase II study. Annals of Oncology, 15(3), Marcus, R., Imrie, K., Solal-Celigny, P., Catalano, J. V., Dmoszynska, A., Raposo, J. C.,... & Wassner-Fritsch, E. (2008). Phase III study of R-CVP compared with cyclophosphamide, vincristine, and prednisone alone in patients with previously untreated advanced follicular lymphoma. Journal of Clinical Oncology, 26(28), Martín, A., Conde, E., Arnan, M., Canales, M. A., Deben, G., Sancho, J. M.,... & Nistal, S. (2008). R-ESHAP as salvage therapy for patients with relapsed or refractory diffuse large B-cell lymphoma: the influence of prior exposure to rituximab on outcome. A GEL/TAMO study. Haematologica, 93(12), Kewalramani T, Zelenetz AD, Nimer SD, et al. Rituximab and ICE (RICE) as second-line therapy prior to autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma. Blood 2004;103: Zelenetz AD, Hamlin P, Kewalramani T, et al. Ifosfamide, carboplatin, etoposide (ICE)-based second-line chemotherapy for the management of relapsed and refractory aggressive non-hodgkin's lymphoma. Ann Oncol 2003;14[suppl 1]:i Savage KJ, Skinnider B, Al-Mansour M, et al. Treating limited stage nodular lymphocyte predominant Hodgkin lymphoma similarly to classical Hodgkin lymphoma with ABVD may improve outcome. Blood 2011;118: ml 31

35 藥物產品規格 商品名學名劑量 5FU 5-Fluorouracil 1g/20 ml/vial Alimta Pemetrexed 100mg/Vial 500mg/Vial Avastin Bevacizumab 100mg/ 4mL/ Vial Campto Irinotecan 100mg/5ml/Vial Cisplatin Cisplatin 50mg/ 100ml/Bot Cyramza Ramucirumab 500mg/50mL/Vial Eloxatin Oxaliplatin 50 mg/10ml/vial Emthexate Methotrexate (M.T.X) 500mg/5ml/amp Erbitux Cetuximab 100mg/20ml/vial Endoxan Cyclophosphamide 500mg/vial Fytosid Etoposide(VP-16) 100mg/5ml/ Vial Gemzar Gemcitabine 200mg/Vial Genataxyl Paclitaxel 30mg/5ml/Vial Herceptin Trastuzumab 440mg/Vial Halaven Eribulin 1 mg /vial Kemocarb Carboplatin 150mg/15ml/Vial Kadcyla(TDM-1) Trastuzumab Emtansine mg/vial 160mg/vial Lipo-Dox Liposomal Doxorubicin 20mg/10mL/Vial Mitomycin Mitomycin C (M.M.C.) 10mg/Vial Navelbine Vinorelbine tartrate 50mg/5ml/Vial Pharmorubicin Epirubicin 10mg/Vial 50mg/Vial Perjeta Pertuzumab 420mg/vial Taxotere Taxotere 20mg/0.5ml/Vial 80mg/2ml/Vial Zaltrap Aflibercept 100mg/4mL/Vial 口服 Endoxan Cyclophosphamide 50mg/Tab Giotrif Afatinib 30 mg, 40 mg/tab Iressa Gefitinib 250 mg/tab

36 TS1 Tegafur+Oteracil+Gimeracil 20mg/Cap Tarceva Erlotinib 150 mg/tab Tykerb Lapatinib 250 mg/tab UFUR Tegafur/ uracil 100mg/224mg/Cap Xeloda Capecitabine 500mg/Tab 33

37 劑量調整 5-Fluorouracil (5-FU) 5-Fluorouracil 老年人 : 參考成人劑量 肝臟功能異常 : 美國食品和藥物管理局核准的劑量不包含特殊的劑量調整指引, 但指出, 必須極其小心使用於肝臟損傷的患者 下面的指引也被作為參考 : Floyd(2006): 膽紅素 >5 mg/dl 避免使用 Koren(1992): 肝臟損傷 ( 程度未明確說明 ): 先給予 <50% 的劑量, 如果毒性未發生可增加劑量 腎臟功能異常 : 美國食品和藥物管理局核准的劑量不包含特殊的劑量調整指導方針, 但指出, 必須極其小心使用於腎臟損傷的患者 血液透析 :Aronoff (2007): 建議 Clcr< 50 ml/minute 的成年患者不需要調整劑量, 已接受血液透析的患者僅應該給予 50% 的劑量 Kemoplat Cisplatin 老年人 : 參考成人劑量 肝臟功能異常 : 無相關資料 腎臟功能異常 : 依據廠商建議腎功能不佳者不建議給藥. 直到腎功能回復至 serum creatinine 小於 1.5mg/dl 或 BUN 小於 25mg/dl 才可以再給藥. FDA 並無提供腎功能不佳的建議劑量 下列治療指引為專家的臨床治療建議劑量 :.Aronoff, 2007 Cl cr (ml/min) 劑量 血液透析 : 血液透析會清除部分劑量 75 % < 10 給予正常劑量的 50 % 已接受血液透析患者血液透析後給予正常劑量的 50 % 膜腹透析 (CAPD) 患者給予正常劑量的 50 % 連續性腎替代治療 (CRRT) 患者給予正常劑量的 75 % 血液學異常 : 嗜中性白血球減少症和 / 或血小板減少症 : 1.febrile neutropenia 或長期性嗜中性白血球減少症或是中性白血球減少症引起的感染症且使用 (G-CSF) 治療的病患,cisplatin 合併 docetaxel 治療時需降低 docetaxe 的劑量由 75mg mg/m 2 調降至 60mg/m 2 2. 伴隨有嗜中性白血球降低引起的併發症發生時,cisplatin 合併 docetaxel 治療, 需降低 docetaxe 的劑量由 60mg mg/m 2 調降至 45mg/m 2 3.grade 4 的血小板低下症,cisplatin 合併 docetaxel 治療時, 需降低 docetaxe 的劑量由 75mg mg/m 2 調降至 60mg/m 2 34

38 4. 停用 docetaxel, 直到中性粒細胞 >1500 cells/cubic millmeter (mm 3 ) 和血小板 >100000cell/mm 3 5. 若毒性再度發生則須停用 docetaxel 腎功能異常是此藥劑量限制毒性 Alimta Pemetrexed 肝臟功能異常 : 3 級 ( 倍 ULN) 或 4 級 (>20 倍 ULN) 轉胺酶上升 : 減少 pemetrexed 75 % 的劑量 腎臟功能異常 : CCr 45 <80ml/minute 同時有使用 NSAID: 要小心使用 CCr 45 ml/minute: 不需調整劑量 CCr< 45 ml/minute: 無劑量調整之研究證據, 廠商建議停用 毒性劑量的調整 : 血液學毒性 : Nadir ANC <500/mm 3 及 nadir platelet 50000/mm 3 : 減少 pemetrexed 75 % 的劑量 Nadir platelet 50000/mm 3 沒有出血 : 減少 pemetrexed 75% 的劑量 Nadir platelet < 50000/mm 3 有出血 : 減少 pemetrexed 50% 的劑量 非血液學毒性 3 級 ( 不包括神經毒性 ): 停止治療直到恢復正常 ; 再開始治療如下 : 3 或 4 級毒性 ( 不包括黏膜炎 ): 減少 pemetrexed 75% 的劑量 3 或 4 級腹瀉或任何需要住院的腹瀉 : 減少 pemetrexed 75% 的劑量 3 或 4 級黏膜炎 : 減少 pemetrexed 50% 的劑量 ( 維持原 cisplatin 的量 ) 神經毒性 : 0-1 級 : 維持原 pemetrexed 的劑量 ( 及 cisplatin) 2 級 : 維持原 pemetrexed 的劑量, 減少 cisplatin 50% 的劑量 Avastin Bevacizumab 老年人 : 參考成人劑量 肝臟功能異常 : 目前尚無 Avastin 用在肝功能障礙的患者的安全性及療效性 腎臟功能異常 : 目前尚無 Avastin 用在肝功能障礙的患者的安全性及療效性 其他 : 1. 使用 Avastin 治療的病人有較高出血的危險性, 特別是與腫瘤相關的出血 在 Avastin 治療期間出現 3 級或 4 級出血的患者應永久停用 Avastin 2. 患者在使用 Avastin 時, 發生胃腸穿孔的危險性較高 發生胃腸穿孔的患者應永久停用 Avastin 3. 以 Avastin 治療之患者的高血壓發生率較高 臨床安全性數據顯示, 高血壓發生率可能與劑量有關 在開始給予 Avastin 治療前, 應適當控制已存在之高血壓 若發生高血壓危象或高血壓性腦病變, 應永久停用 Avastin 35

39 Campto Irinotecan 老年人 : 參考成人劑量 肝臟功能異常 : 1. 對於轉移性肝腫瘤或正常肝功能患者建議並不須更改劑量 2. 臨床醫師建議 :Bilirubin1.5-3 mg/dl irinotecan 劑量調整 75%(Floyd,2006) 腎臟功能異常 : 腎功能不全患者尚無相關使用評估 ; 不建議用於洗腎患者. 血液學異常 : 1. 若患者顆粒性白血球 1500/mm 3 血小板 100,000/mm 3 且因治療而產生腹瀉完全緩解, 即可進行新療程. 2. 依據患者對於治療的耐受性, 劑量可隨之增加 mg/m 2 3. 療程需延緩 1-2 週以利治療產生的毒性回復 ; 若患者於 2 週的延遲治療並未回復, 則考慮停用 irinotecan Eloxatin Oxaliplatin 老年人 : 老年患者不需調整劑量 肝臟功能異常 : Oxaliplatin 尚未對重度肝力能不良的病人進行研究. 對於肝功能異常的病人 使用 Oxaliplatin 後並未觀察到有急性肝毒性加劇的現象, 在臨床試驗時對於肝功 能異常的病患並無調整劑量. 腎臟功能異常 : 血液學異常 : 症 : Clcr ( ml/min ) 劑量 輕度至中度腎功能不全 不需調整 重度腎功能不全 < 20 停用 若產生 3 或 4 級胃腸毒性 4 級啫中性白血球減少症 3 或 4 級血小板減少 1. 第三期直腸癌 : 減少 Oxaliplatin 劑量為 75 mg/m 2, 延緩下次投與劑量直至啫中性白血球 1500/mm 3 及血小板 75,000/mm 3 2. 轉移性結腸直腸癌 : 減少 Oxaliplatin 劑量為 65 mg/m 2, 延緩下次投與劑量直至啫中性白血球 1500/mm 3 及血小板 75,000/mm 3 Emthexate Methotrexate/ M.T.X 老年人 : 參考個別之治療計畫 ; 依腎功能調整劑量 肝臟功能異常 : FDA 尚未核准劑量調整指引 一些臨床醫師使用以下方式進行劑量調整 (Floyd, 2006): 36

