nyuuzyou/wikis huggingface dataset:
Example orders for Pemetrexed (Alimta) in non-small cell lung cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Pemetrexed (Alimta)==
Original references may be found at Pemetrexed (Alimta)
===Example regimen #1===
*Pemetrexed (Alimta) 500 mg/m2 IV on day 1
**Administer over 10 minutes.
21-day cycles
====Supportive therapy====
*Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy 
*Lorazepam (Ativan) 0.5 mg PO x 1 prn nausea/anxiety 
*Prochlorperazine (Compazine) 10 mg PO x 1 prn nausea 
*Dexamethasone (Decadron) 4 mg PO twice per day the day before, day of, and day after chemotherapy
*Cyanocobalamin (Vitamin B12) 1000 mcg IM every 9 weeks, the first dose given at least 1 week prior to start of pemetrexed therapy
*Folic acid 1000 mcg PO daily, to start at least 1 week prior to start of pemetrexed therapy, to continue throughout therapy with pemetrexed
Hydration:
*500 ml NS and/or D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS and/or D5W as needed for IV compatibility.
Monitoring:
*On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr, alk phos, AST, ALT, total bilirubin, albumin, carcinoembryonic antigen
**Depending on provider preference and patient's tolerance, may simplify to CBC with differential, absolute neutrophil count (ANC), with less frequent BUN/Cr & LFT checks
*On cycle 1 day 10, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
*Assess for response with CT scan every 3+ cycles depending on symptoms
Outpatient medications:
*Dexamethasone (Decadron) as described above
*Lorazepam (Ativan) 0.5 mg PO every 6 hours prn anxiety, insomnia, nausea
*Ondansetron (Zofran) 4 mg PO every 6 hours prn nausea
*Prochlorperazine (Compazine) 10 mg PO every 6 hours prn nausea 
*Folic acid 1000 mcg PO daily as described above
Clinical scenario & comments:
*60 year-old lady with stage IV adenocarcinoma of the lung, s/p treatment with first-line therapy for metastatic disease with Carboplatin (Paraplatin) & Pemetrexed (Alimta), with good response. Pemetrexed (Alimta) was used as a maintenance therapy in this setting.
Category:Example chemotherapy order sets
Example orders for Pralatrexate (Folotyn) in peripheral T-cell lymphoma

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Pralatrexate (Folotyn)==
Published regimens and references can be found on the T-cell lymphoma page.
===Example order set #1===
*Pralatrexate (Folotyn) 30 mg/m2 IV push over 3 to 5 minutes once per day on days 1, 8, 15, 22, 29, 36 
7-week cycles
====Supportive therapy====
*Ondansetron (Zofran) 8 mg IV once; 30 minutes prior to chemotherapy
*Prochlorperazine (Compazine) 10 mg PO once prn nausea
*Cyanocobalamin (Vitamin B12) 1 mg IM once every 8 to 10 weeks
*Folic acid 1 mg PO once per day
Hydration:
*Normal saline IV continuous infusion at 5 mL/H
*Normal saline 25 to 50 mL IV prn flush before and after chemotherapy
Monitoring/precautions:
*Suggested to check weekly CBC; check comprehensive metabolic panel (includes renal and hepatic function) before week 1 & 4 doses
*Examine patient for mucositis before each dose of pralatrexate
*Notify physician and hold dose if ANC less than 1000, platelet count less than 50,000
Nursing:
*Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete. 
*Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.
Category:Example chemotherapy order sets
Example orders for R-CHOP in lymphoma

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==R-CHOP==
R-CHOP: Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone
Original references may be found at R-CHOP (Non-Hodgkin lymphoma)
===Example regimen #1===
*Cyclophosphamide (Cytoxan) 750 mg/m2 IV on day 1
**Infuse over 30 to 45 minutes.
*Doxorubicin (Adriamycin) 50 mg/m2 IV on day 1
**Administer IV push through running IV.
*Vincristine (Oncovin) 1.4 mg/m2 (maximum dose of 2mg per cycle) IV on day 1
**Administer IV push through running IV. Make sure to address patient's bowel status. 
*Prednisone (Sterapred) 100 mg PO once per day on days 1 to 5
*Rituximab (Rituxan) 375 mg/m2 IV on day 1
**Infusion rate per hospital policy.
21-day cycles x 6 cycles
====Supportive therapy====
*Pegfilgrastim (Neulasta) 6 mg SC x1 on day 3
*Acetaminophen (Tylenol) 650 mg PO 30 to 60 minutes prior to rituximab
*Diphenhydramine (Benadryl) 25 to 50 mg IV or PO 30 to 60 minutes prior to rituximab. 50 mg to be used for the first dose of Rituximab (Rituxan). Dose may be reduced to 25 mg on subsequent Rituximab (Rituxan) treatments if tolerated.