40 1. 膽紅素 mg/dl 或 GPT/GOT > 3 倍正常值上限 : 應調整劑量為原本之 75% 2. 膽紅素 > 5mg/dL: 避免使用 腎臟功能異常 :Aronoff, 2007: 肌酸酐清除率 (ml/min) 劑量調整 10~50 正常劑量的 50% < 10 正常劑量的 30 % 血液透析正常劑量的 50 % 連續性腎臟替代療法 (CRRT) 正常劑量的 50 % Fytosid Etoposide(VP-16) 肝功能異常及老年人無劑量調整之研究證據, 但肝功能異常使用須小心 腎臟功能異常 : Ccr:10~50ml/min 給予 75% 劑量 Ccr<10ml/min 給予 50% 劑量 骨髓抑制是此藥主要劑量限制毒性 Gemzar Gemcitabine 老年人 : 參照成人劑量 肝臟功能異常 : FDA 核準說明中, 並無包含劑量調整準則, 需小心使用 Gemcitabine 目前 無使用於肝功能不全患者的相關研究, 因此目前無明確的劑量調整準則 臨床上 (Floyd, 2006) 可遵從的準則建議當 Serum bilirubin >1.6 mg/dl 時, 由 800 mg/m 2 開始使用 腎臟功能異常 : FDA 核準說明並無包含劑量調整準則, 需小心使用使用 Gemcitabine 目前 無使用於腎功能不全者的相關研究, 因此目前無明確的劑量調整準則 血液學異常 : 治療時應每隔一週檢查 CBC&DC, 若出現血液毒性, 需要時可依下列準則 降低劑量或停藥 ANC(ul) 血小板 (ul) 總劑量之白分比 >1000 且 > % 或 % <500 或 <50000 停藥 骨髓抑制是此藥劑量限制毒性 Genataxyl Paclitaxel 過敏反應需以 corticosteroid diphenhydramine H2 blocker 於給藥前給予作為預防性給藥 廠商建議 ANC 低於 1500/μL 的病人不要給藥 發生嚴重的嗜中性白血球減少症或神經病變必須減量 20% 37

41 老年人 : 參考成人劑量 肝臟功能異常 : 依據 FDA 建議, 在肝功能正常患者第一次療程中, 給藥劑量為 175 mg/m 2, 輸注大於 3 小時 故肝功能異常患者, 其劑量調整如下 : 輸注 3 小時 GPT/GOT Bilirubin 建議劑量 <10 倍 ULN 和 1.25 倍 ULN 175 mg/m 2 <10 倍 ULN 和 倍 ULN 135 mg/m 2 <10 倍 ULN 和 倍 ULN 90 mg/m 2 10 倍 ULN 或 >5 倍 ULN 避免使用 腎臟功能異常 : 關於腎功能異常的劑量調整,FDA 目前無相關文獻建議 而 2007 年 Arnoff 對於 Cl cr <50 ml/minute 患者, 也無劑量調整資料 劑量限制毒性包括骨髓抑制 過敏反應 心率不整 神經病變 Herceptin Trastuzumab 老年人 : 參考成人劑量肝臟功能異常 : 無劑量調整之需求腎臟功能異常 : 無劑量調整之需求血液學異常 : 依心臟毒性之劑量調整 : LVEF 值降低 16%( 由基礎值至正常值上限間 ) 或 LVEF 值在正常值上限之下或 LVEF 值降低 10%( 基礎值 ) 時, 暫停治療 4 週, 且每 4 週追蹤一次 LVEF 值 若 LVEF 值在 4-8 週後恢復至正常值內且 LVEF 值降低 15%( 由基礎值至正常值上限間 ), 得以繼續治療 若 LVEF 值在停用 8 週以上仍未恢復至正常值或治療期間出現 3 個以上心肌病導致治療中斷情形時, 應繼續停用 Kemocarb Carpoplatin 老年人 : 老年人劑量的調整根據 Calvert 公式 老年人建議劑量計算公式以 GFR 的預估值來計算 以病人 GFR (in ml/minute) 及 target AUC (in mg/ml per minute) 為基礎計算, 劑量是 mg; 非 mg/m 2 Calvert Formula: total dose (mg) = target AUC (in mg/ml per min) [GFR (in ml/min) + 25]target AUC of 5 (range: 4 6) mg/ml per minute: 為之 前已經使用過化療藥物治療病人, 今需使用 carboplatin 單一治療者最常被建議使 用的劑量範圍 肝臟功能異常 : 僅極少部分由肝臟代謝, 因此肝功能不佳病患不須做調整劑量, 且目前無劑 量調整準則 腎臟功能異常 : 38

42 腎功能異常劑量調整建議以 Calvert 公式之 GFR 的預測值來計算 ; 當病人 Clcr <60 ml/minute 時應降低劑量使用 ;FDA 核准建議劑量調整準則 : Baseline Clcr Initial Dose 60 ml/min 360 mg/m 2 ; 之後劑量依骨髓毒性作調整 ml/min 250 mg/m 2 ; 之後劑量依骨髓毒性作調整 ml/min 200 mg/m 2 ; 之後劑量依骨髓毒性作調整當病人 Clcr <15 ml/minute, 在劑量調整上有太多限制, 並無準則可使用特殊病人之劑量調整 : 腎功能異常劑量調整已接受血液透析病患給予建議劑量的 50% 腹膜透析病患 (CAPD) 給予建議劑量的 25% 連續性腎替代性治療 (CRRT) 給予 200 mg/m 2 血液學異常 : 血小板 <50,000 cells/mm 3 或絕對嗜中性白血球數 <500 cells/mm 3 : 給予建議劑量的 75% 骨髓抑制是此藥主要劑量限制毒性 Lipo-Dox Liposomal Doxorubicin 老年人 : 參照成人劑量 微脂體藥物包覆劑型與傳統 doxorubicin hydrochloride 劑型 不可直接進行劑量轉換 肝臟功能異常 : 微脂體藥物包覆劑型與傳統 doxorubicin hydrochloride 劑型不可直接進行劑 量轉換 肝功能指標 劑量調整 GPT/GOT 其 ULN 的 2-3 倍 建議劑量的 75% GPT/GOT 其 ULN 的 3 倍以上或 Bilirubin:1.2-3mg/dL 建議劑量的 50% Bilirubin 3.1-5mg/dL 建議劑量的 25% Bilirubin >5 mg/dl 不建議使用 腎臟功能異常 :Doxorubicin 為肝臟代謝 膽汁排除, 故不需劑量調整之需求 血液學異常 : 血液學檢查異常劑量調整 等級 嗜中性白血球 血小板 劑量調整 (ANC) 第一級 , ,000 不需調整劑量 第二級 1000 < ,000 待 ANC 1500 且血小板 75,000 <75,000 時, 可繼續治療, 不需調整劑量 第三級 ,000 待 ANC 1500 且血小板 75,000 39

43 50,000 時, 可繼續治療, 不需調整劑量 待 ANC 1500 並且血小板 第四級 <500 <25,000 75,000 時, 降低 25% 劑量或不調整劑量 手足症候群 : 等級劑量調整第一級若病患曾經歷第 3 級或 4 級的毒性, 延遲給藥 2 星期, 並依之前劑量降低 25% 的劑量, 以相同投藥間隔給予 延遲給藥 2 星期或直到症狀緩解成第 0-1 級 若 2 星期之內緩解成第 0-1 級且之前無第 3-4 級的毒性時, 依之前劑量和投藥間隔給予 第二級 若 2 星期之內緩解成第 0-1 級且之前有第 3-4 級的毒性時, 依之前劑量降低 25% 並以相同投藥間隔給予 若 2 星期後症狀未獲得緩解則應停藥 延遲給藥 2 星期或者直到症狀緩解成第 0-1 級, 依之前劑量降低 25% 第三級並以相同投藥間隔給予 若 2 星期後症狀未獲得緩解則應停藥 延遲給藥 2 星期或者直到症狀緩解成第 0-1 級, 依之前劑量降低 25% 第四級並以相同投藥間隔給予 若 2 星期後症狀未獲得緩解則應停藥 Mitomycin C M.M.C. 老年人 : 參考成人劑量 因高齡者通常生理機能較低, 骨髓功能更易受抑制, 且抑制 期可能延長, 也容易發生腎功能障礙, 所以投藥時必須小心觀察病人情況, 特別 注意劑量及投與間隔 肝臟功能異常 : 依據廠商建議須經常做臨床肝功能檢查, 以便隨時監控病情, 如發生有異常 時, 須做減量或停藥等適當處理 另長期使用時, 副作用可能增強, 也可能會延 長, 因此須慎重投藥 腎臟功能異常 : 依據廠商建議須經常做臨床腎功能檢查, 以便隨時監控病情, 如發生有異常 時, 須做減量或停藥等適當處理 另長期使用時, 副作用可能增強, 也可能會延 長, 因此須慎重投藥 血液學檢查 : 可能會引起骨髓造血機能抑制, 如全部血球減少 白血球減少 嗜中性白血 球減少 血小板減少 出血和貧血, 依據廠商建議須經常做臨床血液檢查, 以便 隨時監控病情, 如發生有異常時, 須做減量或停藥等適當處理 另長期使用時, 40

44 副作用可能增強, 也可能會延長, 因此須慎重投藥 列出可能發生的副作用, 病人應接受密切的觀察, 如有異狀應做適當處置, 如降低劑量或終止用藥, 如下表 : 5% 5% > 發生率不明 0.1% 腎臟 蛋白尿 血尿 水腫 高血壓 肝臟腸胃系統 厭食 噁心 / 嘔吐 口炎 腹瀉 過敏 皮疹 泌尿系統 ( 膀胱灌 膀胱炎 血尿 膀胱萎縮 洗 ) 其他 身體不適 禿髮 骨髓抑制是此藥主要劑量限制毒性 Navelbine Vinorelbine 老年人 : 參考成人劑量 肝臟功能異常 : FDA 核准之指引如下 : 肝功能不全者給予 Vinorelbine 治療時, 應小心謹慎 若使用 Vinorelbine 治療期間產生高膽紅素血症, 應視其膽紅素血中濃度而調整劑量, 劑量調整方式如下 : Total Bilirubin (mg/dl) 劑量調整 2.0 正常劑量的 100 % 腎臟 2.1 to 3.0 正常劑量的 50 % 異常 : 調整 >3.0 正常劑量的 25 % 量 血液學檢查 : 功能 不需 劑 治療當天顆粒性白血球計數 (cells/mm 3 ) 劑量調整 1,500 正常劑量的 100 % 1,000 to 1,499 正常劑量的 50 % <1000 暫停給藥治療期間若病人因顆粒性白血球低下 (granulocytopenic) 而發燒 產生敗血 症或因顆粒性白血球低下而連續暫停兩次劑量之治療, 隨後的 vinorelbine 治療劑 量調整如下 : 治療當天顆粒性白血球計數 (cells/mm 3 ) 劑量調整 1,500 正常劑量的 75% 41

45 1,000 to 1,499 正常劑量的 37.5% <1,000 暫停給藥白血球低下是此藥主要劑量限制毒性 Pharmorubicin Epirubicin 老年人 : 老年女性患者其 Epirubicin 的血漿清除率減少 35% 然而對降低起始劑量的 方面並沒有具體的建議, 但特別應注意老年患者的毒性監督和劑量調整 ( 尤其是 70 歲以上女性 ) 肝臟功能異常 : FDA 核准的建議如下列準則 ( 根據臨床試驗資料 ): Bilirubin/GOT 劑量調整 1.2-3mg/dl 或 UNL 的 2-4 倍建議起始劑量的 50% 大於 3mg/dl 或 UNL 的 4 倍建議起始劑量的 25% 嚴重肝損害 腎臟功能異常 禁用 FDA 核准建議 : 重度腎功能損害 ( 血清肌酐酸 >5mg/dl) 的病人, 應考慮較 低的劑量 Aronoff( 2007 ) 建議 Cl cr <50 ml/minute. 不作劑量調整需要 血液學異常 : 1. 當病患血小板計數是在 <50,000/ mm 3, ANC <250/ mm 3 或有 neutropenic fever, 應該減少隨後週期的第一天藥量到目前劑量的 75% 下次療程的第 1 天化療, 應等到病患血小板數大於或等於 100,000/ mm 3 或 ANC 大於或等於 1500/ mm 3, 才執行 2. 在病患接受 Epirubicin 治療的第 1 天及第 8 天中, 假如病患血小板數是在 75,000 to 100,000/ mm 3 及 ANC 在 1000 to 1499/ mm 3, 則第 8 天的劑量只要第一天 的 75% 即可 3. 若病患血小板數小於 75,000/ mm 3 或 ANC 小於 1000/ mm 3 時, 則第 8 天劑量可 省略不做 骨髓抑制是此藥短期劑量限制毒性 心臟損傷是長期劑量限制毒性, 最高累積劑量為 900mg/ m2 Endoxan Cyclophosphamide 老年人 : 針對個人情況做調整, 建議開始及維持劑量 :1-2mg/kg/day; 依照 renal clearance 調整 肝臟功能異常 : Cyclophosphamide 的藥物動力學在肝功能不良的病人並沒有明顯的改變 FDA 核准的建議劑量並不包括肝功能劑量的調整準則. 下列的準則曾被一些臨床醫師採用 (Floyd, 2006): Serum bilirubin mg/dl 或 GPT/GOT >3 倍 ULN: 使用 75% 的劑量 Serum bilirubin >5 mg/ml: 避免使用 42

46 腎臟功能異常 : FDA 所核准的建議劑量沒有足夠的證據去建議在腎功能的劑量調整. 下列的準則曾被一些臨床醫師採用 (Aronoff, 2007): 兒童或成人 :Cl cr <10 ml/minute: 使用正常劑量的 75% 血液透析的作用 : 中度透析 (20% to 50%): 透析後給予 50% 的劑量 連續可活動性腹膜透析 (CAPD) : 給予正常劑量的 75% 連續性腎臟替代療法 (CRRT): 給予正常劑量的 100% 骨髓抑制和出血性膀胱炎是此藥劑量限制毒性, 而骨髓抑制是最主要的 Taxotere Docetaxel 所有的病人必須於給藥前給予皮質類固醇作為預防性給藥, 以降低過敏反應和體液滯留的嚴重度 老年人 : 參照成人劑量 肝臟功能異常 : 1. 當 Total bilirubin> 正常值上限或 GOT/GPT>1.5 倍且 Alkaline phosphatase(alp >2.5 倍正常值上限時, 不建議使用 docetaxel 2. 其它文獻建議 Floyd, 2006 : GOT/GPT>ULN 的 倍時, 將劑量調整為正常劑量的 75% GOT/GPT>ULN 的 6 倍時, 需依照臨床上的評估 腎臟功能異常 :Docetaxel 只有少部分由腎排除, 不需調整劑量 血液學異常 : 依毒性調整劑量 : 1.Docetaxel 引起的毒性包含 febrile neutropenia,neutrophils 持續一星期以上低於 500 cells/mm 3, 嚴重或蓄積性皮膚反應 2. 乳癌患者, 若起始劑量為 100 mg/m 2, 其血液學檢查異常時, 應將劑量降低為 75 mg/m 2 若副作用持續, 應將劑量降至 55 mg/m 2 或停用 若末稍神經病變大於 3 級時應停用 3. neutrophils 小於 1500 cells/mm 3 的患者不建議使用 docetaxel 劑量限制毒性包括骨髓抑制 過敏反應 肝損傷 43

47 常見副作用 Gemcitabine 副作用 >10% Peripheral edema (20%), edema (13%), Pain (10% to 48%), fever (30% to 41%), somnolence (5% to 11%), Rash (24% to 30%), alopecia (15% to 18%), pruritus (13%), Nausea/vomiting (64% to 71%; grades 3/4: 1% to 13%), constipation (10% to 31%), diarrhea (19% to 30%), stomatitis (10% to 14%),Anemia (65% to 73%; grade 4: 1% to 3%), leukopenia (62% to 71%; grade 4: 1%), neutropenia (61% to 63%; grade 4: 6% to 7%), thrombocytopenia (24% to 47%; grade 4: 1%), hemorrhage (4% to 17%; grades 3/4: <1% to 2%); myelosuppression is the dose-limiting toxicity, Transaminases increased (67% to 78%; grades 3/4: 1% to 12%), alkaline phosphatase increased (55% to 77%; grades 3/4: 2% to 16%), bilirubin increased (13% to 26%; grades 3/4: <1% to 6%), Proteinuria (10% to 45%; grades 3/4: <1%), hematuria (13% to 35%; grades 3/4: <1%), BUN increased (8% to 16%; grades 3/4: 0%), Dyspnea (6% to 23%), Flu-like syndrome (19%), infection (8% to 16%; grades 3/4: <1% to 2%) 副作用 1% to 10% Injection site reactions (4%), Paresthesia (2% to 10%), Creatinine increased (2% to 8%), Bronchospasm (<2%) 副作用 <1% Adult respiratory distress syndrome, anaphylactoid reaction, anorexia, arrhythmias, bullous skin eruptions, cellulitis, cerebrovascular accident, CHF, chills, cough, desquamation, diaphoresis, gangrene, GGT increased, headache, hemolytic uremic syndrome (HUS), hepatotoxic reaction (rare), hypertension, insomnia, interstitial pneumonitis, liver failure, malaise, MI, peripheral vasculitis, petechiae, pulmonary edema, pulmonary fibrosis, radiation recall, renal failure, respiratory failure, rhinitis, sepsis, supraventricular arrhythmia, weakness 5-Fluorouracil (5-Fluorouracil (5-FU)) 副作用 Angina, myocardial ischemia, nail changes,acute cerebellar syndrome, confusion, disorientation, euphoria, headache, nystagmus, Alopecia, dermatitis, dry skin, fissuring, palmar-plantar erythrodysesthesia syndrome, pruritic maculopapular rash, photosensitivity, vein pigmentations, Anorexia, bleeding, diarrhea, esophagopharyngitis, nausea, sloughing, stomatitis, ulceration, vomiting, Agranulocytosis, anemia, leukopenia, pancytopenia, thrombocytopenia Myelosuppression: (Onset: 7-10 days;nadir: 9-14 days;recovery: days), Thrombophlebitis,Lacrimation, lacrimal duct stenosis, photophobia, visual changes, Epistaxis, Anaphylaxis, generalized allergic reactions, nail loss 44

48 Epirubicin 副作用 >10% Lethargy (1% to 46%),Alopecia (69% to 96%), Amenorrhea (69% to 72%), hot flashes (5% to 39%), Nausea/vomiting (83% to 92%; grades 3/4: 22% to 25%), mucositis (9% to 59%; grades 3/4: 9%), diarrhea (7% to 25%), Leukopenia (50% to 80%; grades 3/4: 2% to 59%), neutropenia (54% to 80%; grades 3/4: 11% to 67%; nadir: days; recovery: 21 days), anemia (13% to 72%; grades 3/4: 6%), thrombocytopenia (5% to 49%; grades 3/4: 5%), Injection site reactions (3% to 20%; grades 3/4: <1%), Conjunctivitis (1% to 15%), Infection (15% to 22%; grades 3/4: 2%) 副作用 1% to 10% LVEF decreased (asymptomatic; delayed: 1% to 2%), HF (0.4% to 1.5%), Fever (1% to 5%), Rash (1% to 9%), skin changes (1% to 5%), Anorexia (2% to 3%), Neutropenic fever (grades 3/4: 6%) 副作用 <1% Abdominal pain, acute lymphoid leukemia (ALL), acute myelogenous leukemia (AML), anaphylaxis, ascites, atrioventricular block, bradycardia, bundle-branch block, cardiomyopathy, chills, dehydration, dyspnea, ECG abnormalities, esophagitis, hepatomegaly, hyperpigmentation (oral mucosa, nails, skin), hypersensitivity, myelodysplastic syndrome, photosensitivity, premature menopause, premature ventricular contractions, pulmonary edema, pulmonary embolism, radiation recall, shock, sinus tachycardia, stomatitis, ST-T wave changes (nonspecific), tachyarrhythmias, thromboembolism, thrombophlebitis, transaminases increased, urticaria, ventricular tachycardia Cyclophosphamide 副作用 >10% Alopecia (40% to 60%), May cause sterility, Nausea and vomiting, anorexia, diarrhea, mucositis, stomatitis, acute hemorrhagic cystitis (7% to 40%), Thrombocytopenia and anemia are less common than leukopenia (ALL)Onset: 7 days;nadir: days ;Recovery: 21 days 副作用 1% to 10% Facial flushing, Headache, Skin rash, Nasal congestion occurs when I.V. doses are administered too rapidly; patients experience runny eyes, rhinorrhea, sinus congestion, and sneezing during or immediately after the infusion. 副作用 <1% High-dose therapy may cause cardiac dysfunction manifested as CHF; cardiac necrosis or hemorrhagic myocarditis has occurred rarely, but may be fatal. Interstitial pneumonitis and pulmonary fibrosis are occasionally seen with high doses. Cyclophosphamide may also potentiate the cardiac toxicity of anthracyclines. Other adverse reactions include anaphylactic reactions, darkening of skin/fingernails, dizziness, hemorrhagic colitis, hemorrhagic ureteritis,hepatotoxicity, hyperuricemia, hypokalemia, jaundice, malaise, neutrophilic eccrine hidradenitis, radiation recall, renal tubular necrosis, secondary malignancy (eg, bladder carcinoma), SIADH, Stevens-Johnson syndrome, toxic epidermal necrolysis, weakness. Docetaxel 45

49 副作用 >10% Fluid retention (13% to 60%; dose dependent),neurosensory events (20% to 58%; including neuropathy), fever (31% to 35%), neuromotor events (16%),Alopecia (56% to 76%), cutaneous events (20% to 48%), nail disorder (11% to 41%),Stomatitis (19% to 53%; severe 1% to 8%), diarrhea (23% to 43%; severe: 5% to 6%), nausea (34% to 42%), vomiting (22% to 23%), Neutropenia (84% to 99%; grade 4: 75% to 86%; onset: 4-7 days, nadir: 5-9 days, recovery: 21 days; dose dependent), leukopenia (84% to 99%; grade 4: 32% to 44%), anemia (65% to 94%; dose dependent; grades 3/4: 8% to 9%), thrombocytopenia (8% to 14%; grade 4: 1%; dose dependent), febrile neutropenia (6% to 12%; dose dependent), Transaminases increased (4% to 19%), Weakness (53% to 66%; severe 13% to 18%), myalgia (3% to 23%), Pulmonary events (41%), Infection (1% to 34%; dose dependent), hypersensitivity (1% to 21%; with premedication 15%) 副作用 1% to 10% Left ventricular ejection fraction decreased (prostate cancer: 10%; metastatic breast cancer: 8%), hypotension (3%), Rash/erythema (2%), Taste perversion (6%), Bilirubin increased (9%), alkaline phosphatase increased (4% to 7%), Infusion-site reactions (4%, including hyperpigmentation, inflammation, redness, dryness, phlebitis, extravasation, swelling of the vein), Arthralgia (3% to 9%), Epiphora associated with canalicular stenosis ( 77% with weekly administration; 1% with every 3-week administration) 副作用 <1% Acute myeloid leukemia (AML), acute respiratory distress syndrome (ARDS), anaphylactic shock, angina, ascites, atrial fibrillation, atrial flutter, bleeding episodes, bronchospasm, cardiac tamponade, chest pain, chest tightness, colitis, conjunctivitis, constipation, cutaneous lupus erythematosus, deep vein thrombosis, dehydration, disseminated intravascular coagulation (DIC), drug fever, duodenal ulcer, dyspnea, dysrhythmia, ECG abnormalities, erythema multiforme, esophagitis, gastrointestinal hemorrhage, gastrointestinal obstruction, gastrointestinal perforation, hand and foot syndrome, hearing loss, heart failure, hepatitis, hypertension, ileus, interstitial pneumonia, ischemic colitis, lacrimal duct obstruction, loss of consciousness (transient), MI, multiorgan failure, myelodysplastic syndrome, neutropenic enterocolitis, ototoxicity, pleural effusion, pruritus, pulmonary edema, pulmonary embolism, pulmonary fibrosis, radiation pneumonitis, radiation recall, renal insufficiency, seizure, sepsis, sinus tachycardia, Stevens-Johnson syndrome, syncope, toxic epidermal necrolysis, tachycardia, thrombophlebitis, unstable angina, visual disturbances (transient) 46