*Ondansetron (Zofran) 8 mg IV 30 minutes prior to CHOP
*Hydrocortisone (Cortef) 50 mg IV prn Rituximab (Rituxan) infusion reaction, may repeat x1
Hydration:
*Prehydration with 500 ml NS at 500 mL/hour, to start 60 minutes before chemotherapy
*500 ml NS at KVO rate to be used as running IV for chemotherapy infusion. Give up to 500 ml NS.
Monitoring:
*On day 1 of each cycle: CBC with differential, absolute neutrophil count (ANC), BUN/Cr as part of a comprehensive metabolic panel, alk phos, AST, ALT, total bilirubin, albumin, LDH
**Physician to be notified if liver function tests or bilirubin are not within normal limits
*On day 8, check nadir CBC with differential, absolute neutrophil count (ANC). Need for further nadir count checks to be determined by degree of cytopenias.
*Check hepatitis B status prior to therapy with rituximab
Outpatient medications:
*Prednisone (Sterapred) as described above
*Ondansetron (Zofran) 8 mg PO every 8 hours prn nausea
*Acyclovir (Zovirax) 400 mg PO every 8 hours
*Allopurinol (Zyloprim) 100 to 300 mg PO once per day, adjusted for renal function 
Clinical scenario & comments:
*74 year-old gentleman with diffuse large B-cell lymphoma (DLBCL), using R-CHOP as first-line therapy. This patient had a creatinine of 1.4, with calculated creatinine clearance by Cockcroft-Gault of 55, but the team chose to be more conservative with allopurinol dosing and used 100 mg PO daily.
Category:Example chemotherapy order sets
Example orders for Sipuleucel-T (Provenge) in prostate cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Sipuleucel-T (Provenge)==
Published regimens and references can be found on the prostate cancer page.
===Example order set #1===
*Sipuleucel-T (Provenge) 1 bag IV over 60 minutes once per day on days 1, 15, 29. Prior to administration, gently agitate bag of sipuleucel-T to resuspend. Use standard tubing without a filter.
====Supportive therapy====
*Acetaminophen (Tylenol) 650 mg PO once; 30 minutes prior to infusion
*Diphenhydramine (Benadryl) 25 to 50 mg PO once; 30 minutes prior to infusion
Monitoring/precautions:
*Confirm that patient has not had fevers or chills prior to receiving acetaminophen so that staff can property monitoring for side effects from sipuleucel-T infusion. 
*Observe patient for at least 30 minutes after each infusion in case the patient develops an acute infusion reaction.
Nursing:
*Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete. 
*Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.
Category:Example chemotherapy order sets
Example orders for Vinorelbine and Bevacizumab in breast cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Vinorelbine & Bevacizumab==
Published regimens and references can be found on the breast cancer page.
===Example order set #1===
*Vinorelbine (Navelbine) 25 mg/m2 IV push once per day on days 1, 8, 15
*Bevacizumab (Avastin) 10 mg/kg IV over 30 to 90 minutes (first dose should be over 90 minutes, and if tolerated, subsequent doses can be given over 30 minutes) once per day on days 1 & 15
28-day cycles
====Supportive therapy====
*Ondansetron (Zofran) 8 mg PO once; 30 minutes prior to chemotherapy
*Optional: Prochlorperazine (Compazine) 10 mg PO once prn nausea prior to chemotherapy
Hydration:
*Normal saline IV continuous infusion at 5 mL/H
*Normal saline 25 to 50 mL IV prn flush before and after chemotherapy
Monitoring/precautions:
*For cycle 1, check blood pressure before, during, and after bevacizumab infusion. For subsequent cycles, check blood pressure before and after bevacizumab.
*Check urine dipstick for protein every 30 days; notify physician if protein ≥100 mg/dL
Nursing:
*Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete. 
*Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.
Category:Example chemotherapy order sets
Example orders for mFOLFOX6-B in colon cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==mFOLFOX 6 & Bevacizumab (Avastin)==
Published regimens and references may be found on the colon cancer page.