50 Doxorubicin Peg-Liposome 副作用 >10% Peripheral edema ( 11%), Fever (8% to 21%), headache ( 11%), pain ( 21%), Palmar-plantar erythrodysesthesia/hand-foot syndrome ( 51% in ovarian cancer [grades 3/4: 24%]; 3% in Kaposi's sarcoma), rash ( 29% in ovarian cancer, 5% in Kaposi's sarcoma), alopecia (9% to 19%), Nausea (17% to 46%), stomatitis (5% to 41%), vomiting (8% to 33%), constipation ( 30%), diarrhea (5% to 21%), anorexia ( 20%), mucositis ( 14%), dyspepsia ( 12%), intestinal obstruction ( 11%), Myelosuppression (onset: 7 days; nadir: days; recovery: days), thrombocytopenia (13% to 65%; grades 3/4: 1%), neutropenia (12% to 62%; grade 4: 4%), leukopenia (36%), nemia (6% to 74%; grade 4: <1%), Weakness (7% to 40%), back pain ( 12%), Pharyngitis ( 16%), dyspnea ( 15%), Infection ( 12%) 副作用 1% to 10% Cardiac arrest, chest pain, deep thrombophlebitis, edema, hypotension, pallor, tachycardia, vasodilation, Agitation, anxiety, chills, confusion, depression, dizziness, emotional lability, insomnia, somnolence, vertigo, Acne, bruising, dry skin (6%), exfoliative dermatitis, fungal dermatitis, furunculosis, maculopapular rash, pruritus, skin discoloration, vesiculobullous rash, Dehydration, hypercalcemia, hyperglycemia, hypokalemia, hyponatremia, Abdomen enlarged, anorexia, ascites, cachexia, dyspepsia, dysphagia, esophagitis, flatulence, gingivitis, glossitis, ileus, mouth ulceration, oral moniliasis, rectal bleeding, taste perversion, weight loss, xerostomia, Cystitis, dysuria, leukorrhea, pelvic pain, polyuria, urinary incontinence, urinary tract infection, urinary urgency, vaginal bleeding, vaginal moniliasis, Hemolysis, prothrombin time increased, ALT increased, alkaline phosphatase increased, hyperbilirubinemia, Thrombophlebitis, Arthralgia, hypertonia, myalgia, neuralgia, neuritis (peripheral), neuropathy, paresthesia ( 10%), pathological fracture, Conjunctivitis, dry eyes, retinitis, Ear pain, Albuminuria, hematuria, Apnea, cough ( 10%), epistaxis, pleural effusion, pneumonia, rhinitis, sinusitis, Allergic reaction; infusion-related reactions (7%; includes bronchospasm, chest tightness, chills, dyspnea, facial edema, flushing, headache, herpes simplex/zoster, hypotension, pruritus); moniliasis, diaphoresis 副作用 <1% Abscess, acute brain syndrome, abnormal vision, acute myeloid leukemia (secondary), alkaline phosphatase increased, anaphylactic or anaphylactoid reaction, asthma, balanitis, blindness, bone pain, bronchitis, BUN increased, bundle branch block, cardiomegaly, cardiomyopathy, cellulitis, CHF, colitis, creatinine increased, cryptococcosis, diabetes mellitus, erythema multiforme, erythema nodosum, eosinophilia, fecal impaction, flu-like syndrome, gastritis, glucosuria, hemiplegia, hemorrhage, hepatic failure, hepatitis, hepatosplenomegaly, hyperkalemia, hypernatremia, hyperuricemia, hyperventilation, hypoglycemia, hypolipidemia, hypomagnesemia, hypophosphatemia, hypoproteinemia, hypothermia, injection site hemorrhage, injection site pain, jaundice, ketosis, lactic dehydrogenase increased, kidney failure, lymphadenopathy, lymphangitis, migraine, myositis, optic neuritis, palpitation, pancreatitis, pericardial effusion, petechia, pneumothorax, pulmonary embolism, radiation injury, sclerosing cholangitis, seizure, sepsis, skin necrosis, skin ulcer, syncope, Stevens-Johnson syndrome, tenesmus, thromboplastin decreased, thrombosis, tinnitus, toxic epidermal necrolysis, urticaria, visual field defect, ventricular arrhythmia 47

51 Trastuzumab 副作用 >10% LVEF decreased (4% to 22%), Pain (47%), fever (6% to 36%), chills (5% to 32%), headache (10% to 26%), insomnia (14%), dizziness (4% to 13%), Rash (4% to 18%), Nausea (6% to 33%), diarrhea (7% to 25%), vomiting (4% to 23%), abdominal pain (2% to 22%), anorexia (14%), Weakness (4% to 42%), back pain (5% to 22%), Cough (5% to 26%), dyspnea (3% to 22%), rhinitis (2% to 14%), pharyngitis (12%), Infusion reaction (21% to 40%, chills and fever most common; severe: 1%), infection (20%) 副作用 1% to 10% Peripheral edema (5% to 10%), edema (8%), HF (2% to 7%; severe: <1%), tachycardia (5%), hypertension (4%), arrhythmia (3%), palpitation (3%), Depression (6%), Acne (2%), nail disorder (2%), pruritus (2%), Constipation (2%), dyspepsia (2%), Urinary tract infection (3% to 5%), Anemia (4%), leukopenia (3%), Paresthesia (2% to 9%), bone pain (3% to 7%), arthralgia (6% to 8%), myalgia (4%), muscle spasm (3%), peripheral neuritis (2%), neuropathy (1%), Sinusitis (2% to 9%), nasopharyngitis (8%), upper respiratory infection (3%), epistaxis (2%), pharyngolaryngeal pain (2%), Flu-like syndrome (2% to 10%), accidental injury (6%), influenza (4%), allergic reaction (3%), herpes simplex(2%) 副作用 <1% Acute respiratory distress syndrome (ARDS), amblyopia, anaphylaxis, anaphylactoid reaction, angioedema, apnea, ascites, asthma, ataxia, bone necrosis, bronchospasm, cardiac arrest, cardiomyopathy, cellulitis, coagulopathy, colitis, confusion, deafness, esophageal ulcer, gastroenteritis, glomerulonephritis (membraneous, focal and fibrillary), glomerulopathy, glomerulosclerosis, hematemesis, hemorrhage, hemorrhagic cystitis, hepatic failure, hepatitis, herpes zoster, hydrocephalus, hydronephrosis, hypercalcemia, hypersensitivity, hypotension, hypothyroidism, hypoxia, ileus, intestinal obstruction, interstitial pneumonitis, laryngitis, leukemia (acute), lymphangitis, mania, mural thrombosis, myopathy, nephrotic syndrome, neutropenia, oligohydramnios, pancreatitis, pancytopenia, paroxysmal nocturnal dyspnea, pathological fracture, pericardial effusion, pleural effusion, pneumonitis, pneumothorax, pulmonary edema (noncardiogenic) pulmonary fibrosis, pulmonary hypertension, pulmonary infiltrate, pyelonephritis, radiation injury, renal failure, respiratory distress, respiratory failure, seizure, sepsis, shock, skin ulcers, stroke, syncope, stomatitis, thyroiditis (autoimmune), vascular thrombosis, ventricular dysfunction, volume overload Methotrexate 副作用 >10% Acute reaction manifested as severe headache, nuchal rigidity, vomiting, and fever; may be alleviated by reducing the dose, Subacute toxicity: 10% of patients treated with mg/m 2 of I.T. methotrexate may develop this in the second or third week of therapy; consists of motor paralysis of extremities, cranial nerve palsy, seizure, or coma. This has also been seen in pediatric cases receiving very high-dose I.V. methotrexate. Demyelinating encephalopathy: Seen months or years after receiving methotrexate; usually in association with cranial irradiation or other systemic chemotherapy. Reddening of skin, 48

52 Hyperuricemia, defective oogenesis or spermatogenesis, Ulcerative stomatitis, glossitis, gingivitis, nausea, vomiting, diarrhea, anorexia, intestinal perforation, mucositis (dose dependent; appears in 3-7 days after therapy, resolving within 2 weeks), Leukopenia, myelosuppression (nadir: 7-10 days), thrombocytopenia, Renal failure, azotemia, nephropathy, Pharyngitis 副作用 1% to 10% Vasculitis, Dizziness, malaise, encephalopathy, seizure, fever, chills, Alopecia, rash, photosensitivity, depigmentation or hyperpigmentation of skin, Diabetes, Cystitis, Hemorrhage, Cirrhosis and portal fibrosis have been associated with chronic methotrexate therapy; acute elevation of liver enzymes are common after high-dose methotrexate, and usually resolve within 10 days. Arthralgia, Blurred vision. Renal dysfunction: Manifested by an abrupt rise in serum creatinine and BUN and a fall in urine output; more common with high-dose methotrexate, and may be due to precipitation of the drug. Pneumonitis: Associated with fever, cough, and interstitial pulmonary infiltrates; treatment is to withhold methotrexate during the acute reaction; interstitial pneumonitis has been reported to occur with an incidence of 1% in patients with RA (dose mg/week) 副作用 <1% Acute neurologic syndrome (at high dosages - symptoms include confusion, hemiparesis, transient blindness, and coma); anaphylaxis, alveolitis, cognitive dysfunction (has been reported at low dosage), decreased resistance to infection, erythema multiforme, hepatic failure, leukoencephalopathy (especially following craniospinal irradiation or repeated high-dose therapy), lymphoproliferative disorders, osteonecrosis and soft tissue necrosis (with radiotherapy), pericarditis, plaque erosions (psoriasis), seizure (more frequent in pediatric patients with ALL), Stevens-Johnson syndrome, thromboembolism Cisplatin 副作用 >10% Peripheral neuropathy is dose- and duration-dependent. Mild alopecia, Nausea and vomiting (76% to 100%), Myelosuppression (25% to 30%; mild with moderate doses, mild-to-moderate with high-dose therapy) : WBC: Mild, Platelets: Mild (onset: 10 days; Nadir: days; Recovery: days), Liver enzymes increased, Nephrotoxicity (acute renal failure and chronic renal insufficiency) Ototoxicity (10% to 30%; manifested as high frequency hearing loss; ototoxicity is especially pronounced in children) 副作用 1% to 10% Diarrhea, Tissue irritation 副作用 <1% Anaphylactic reaction, arrhythmias, blurred vision, bradycardia, cerebral blindness, hemolytic anemia, liver enzymes increased, mild alopecia, mouth sores, optic neuritis, papilledema 49

53 Carboplatin 副作用 >10% Pain (23%), Hyponatremia (29% to 47%), hypomagnesemia (29% to 43%), hypocalcemia(22% to 31%), hypokalemia (20% to 28%), Vomiting (65% to 81%), abdominal pain (17%), nausea (without vomiting: 10% to 15%), Myelosuppression (dose related and dose limiting; nadir at ~21 days; recovery by ~28 days), anemia (71% to 90%; grades 3/4: 21%), leukopenia (85%; grades 3/4: 15% to 26%), neutropenia (67%; grades 3/4: 16% to 21%), thrombocytopenia (62%; grades 3/4: 25% to 35%), Alkaline phosphatase increased (24% to 37%), AST increased (15% to 19%), Weakness (11%), Creatinine clearance decreased (27%), BUN increased (14% to 22%), Hypersensitivity/ Allergic reaction (2% to 16%) 副作用 1% to 10% Neurotoxicity (5%), Alopecia (2% to 3%), Constipation (6%), diarrhea (6%), stomatitis/mucositis (1%), taste dysgeusia (1%), Bleeding (5%), hemorrhagic complications (5%), Bilirubin increased (5%), Peripheral neuropathy (4% to 6%), Visual disturbance (1%), Ototoxicity (1%), Creatinine increased (6% to 10%), Infection (5%) 副作用 <1% <1% (Limited to important or life-threatening): Anaphylactic reaction, bronchospasm, cardiac failure, cerebrovascular accident, dehydration, embolism, erythema, hemolytic uremic syndrome (HUS), hyper-/hypotension, injection site reactions (pain, redness, swelling), necrosis (associated with extravasation), neutropenic fever, pruritus, rash, secondary malignancies, urticaria, vision loss Paclitaxel 副作用 >10% Flushing (28%), ECG abnormal (14% to 23%), edema (21%), hypotension (4% to 12%), Alopecia (87%), rash (12%), Nausea/vomiting (52%), diarrhea (38%), mucositis (17% to 35%; grades 3/4: up to 3%), stomatitis (15%; most common at doses >390 mg/m 2 ), abdominal pain (with intraperitoneal paclitaxel) Neutropenia (78% to 98%; grade 4: 14% to 75%; onset 8-10 days, median nadir 11 days, recovery days), leukopenia (90%; grade 4: 17%), anemia (47% to 90%; grades 3/4: 2% to 16%), thrombocytopenia (4% to 20%; grades 3/4: 1% to 7%), bleeding (14%), Alkaline phosphatase increased (22%), AST increased (19%), Injection site reaction (erythema, tenderness, skin discoloration, swelling: 13%), Peripheral neuropathy (42% to 70%; grades 3/4: up to 7%), arthralgia/myalgia (60%), weakness (17%), Creatinine increased (observed in KS patients only: 18% to 34%; severe: 5% to 7%), Hypersensitivity reaction (31% to 45%; grades 3/4: up to 2%),infection (15% to 30%) 副作用 1% to 10% Bradycardia (3%), tachycardia (2%), hypertension (1%), rhythm abnormalities (1%), syncope (1%), venous thrombosis (1%), Nail changes (2%), Febrile neutropenia (2%), Bilirubin increased (7%), Dyspnea (2%) 副作用 <1% Anaphylaxis, ataxia, atrial fibrillation, AV block, back pain, cardiac conduction abnormalities, cellulitis, 50

54 CHF, chills, conjunctivitis, dehydration, enterocolitis, extravasation recall, hepatic encephalopathy, hepatic necrosis, induration, intestinal obstruction, intestinal perforation, interstitial pneumonia, ischemic colitis, lacrimation increased, maculopapular rash, malaise, MI, necrotic changes and ulceration following extravasation, neuroencephalopathy, neutropenic enterocolitis, ototoxicity (tinnitus and hearing loss), pancreatitis, paralytic ileus, phlebitis, pruritus, pulmonary embolism, pulmonary fibrosis, radiation recall, radiation pneumonitis, renal insufficiency, seizure, skin exfoliation, skin fibrosis, skin necrosis, Stevens-Johnson syndrome, supraventricular tachycardia, toxic epidermal necrolysis, ventricular tachycardia (asymptomatic), visual disturbances (scintillating scotomata) Vinorelbine 副作用 >10% Alopecia (12% to 30%), Nausea (31% to 44%; grade 3: 1% to 2%), constipation (35%; grade 3: 3%), vomiting (20% to 31%; grade 3: 1% to 2%), diarrhea (12% to 17%), Leukopenia (83% to 92%; grade 4: 6% to 15%), granulocytopenia (90%; grade 4: 36%; nadir: 7-10 days; recovery days; dose-limiting), neutropenia (85%; grade 4: 28%), anemia (83%; grades 3/4: 9%), AST increased (67%; grade 3: 5%; grade 4: 1%), total bilirubin increased (5% to 13%; grade 3: 4%; grade 4: 3%), Injection site reaction (22% to 28%; includes erythema, vein discoloration), injection site pain (16%), Weakness (36%), peripheral neuropathy (25%; grade 3: 1%; grade 4: <1%) Creatinine increased (13%) 副作用 1% to 10% Vasculitis Chest pain (5%), Rash (<5%), Gastrointestinal: Paralytic ileus (1%), Hematologic: Neutropenic fever/sepsis (8%; grade 4: 4%), thrombocytopenia (3% to 5%; grades 3/4: 1%), Local: Phlebitis (7% to 10%), Neuromuscular & skeletal: Loss of deep tendon reflexes (<5%), myalgia (<5%), arthralgia (<5%), jaw pain (<5%), Otic: Ototoxicity ( 1%), Respiratory: Dyspnea (7%) 副作用 <1% Abdominal pain, allergic reactions, anaphylaxis, angioedema, back pain, DVT, dysphagia, esophagitis, flushing, gait instability, headache, hemorrhagic cystitis, hyper-/hypotension, hyponatremia, intestinal necrosis, intestinal obstruction, intestinal perforation, interstitial pulmonary changes, local rash, local urticaria, MI (rare), mucositis, muscle weakness, pancreatitis, paralytic ileus, pneumonia, pruritus, pulmonary edema, pulmonary embolus, radiation recall (dermatitis, esophagitis), skin blistering, syndrome of inappropriate ADH secretion, tachycardia, thromboembolic events, tumor pain, urticaria, vasodilation Oxaliplatin 副作用 >10% Fatigue (61%), fever (25%), pain (14%), headache (13%), insomnia (11%), Nausea (64%), diarrhea (46%), vomiting (37%), abdominal pain (31%), constipation (31%), anorexia (20%), stomatitis (14%), Anemia (64%; grades 3/4: 1%), thrombocytopenia (30%; grades 3/4: 3%), leukopenia (13%), AST increased (54%; grades 3/4: 4%), ALT increased (36%; grades 3/4: 1%), total bilirubin increased (13%; grades 3/4: 5%), Peripheral neuropathy (may be dose limiting; 76%; acute 65%; grades 3/4: 5%; 51

55 persistent 43%; grades 3/4: 3%), back pain (11%), Dyspnea (13%), cough (11%) 副作用 1% to 10% Edema (10%), chest pain (5%), peripheral edema (5%), flushing (3%), thromboembolism (2%), Dizziness (7%), Rash (5%), alopecia (3%), hand-foot syndrome (1%), Dehydration (5%), hypokalemia (3%), Dyspepsia (7%), taste perversion (5%), flatulence (3%), mucositis (2%), gastroesophageal reflux (1%), dysphagia (acute 1% to 2%), Dysuria (1%), Neutropenia (7%), Injection site reaction (9%; redness/swelling/pain), Rigors (9%), arthralgia (7%), Abnormal lacrimation (1%), Serum creatinine increased (5% to 10%), URI (7%), rhinitis (6%), epistaxis (2%), pharyngitis (2%), pharyngolaryngeal dysesthesia (grades 3/4: 1% to 2%), Allergic reactions (3%); hypersensitivity (includes urticaria, pruritus, facial flushing, shortness of breath, bronchospasm, diaphoresis, hypotension, syncope: grades 3/4: 2% to 3%); hiccup (2%) 副作用 <1% Acute renal failure, alkaline phosphatase increased, anaphylactic/anaphylactoid reactions, anaphylactic shock, angioedema, aphonia, ataxia, colitis, cranial nerve palsies, deep tendon reflex loss, deafness, diplopia, dysarthria, dysphonia, eosinophilic pneumonia, extravasation (including necrosis), fasciculations, gait abnormal, hematuria, hemolysis, hemolytic anemia (immuno-allergic), hemolytic uremia syndrome, hemorrhage, hepatic failure, hepatitis, hepatotoxicity, hypertension, hypomagnesemia, hypoxia, ileus, INR increased, interstitial lung diseases, interstitial nephritis (acute), intestinal obstruction, intracerebral bleeding, Lhermittes' sign, metabolic acidosis, muscle spasm, myoclonus, neutropenic fever, neutropenic sepsis, nodular regenerative hyperplasia, optic neuritis, pancreatitis, peliosis, prothrombin time increased, ptosis, rectal hemorrhage, rhabdomyolysis, seizure, sepsis, thrombocytopenia (immuno-allergic), trigeminal neuralgia, tubular necrosis (acute), veno-occlusive liver disease (sinusoidal obstruction syndrome and perisinusoidal fibrosis), visual disturbance (acuity decreased, field disturbance, transient loss) Irinotecan 副作用 >10% Vasodilation (9% to 11%), Cholinergic toxicity (47% - includes rhinitis, increased salivation, miosis, lacrimation, diaphoresis, flushing and intestinal hyperperistalsis); fever (44% to 45%), pain (23% to 24%), dizziness (15% to 21%), insomnia (19%), headache (17%), chills (14%), Alopecia (46% to 72%), rash (13% to 14%), Dehydration (15%), Diarrhea, late (83% to 88%; grade 3/4: 5% to 31%), diarrhea, early (43% to 51%; grade 3/4: 6% to 22%), nausea (70% to 86%), abdominal pain (57% to 68%), vomiting (62% to 67%), cramps (57%), anorexia (44% to 55%), constipation (30% to 32%), mucositis (30%), weight loss (30%), flatulence (12%), stomatitis (12%), Anemia (60% to 97%; grades 3/4: 5% to 22%), leukopenia (63% to 96%, grades 3/4: 14% to 28%), thrombocytopenia (96%, grades 3/4: 1% to 4%), neutropenia (30% to 96%; grades 3/4: 14% to 31%), Bilirubin increased (84%), alkaline phosphatase increased (13%), Weakness (69% to 76%), back pain (14%), Dyspnea (22%), cough (17% to 20%), rhinitis (16%), Diaphoresis (16%), infection (14%) 副作用 1% to 10% 52

56 Edema (10%), hypotension (6%), thromboembolic events (5%), Somnolence (9%), confusion (3%), Abdominal fullness (10%), dyspepsia (10%), Neutropenic fever (grades 3/4: 2% to 6%), hemorrhage (grades 3/4: 1% to 5%), neutropenic infection (grades 3/4: 1% to 2%), AST increased (10%), ascites and/or jaundice (grades 3/4: 9%), Pneumonia (4%) 副作用 <1% postmarketing, and/or case reports: ALT increased, amylase increased, anaphylactoid reaction, anaphylaxis, angina, arterial thrombosis, bleeding, bradycardia, cardiac arrest, cerebral infarct, cerebrovascular accident, circulatory failure, colitis, deep thrombophlebitis, dysrhythmia, embolus, gastrointestinal bleeding, gastrointestinal obstruction, hepatomegaly, hiccups, hyperglycemia, hypersensitivity, hyponatremia, ileus, interstitial lung disease, intestinal perforation, ischemic colitis, lipase increased, lymphocytopenia, megacolon, MI, muscle cramps, myocardial ischemia, pancreatitis, paresthesia, peripheral vascular disorder, pulmonary embolus; pulmonary toxicity (dyspnea, fever, reticulonodular infiltrates on chest x-ray); renal failure (acute), renal impairment, syncope, thrombophlebitis, thrombosis, typhlitis, ulceration, ulcerative colitis, vertigo Etoposide (VP-16) 副作用 >10% Alopecia (8% to 66%), Ovarian failure (38%), amenorrhea, Nausea/vomiting (31% to 43%), anorexia (10% to 13%), diarrhea (1% to 13%), mucositis/esophagitis (with high doses), Leukopenia (60% to 91%; grade 4: 3% to 17%; onset: 5-7 days; nadir: 7-14 days; recovery: days), thrombocytopenia (22% to 41%; grades 3/4: 1% to 20%; nadir 9-16 days), anemia (up to 33%) 副作用 1% to 10% Hypotension (1% to 2%; due to rapid infusion), Stomatitis (1% to 6%), abdominal pain (up to 2%), Hepatic toxicity (up to 3%), Peripheral neuropathy (1% to 2%), Anaphylactic-like reaction (I.V. infusion: 1% to 2%; including chills, fever, tachycardia, bronchospasm, dyspnea) 副作用 <1% Anovulatory cycles, back pain; blindness (transient, cortical); CHF, constipation, cough, cyanosis, diaphoresis, dysphagia, erythema; extravasation (induration, necrosis, swelling); facial swelling, fatigue, fever, headache, hepatic toxicity, hepatitis, hyperpigmentation, hypersensitivity, hypersensitivity-associated apnea, hypomenorrhea, interstitial pneumonitis, laryngospasm, maculopapular rash, malaise, metabolic acidosis, MI, optic neuritis, perivasculitis, pruritus, pulmonary fibrosis, radiation-recall dermatitis, rash, seizure, somnolence, Stevens-Johnson syndrome, tachycardia, taste perversion, thrombophlebitis, tongue swelling, toxic epidermal necrolysis, urticaria, weakness 53

57 Mitomycin 副作用 >10% CHF (3% to 15%), Fever (14%), Alopecia, nail banding/discoloration, Nausea, vomiting and anorexia (14%), Anemia (19% to 24%); myelosuppression, common, dose limiting, delayed (Onset: 3 weeks; Nadir: 4-6 weeks; Recovery: 6-8 weeks) 副作用 1% to 10% Rash, Stomatitis, Paresthesia, Creatinine increase (2%), Interstitial pneumonitis, infiltrates, dyspnea, cough (7%) 副作用 <1% <1% (Limited to important or life-threatening): Extravasation reactions, hemolytic uremic syndrome, malaise, pruritus, renal failure, bladder fibrosis/contraction (intravesical administration) Cetuximab 副作用 >10% Fatigue (89%), pain (17% to 51%), headache (26% to 33%), insomnia (10% to 30%), fever (27% to 30%), confusion (15%), anxiety (14%), chills/rigors (13%), depression (7% to 13%), Acneiform rash (76% to 90%; grades 3/4: 1% to 17%; onset: 14 days), rash (89%), dry skin (49%), pruritus (11% to 40%), nail changes/disorder (16% to 21%), Hypomagnesemia (55%; grades 3/4: 6% to 17%), Abdominal pain (26% to 59%), constipation (26% to 46%), diarrhea (25% to 39%), vomiting (25% to 37%), nausea (mild-to-moderate 29%), weight loss (7% to 27%), anorexia (23%), stomatitis (10% to 25%), xerostomia (11%), Weakness (45% to 48%), bone pain (15%), Dyspnea (17% to 48%), cough (11% to 29%), Infection (13% to 35%), infusion reaction (15% to 21%; grades 3/4: 2% to 5%; 90% of severe reactions occurred with first infusion) 副作用 1% to 10% Peripheral edema (10%), cardiopulmonary arrest (2%; with radiation therapy), Alopecia (4%), skin disorder (4%), Dehydration (2% to 10%), Dyspepsia (6%), Anemia (9%), Alkaline phosphatase increased (5% to 10%), transaminases increased (5% to 10%), Back pain (10%), Conjunctivitis (7%), Renal failure (1%), Pulmonary embolus (1%), Sepsis (1% to 4%) 副作用 <1% Abscess formation, arrhythmia, aseptic meningitis, blepharitis, bronchospasm, cardiac arrest, cellulitis, cheilitis, hoarseness, hypertrichosis, hypotension, interstitial lung disease (occurred between the fourth and eleventh doses), keratitis, leukopenia, loss of consciousness, MI, paronychial inflammation, sepsis, shock, skin fissure, skin infection, stridor Capecitabine 副作用 >10% Edema (9% to 15%), Fatigue (16% to 42%), fever (7% to 18%), pain (12%), Palmar-plantar erythrodysesthesia (hand-and-foot syndrome) (54% to 60%; grade 3: 11% to 17%; may be dose limiting), dermatitis (27% to 37%), Diarrhea (47% to 57%; may be dose limiting; grade 3: 12% to 13%; grade 4: 54

58 2% to 3%), nausea (34% to 53%), vomiting (15% to 37%), abdominal pain (7% to 35%), stomatitis (22% to 25%), appetite decreased (26%), anorexia (9% to 23%), constipation (9% to 15%), Lymphopenia (94%; grade 4: 14%), anemia (72% to 80%; grade 4: <1% to 1%), neutropenia (2% to 26%; grade 4: 2%), thrombocytopenia (24%; grade 4: 1%), Bilirubin increased (22% to 48%; grades 3/4: 11% to 23%), Paresthesia (21%), Eye irritation (13% to 15%), Dyspnea (14%) 副作用 5% to 10% Venous thrombosis (8%), chest pain (6%), Headache (5% to 10%), lethargy (10%), dizziness (6% to 8%), insomnia (7% to 8%), mood alteration (5%), depression (5%), Nail disorder (7%), rash (7%), skin discoloration (7%), alopecia (6%), erythema (6%), Dehydration (7%), Motility disorder (10%), oral discomfort (10%), dyspepsia (6% to 8%), upper GI inflammatory disorders (colorectal cancer: 8%), hemorrhage (6%), ileus (6%), taste perversion (colorectal cancer: 6%), Back pain (10%), weakness (10%), neuropathy (10%), myalgia (9%), arthralgia (8%), limb pain (6%), Abnormal vision (colorectal cancer: 5%), conjunctivitis (5%), Cough (7%), Viral infection (colorectal cancer: 5%) 副作用 <5% Angina, ascites, asthma, atrial fibrillation, bradycardia, bronchitis, bronchopneumonia, bronchospasm, cachexia, cardiac arrest, cardiac failure, cardiomyopathy, cerebral vascular accident, cholestatic hepatitis, coagulation disorder, colitis, confusion, deep vein thrombosis, diaphoresis, duodenitis, dysarthria, dysphagia, dysrhythmia, ecchymoses, ECG changes, encephalopathy, epistaxis, esophagitis, fibrosis, fungal infection, gastric ulcer, gastritis, gastroenteritis, gastrointestinal perforation, hematemesis, hemoptysis, hepatic failure, hepatic fibrosis, hepatitis, hypokalemia, hypomagnesemia, hyper-/hypotension, hypersensitivity, hypertriglyceridemia, idiopathic thrombocytopenia purpura, ileus, infection, intestinal obstruction (~1%), keratoconjunctivitis, lacrimal duct stenosis, leukopenia, loss of consciousness, lymphedema, MI, multifocal leukoencephalopathy, myocardial ischemia, myocarditis, necrotizing enterocolitis (typhlitis), oral candidiasis, pericardial effusion, thrombocytopenic purpura, pancytopenia, photosensitivity reaction, pneumonia, pruritus, pulmonary embolism, radiation recall syndrome, renal impairment, respiratory distress, sedation, sepsis, skin ulceration, tachycardia, thrombophlebitis, toxic megacolon, tremor, ventricular extrasystoles 55

59 副作用評估級數與常見處理 Alopecia( 掉髮 ) 分級 Grade 0: 無 Grade 1: 輕度掉髮, 掉髮量 <25% 全髮量 Grade 2: 明顯髮量減少, 掉髮量約為 25~50% 全髮量 Grade 3: 掉髮量 >50% 全髮量常見處理 1. 無藥物可預防掉髮 2. 開始治療前可減短頭髮 3. 可建議化學藥物滴注時睡冰枕或戴冰帽 4. 使用中性洗髮精 避免使用髮膠 定型液及吹風機, 以減少掉髮 5. 建議可戴假髮或頭巾 6. 此副作用為可逆性, 自第一次化學治療後 1~2 個星期後開始, 治療 2 個月內達到高峰 一但化學治療停止約 1~2 個月後, 毛髮會再生 Anemia( 貧血 ) 分級 Grade 0: 正常 Grade 1:Hgb< 正常 10 g/dl Grade 2:Hgb < g/dl Grade 3:Hgb < g/dl Grade 4:Hgb <6.5g/dl 常見處理 1. Grade 0 2: 不需要積極的醫療處置, 持續追蹤觀察臨床症狀 2. Grade 3 4: 配合臨床症狀, 建議醫療處置如下 : 甲 輸血 : 但依醫師臨床評估, 決定是否需要輸血 乙 注射 EPO: 健保規定癌症病患只限於患有固態腫瘤並接受含鉑 (platinum) 的化學藥物導致貧血 (Hgb<8.0 gm/dl) 最初劑量 150U/Kg 每週三次, 最高劑量 300U/Kg 每週三次, 研究顯示針對乳癌患者, 注射 EPO 易導致病程延長 3. 注意安全, 預防跌倒, 採漸進緩慢的活動方式 4. 減少體力耗損, 可多休息 Anorexia ( 厭食 ) 分級 Grade 0: 正常 Grade 1: 食慾降低 Grade 2: 進食量減少 Grade 3: 需要靜脈點滴 Grade 4: 需要鼻胃管灌食或非腸胃道的營養 ( 如 TPN) Constipation( 便秘 ) 56

60 分級 常見處理 Grade 0: 無 Grade 1: 需軟便劑或飲食調整 Grade 2: 需瀉劑 Grade 3: 糞便填塞時需指挖或灌腸 Grade 4: 阻塞或毒性巨結腸 (Megacolon) 1. 評估引發因子 2. 依據病因及臨床症狀給予處理 Chills rigors( 寒冷 寒顫 ) 分級 Grade 0: 無 Grade 1: 輕度, 需症狀治療 ( 如 : 毯 ) 或非麻醉藥物 Grade 2: 嚴重度或長期, 需要麻醉藥物 Grade 3: 對麻醉藥物無反應 Grade 4:- 常見處理 1. 評估引發因子 2. 依據病因及臨床症狀給予處理, 如給於抗組織胺藥物緩解症狀, 必要時使用麻醉藥物緩解嚴重的症狀 3. 保暖 Cough( 咳嗽 ) 分級 Grade 0: 無 Grade 1: 輕度, 不需要藥物緩解症狀 Grade 2: 需要麻醉鎮咳劑 Grade 3: 嚴重咳嗽或咳嗽筋攣, 控制不良或對藥物無反應 Grade 4:- 常見處理 1. 評估引發因子 2. 依據病因及臨床症狀給予處理, 如給於鎮咳劑或麻醉性鎮咳劑緩解症狀 Conjunctivitis( 結膜炎 ) 分級 Grade 0: 無 Grade 1: 眼睛異常改變但無症狀或有症狀但無視力障礙 ( 如疼痛及刺激感 ) Grade 2: 有症狀且干擾眼睛功能, 但不影響日常生活 Grade 3: 有症狀且干擾眼睛功能, 並影響日常生活 Grade 4:- 常見處理 1. 評估引發因子 2. 可照會眼科專科醫師治療 57

61 Diarrhea( 腹瀉 ) 分級 Grade 0: 無 Grade 1: 治療前, 一天增加四次解便次數 Grade 2: 一天增加四次至六次解便次數或晚上解便 Grade 3: 解便次數 >7/ 天或失禁 ; 或需要腸外支持防脫水 Grade 4: 需要加強生理方面血流動力學的照護常見處理 1. 評估引發因子 2. 評估電解質變化, 注意是否有脫水情行 3. 依據病因及臨床症狀處理, 如止瀉劑的使用 點滴輸液的補充 4. 補充口服左旋麩醯胺酸 (L-glutamine)( 需自費自購 ), 可減緩腸道黏膜受損 Dyspepsia( 消化不良 ) 分級 Grade 0: 無 Grade 1: 輕度, 但可以正常飲食 Grade 2: 中度, 但可以採軟質或流質飲食 Grade 3: 重度, 需要管灌營養或給靜脈營養 Grade 4: 完全阻塞, 需要腸內或腸外營養支持常見處理 1. 評估引發因子 2. 評估營養狀況 3. 依據病因及臨床症狀處理, 如腸蠕動促進劑的使用, 促進蠕動幫助消化 Dizziness( 頭暈 ) 分級 Grade 0: 無 Grade 1: 身體不受干擾 Grade 2: 身體受干擾但不影響日常生活 Grade 3: 完全干擾日常生活 Grade 4: 無法下床常見處理 1. 評估引發因子, 注意是否為腦神經或心血管疾病所引起的頭暈 2. 注意安全, 預防跌倒, 採漸進緩慢的活動方式 3. 依據病因及臨床症狀處理, 可照會耳鼻喉科專科醫師協助處理 58

62 Dyspnea( 呼吸困難 ) 分級 Grade 0: 正常 Grade 1:- Grade 2: 費力時呼吸困難 Grade 3: 正常活動時呼吸困難 Grade 4: 休息時呼吸困難或需要呼吸器維持常見處理 1. 評估引發因子, 注意是否為心肺急症導致的呼吸困難 2. 觀察血行動力學變化, 如 : 氧氣飽合濃度 生命徵象 3. 依據病因及臨床症狀處理 Fever( 發燒 ) 分級 Grade 0: 無 Grade 1: 體溫維持在 Grade 2: 體溫維持在 Grade 3: 體溫維持在 >40, 時間維持在 24 小時內 Grade 4: 體溫維持在 <40, 時間超過 24 小時備註 : neutropenia ferver 定義 :ANC<1000/mm3 及 BT 38.5 常見處理依臨床症狀評估患者的發燒是否為白血球低下所引起, 可抽血檢驗 CBC DC 依據病因及臨床症狀處理, 如適時給予解熱鎮痛劑或抗生素治療 Fluid retention( 體液滯留 ) 分級 Grade 0: 無 Grade 1: 無症狀 Grade 2: 有症狀, 需要利尿劑 Grade 3: 有症狀, 需藉由穿刺方式減少液體留至體內 Grade 4: 威脅生命常見處理評估引發因子, 排除肝 腎與心血管疾病導致的體液滯留, 若是因化療所導致, 可連續服類固醇藥物或低劑量的利尿劑治療 Fatigue( 疲倦 ) 分級 Grade 0: 正常 Grade 1: 比平常疲倦但不影響日常生活 Grade 2: 中度疲倦 (ECOG 1) 或會造成難以執行的一些活動 Grade 3: 重度疲倦 (ECOG 2) 或喪失能力而進行一些活動 Grade 4: 臥病不起或喪失能力常見處理 1. 評估引發因子, 注意是否為貧血 肝功能或其它功能異常引起的疲倦 2. 依據病因及臨床症狀處理 59

63 Hand-foot syndrome( 手足症候群 ) 分級 Grade 0: 無 Grade 1: 皮膚改變或皮膚炎症 ( 紅斑 脫皮 ) Grade 2: 皮膚改變且會痛, 不干擾生活功能 Grade 3: 皮膚改變且會痛, 干擾生活功能 Grade 4:- 常見處理 1. 無藥物可預防手足症候群, 可於化療滴注時手足接受冷凍療法, 如手握冰塊, 腳泡冰水, 但注意避免凍傷 2. 可用含尿素 (Urea) 成份的軟膏, 如 : Sinpharderm cream 治療 3. 維生素 B6( 每天口服約 毫克 ) 可能對一些手足症候群的病患有幫助, 但確實的功效則未定 Headache( 頭痛 ) 分級 Grade 0: 無 Grade 1: 輕度疼痛但對身體不干擾 Grade 2: 中度疼痛 : 服用止痛劑後, 身體受疼痛干擾但不干擾日常生活 Grade 3: 重度疼痛 : 服用止痛劑後仍干擾日常生活 Grade 4:- 常見處理需先排除腦神經疾病因素, 如腦部轉移, 依據病因及臨床症狀處理 Hematuria( 血尿 ) 分級 Grade 0: 無 Grade 1: 只有在顯微鏡下才發現 Grade 2: 明顯且間歇性出血但無凝塊 Grade 3: 持續性嚴重出血或有血塊, 需導尿設備協助或輸血 Grade 4: 需外科手術協助或膀胱深處潰瘍或壞死常見處理 1. 當出現血尿時可藉由膀胱灌洗或給予止血劑, 如 :Transamin 2. 當高劑量使用 Cyclophasphamide(>2g/ m2 ) 治療時, 為了預防出血性膀胱炎, 可合併尿路解毒劑, 如 :mesna Hot flashes( 潮紅 ) 分級 Grade 0: 無 Grade 1: 輕度或潮紅症狀小於一天 Grade 2: 中度且潮紅症狀大於一天 Grade 3:- 60

64 常見處理 評估引發因子, 依據病因及臨床症狀給予處理 Hyponatremia( 低血鈉 ) 分級 Grade 0: 正常 Grade 1: 鈉 <130 mmol Grade 2:- Grade 3: 鈉 mmol Grade 4: 鈉 <120 mmol 常見處理評估引發因子, 如內分泌 代謝 肝 腎等功能異常, 再依病因及臨床症狀處理 Hypocacelmia( 低血鈣 ) 分級 Grade 0: 鈣離子數值於正常範圍 Grade 1:2.0~4.5 mg/dl Grade 2: <2.0 mg/dl Grade 3:1.5 - <1.75 mg/dl Grade 4:<1.5 mg/dl Hypotension( 低血壓 ) 分級 Grade 0: 正常 Grade 1: 改變, 但不需要治療 Grade 2: 需體液補充或其他治療, 但不需要住院 ; 無生理反應 Grade 3: 需要持續性醫療照顧及治療 ; 生理反應未改善 Grade 4: 休克 ( 酸血症及相關重要器官灌流不足 ) 常見處理評估引發因子, 排除心肺疾病因素, 依據病因及臨床症狀給予治療 Hypokalemia( 低血鉀 ) 分級 Grade 0: 鉀離子數值於正常範圍 Grade 1:3.0~3.6 mmol/l Grade 2:- Grade 3:2.5 - <3.0 mmol/l Grade 4:<2.5 mmol/l Hypomagnesemia( 低血鎂 ) 分級 Grade 0: 鎂離子數值於正常範圍 Grade 1:1.2~3.6 mmol/l Grade 2:0.9 - <1.2 mmol/l Grade 3:0.7 - <0.9 mmol/l Grade 4:<0.7 mmol/l 61

65 Insomnia( 失眠 ) 分級 Grade 0: 無 Grade 1: 偶爾不易入睡 Grade 2: 難以入睡, 但不影響日常生活 Grade 3: 經常難以入睡, 且干擾到日常生活 Grade 4:- 常見處理依臨床症狀可給予安眠藥或嚴重者照會精神科專科醫師 Injection site reaction( 注射部位異常反應 ) 分級 Grade 0: 無 Grade 1: 注射部位癢或痛或紅 Grade 2: 注射部位痛或腫, 而且合併發炎或靜脈炎 Grade 3: 注射部位嚴重的潰瘍或壞死, 或一直無法改善, 或需要外科擴創處理 Grade 4:- Irregular menses( 月經不規則 ) 分級 Grade 0: 無 Grade 1: 偶爾不正常或延長間隔時間, 但持續的月經週期 Grade 2: 極不正常, 但持續的月經週期 Grade 3: 無月經 Grade 4:- 常見處理 1. 無藥物可預防化療引起的月經停止 2. 化療期間, 月經週期可能會不正常, 當療程終止後約數月, 月經會恢復 3. 化療期間, 不適合懷孕, 仍需避孕, 建議至少避孕到化療結束後半年才可受孕 Leukopenia( 白血球低下 ) 分級 Grade 0: 正常 Grade 1:WBC<LLN 3000/ mm Grade 2:WBC< /mm Grade 3:WBC< /mm Grade 4:WBC<1000/mm 備註 : 院內 LLN:4800/ mm 常見處理 1. 白血球數目通常在接受化學治療後第 天到達最低, 通常 3 週會恢復 2. 白血球低下需預防感染, 觀察感染徵象 62

66 3. 可注射 GCSF,GCSF 健保規範 : 惡性疾病患者在接受化學治療後, 曾經發生白血球少於 1000/cumm, 或中性白血球 (ANC) 少於 500/cumm 者, 即可使用 (96/1/1) 患者如白血球超過 4000/cumm, 或中性白血球超過 2000/cumm 時, 應即停藥 4. 下列使用 GCSF 者須小心 : 藥物過敏者 使用阿斯匹靈者等有血小板能凝集抑制作用的藥劑 懷孕者. Liver dysfunction( 肝功能異常 ) 分級 Grad e 0 Grad e 1 Grad e 2 Grad e 3 Grad e 4 T-Bilirubi n(mg/dl) γ-gt (IU/L) ALP GOT GPT Albumin (IU/L) (IU/L) (IU/L) (g/dl) <2 >4 >1000 >4740 >660 >680 - 常見處理 1. 若肝功能值異常, 需視病患情況調整化學藥物劑量 2. 若 GOT GPT 大於正常值的 2 倍, 可服用 Procam 1 # tid pc LV dysfunction(lvef decreased 左心室射出率 ) 分級 Grade 0: 正常 Grade 1:EF 小於 <10-20% 並無症狀 Grade 2: 無症狀,EF 減少 20% 並無症狀 Grade 3: 需要治療的心臟衰竭反應 Grade 4: 嚴重至需要插管的心臟衰竭反應常見處理依臨床症狀評估, 若症狀嚴重, 先考慮停止化學治療 Mucostitis( 口腔發炎 ) 分級 Grade 0: 正常 Grade 1: 無痛性潰瘍, 紅斑, 或輕微疼痛無病兆 63

67 常見處理 Grade 2: 有疼痛性潰瘍 紅斑或水泡, 但可由口吃或吞嚥 Grade 3: 有疼痛性潰瘍 紅斑或水泡, 需要補充點滴 Grade 4: 嚴重潰瘍 需要腸外或腸內營養支持或預防性插管 1. 補充口服左旋麩醯胺酸 (L-glutamine), 可減緩口腔黏膜破損或疼痛感 2. 嚴重的口腔潰瘍, 造成疼痛, 可於進食前口含 Xylocaine jelly 或 Dexaltin, 減輕疼痛 3. 冷凍療法 : 化學治療前 5 分鐘口含大小適中圓滑的冰塊直到化學藥物完全滴注結束, 可有效降低口腔潰瘍的發生率 Nail disorder( 指甲變化 ) 分級 Grade 0: 正常 Grade 1: 脫色或湯匙狀指甲症或凹陷 Grade 2: 部份或全部指甲減少或指甲痛 Grade 3:- Grade 4:- 常見處理治療結束後症狀會自然改善 Nausea( 噁心 )/vomiting( 嘔吐 ) Nausea Grade 0: 無分級 Grade 1: 吃的下 Grade 2: 由口進食量明顯減少 Grade 3: 幾乎無攝食, 需要補充點滴 Grade 4:- Vomiting Grade 0: 無分級 Grade 1: 一天吐 1 次 Grade 2: 一天吐 2 5 次 Grade 3: 一天吐 6 次或需要補充點滴 Grade 4: 需要腸外營養及持續性醫療照顧及治療常見處理一 低度致吐性化學藥物 : 1. 於化療前 30 分鐘,Solu-medrol 40mg iv + Vomiz 8mg iv( 自費 ) 2. 於化療後第二天和第三天各早晚口服 Dexamethasone 4mg( 本院無此藥 ) 二 中度致吐性化學藥物 cisplatin( 30mg/m2/day, 50mg/m2/day) epirubicin ( 70mg/ m 2 /day) CPT-11 carboplatin oxaliplatin : 1. 於化療前 30 分鐘,Solu-medrol 40mg iv + Vomiz 8mg iv( 健保 ) 2. 於化療後第二天和第三天, 一天 2 次口服 Zofran8mg 或於化療後第二天和第三天各早晚口服 Dexamethasone 4mg( 本院無此藥 ) 三 高度致吐性化學藥物 cisplatin(>50mg/m2/day) cyclophosphamide 64

68 (>1500mg/m2/day) methotrexate ( 1.2gm/m2 /day) : 1. 於化療前 1 小時口服 Emend 125mg( 本院無此藥 ) 2. 於化療前 30 分鐘,Solu-medrol 40mg iv + Vomiz8mg iv( 健保 ) 3. 於化療後第二天和第三天的早晨各口服 Emend80mg( 本院無此藥 ) 及化療後第二天 第三天 第四天各早晚服 Dexamethasone 4 mg( 本院無此藥 ) Neuropathy-sensory( 感覺神經病變 ) 分級 Grade 0: 正常 Grade 1: 深部肌腱反射喪失或皮膚感覺異常 ( 含刺痛 ), 但不影響功能 Grade 2: 客觀感覺喪失或皮膚感覺異常 ( 含刺痛 ), 並影響功能, 但不影響日常生活功能 Grade 3: 反射喪失或皮膚感覺異常並會影響日常生活功能 Grade 4: 永久性皮膚感覺功能喪失常見處理 1. 預防姿位性低血壓 2. 避免飲酒及服用 Barbiturates Phenothiazines Aminogycoside 藥物 3. 教導預防便秘及排空膀胱的方法 4. 協助肢體麻痺或步態不穩並注意安全 5. 毒性嚴重時應停藥, 如 : 肌肉疼痛 Peripheral edema( 周邊肢體水腫 ) 分級 Grade 0: 無 Grade 1: 無症狀不需要治療 Grade 2: 有症狀且需要治療 Grade 3: 藥物無法改善水腫症狀且須立即停藥 Grade 4: 全身水腫 ( 全身水腫嚴重 ) 常見處理評估引發因子, 排除肝 腎與心血管疾病因素, 依臨床症狀處理可給予利尿劑 Proteinuria( 蛋白尿 ) 分級 Grade 0: 無或 <0.15g/24 小時 Grade 1:1 價或 g/24 小時 Grade 2:2 3 價或 g/24 小時 Grade 3:4 價或 0.3 g/24 小時 Grade 4: 腎病症候群常見處理 1. 評估引發因子, 若是腎臟損傷嚴重考慮是否調整治療劑量 2. 依據病因及臨床症狀給予治療 65

69 Pruritus( 皮膚癢 ) 分級 Grade 0: 無 Grade 1: 輕度或局部性騷癢, 經局部治療會自然緩解 Grade 2: 嚴重或廣泛性搔癢, 經全身治療會自然緩解 Grade 3: 嚴重或廣泛性搔癢, 經藥物治療後仍難以控制 Grade 4:- 常見處理依據病因及臨床症狀給予治療, 如給予抗組織胺類藥物或類固醇藥膏 Pain,chest( 胸痛 ) 分級 Grade 0: 無 Grade 1: 輕度疼痛但對身體不受干擾 Grade 2: 中度疼痛 : 服用止痛劑後, 身體受疼痛干擾但不干擾日常生活 Grade 3: 重度疼痛 : 服用止痛劑後仍干擾日常生活 Grade 4:- 常見處理 1. 評估引發因子, 排除心肺血管急症因素 2. 監測心電圖 3. 依據病因及臨床症狀評估給予治療 Pain,abdominal( 腹痛 ) 分級 Grade 0: 無 Grade 1: 輕度疼痛但不干擾日常活動 Grade 2: 中度疼痛, 需靠止痛劑緩解疼痛不影響日常活動 Grade 3: 嚴重疼痛, 需止痛劑緩解疼痛且仍影響日常活動 Grade 4: 無法緩解常見處理 1. 評估引發因子 2. 依據病因及臨床症狀給予處理 Phlebitis( 靜脈炎 ) 分級 Grade 0: 無 Grade 1:- Grade 2: 有 Grade 3:- Grade 4:- Rash( 紅疹 ) 分級 Grade 0: 無 Grade 1: 有皮癬或丘疹或紅斑的出現, 無伴隨症狀 66

70 常見處理 Grade 2: 有皮癬或丘疹或紅斑及騷癢的出現 <50%BSA Grade 3: 有皮癬或丘疹或紅斑或水泡的出現 >50%BSA Grade 4: 全身性脫落性皮膚炎或潰瘍性皮膚炎建議照會皮膚科醫師或需要時可給予抗組織胺類藥物及藥膏使用 Renal dysfunction( 腎功能異常 ) 分級 Grade 0: 無 Grade 1:- Grade 2:- Grade 3: 需要透析但可逆 Grade 4: 需要透析且不可逆常見處理針對具有腎毒性的化學治療須特別注意, 前後需給予大量液體 (> 3000 cc /Day) 並監測腎功能 SIADH( 抗利尿激素不適當分泌症候群 ) 分級 Grade 0: 無 Grade 1:- Grade 2:- Grade 3: 有 Grade 4:- Sinus bradycardia( 竇性心搏過慢 ) 分級 Grade 0: 正常 Grade 1: 無症狀也不需要治療 Grade 2: 有症狀但不需要治療 Grade 3: 有症狀也需要治療 Grade 4: 生命受到威脅 ( 例如 : 心律不整是因 CHF hypotension syncope shock 引起 ) Thrombocytopenia( 血小板低下 ) 分級 Grade 0: 正常 Grade 1:PLT< 正常 75,000/mm Grade 2:PLT<75,000 50,000/mm Grade 3:PLT<50,000 10,000/mm Grade 4:PLT<10,000/mm3 常見處理 1.Grade 0 2: 不需輸注血小板 2.Grade 3 4: 必要時輸注血小板 3. 血小板數值低於 2 萬需預防自發性出血 4. 觀察出血徵象 : 牙齦出血 血尿 血便 5. 避免使用 NSAID 或抗凝劑 67

71 Tachycardia( 心搏過速 ) 分級 Grade 0: 無 Grade 1: 無症狀, 不需要治療 Grade 2: 有症狀, 並非需要治療 Grade 3: 有症狀且需要治療 Grade 4:- 常見處理需先排除心肺疾病因素, 依臨床症狀評估處理, 必要時需可停止注射化學藥物 Weakness( 虛弱無力 ) 分級 Grade 0: 無 Grade 1: 無症狀的身體無力 Grade 2: 有症狀的身體無力但不影響日常生活 Grade 3: 有症狀的身體無力且影響日常生活 Grade 4: 無力至臥床不起常見處理評估引發因子, 注意是否為貧血 腦神經或其它功能異常引起的虛弱無力, 依據病因及症狀處理 68

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73 biweekly irinotecan monotherapy or a combination of irinotecan plus 5-fluorouracil/leucovorin (mfolfiri) in patients with metastatic gastric adenocarcinoma refractory to or progressive after first-line chemotherapy. Kim Y, et al. J Clin Oncol 26: 2008 (May 20 suppl; abstr 4577). Macdonald JS, et al. N Engl J Med 2001; 345:725. Mavroudis, D, Malamos, D, Polyzos, A, Kouroussis, CH, Christophilakis, CH, Varthalitis, I, Androulakis, N, Kalbakis, K, Milaki, G, Georgoulias, V. (2004). Front line Chemotherapy with docetaxel and gemcitabine administered every two weeks in patients with metastatic breast cancer :a multicenter phase II study.oncology, 67, Nabholtz, J.M, Mackey, J.R, Smylie, M, Paterson, A, Noel, D.R, Al-Tweigeri, T, Tonkin, K, North, S, Azli, N, Riva, A. (2001). Phase II study of docetaxel, doxorubicin, and cyclophosphamide as first-line chemotherapy for metastatic breast cancer. American Society of Clinical Oncology, 19, Larson, R. A. (2007, May 3). Prophylaxis of infection during chemotherapy-induced neutropenia. Retrieved December 8, 2007, from Quek R, et al. J Clin Oncol 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: Roth AD et al. J Clin Oncol 2007; 25:3217. Wen, P. Y, Plotkin, S. R. (2007, September 26). Neurologic complications of cancer chemotherapy. Retrieved December 8, 2007, from Hesketh, P. J. (2007, October 7). Prevention and treatment of chemotherapy-induced nausea and vomiting. Retrieved December 8, 2007, from Shapiro, C. (2007, October 16). Side effects of adjuvant chemotherapy for early stage breast cancer. Retrieved December 8, 2007, from 發行日期 :2017 年 6 月 發行版次 : 第 1 版 編輯人員 : 侯明鋒 吳政毅 莊捷翰 許經偉 王遜模 陳煌麒 蔡東霖 鐘堉緁 梁博程 林宜竑 陳映哲 蘇家弘 王秋麟 張慧名 沈榮宗 張美玉 艾紀瑩 王亞婷 黃惠娟 黃鈞民 李欣樺 蔡郁棻 伍秀瑩 陳雅玲 編註 : 親愛的同仁您好! 若您對此本處方集有任何的意見或問題, 歡迎您聯絡癌症中心, 謝謝! 70