===Example regimen #1===
*Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on days 1 & 15 after oxaliplatin and leucovorin
*Fluorouracil (5-FU) 1200 mg/m2/day (total dose 2400 mg/m2) IV continuous infusion over 46 hours on days 1 to 2, 15-16, given after 5-FU bolus
*Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours on days 1 & 15, given after bevacizumab, concurrently with oxaliplatin
**Mixed in 250 mL D5W.
*Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on days 1 & 15, given after bevacizumab, concurrently with leucovorin
**Mixed in 500 mL D5W, and only infuse through D5W line.
*Bevacizumab (Avastin) 5 mg/kg IV on days 1 & 15, given first
**Only infuse through NS line. Infusion times for bevacizumab are 90 for cycle 1, 60 minutes for cycle 2, then 30 minutes for cycles 3 and later.
28-day cycles
====Supportive medications====
*Ondansetron (Zofran) 8 mg IV 30 minutes prior to oxaliplatin
*Dexamethasone (Decadron) 10 mg IV 30 minutes prior to oxaliplatin
*Lorazepam (Ativan) 0.5-1 mg PO prn nausea/anxiety, given 30 minutes prior to chemotherapy
*Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start prior to oxaliplatin to decrease likelihood of neuropathy
*Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start after oxaliplatin infusion is complete to decrease likelihood of neuropathy
*Calcium and magnesium are no longer recommended to reduce risk of oxaliplatin-induced neuropathy: Charles L. Loprinzi, Rui Qin, Shaker R. Dakhil, Louis Fehrenbacher, Philip J. Stella, Pamela J. Atherton, Drew K. Seisler, Rubina Qamar, Grant Carlton Lewis, Axel Grothey. Phase III randomized, placebo (PL)-controlled, double-blind study of intravenous calcium/magnesium (CaMg) to prevent oxaliplatin-induced sensory neurotoxicity (sNT), N08CB: An alliance for clinical trials in oncology study. 2013 ASCO Annual Meeting abstract 3501. link to abstract
Hydration:
*500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.
*500 ml NS at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS.
Monitoring:
*Hold if ANC <1500 or platelets <75 and notify physician.
*Check blood pressure during and after the first two doses of bevacizumab; for the third dose and later, check blood pressure before and after bevacizumab.
*Check urine protein every month; notify physician for urine protein >100 mg/dL.
Comments:
*My institution administers this regimen in 28-day cycles.
Category:Example chemotherapy order sets
Example orders for mFOLFOX 6 in colon cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==mFOLFOX 6==
Published regimens and references may be found on the colon cancer page.
===Example regimen #1===
*Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on day 1 after oxaliplatin and leucovorin
*Fluorouracil (5-FU) 1200 mg/m2/day (total dose 2400 mg/m2) IV continuous infusion over 46 hours on days 1 to 2, given after 5-FU bolus
*Leucovorin (Folinic acid) 400 mg/m2 IV over 2 hours on day 1, given first, concurrently with oxaliplatin
**Mixed in 250 mL D5W.
*Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on day 1, given first, concurrently with leucovorin
**Mixed in 500 mL D5W, and only infuse through D5W line.
14-day cycles x 12 cycles, to start within 10 weeks of surgery (if adjuvant); in metastatic settings, given until progression of disease or unacceptable toxicity
====Supportive therapy====
*Ondansetron (Zofran) 8 mg IV 30 minutes prior to oxaliplatin
*Dexamethasone (Decadron) 10 mg IV 30 minutes prior to oxaliplatin
*Lorazepam (Ativan) 0.5-1 mg PO prn nausea/anxiety, given 30 minutes prior to chemotherapy
*Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start prior to oxaliplatin to decrease likelihood of neuropathy
*Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start after oxaliplatin infusion is complete to decrease likelihood of neuropathy
*Calcium and magnesium no longer recommended to reduce risk of oxaliplatin-induced neuropathy: Charles L. Loprinzi, Rui Qin, Shaker R. Dakhil, Louis Fehrenbacher, Philip J. Stella, Pamela J. Atherton, Drew K. Seisler, Rubina Qamar, Grant Carlton Lewis, Axel Grothey. Phase III randomized, placebo (PL)-controlled, double-blind study of intravenous calcium/magnesium (CaMg) to prevent oxaliplatin-induced sensory neurotoxicity (sNT), N08CB: An alliance for clinical trials in oncology study. 2013 ASCO Annual Meeting abstract 3501. link to abstract
Hydration:
*500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.
Monitoring:
*Hold if ANC less than 1500 or platelets less than 75 and notify physician.
Category:Example chemotherapy order sets
Example orders for simplified biweekly 5-FU & leucovorin (sLV5FU2) in colon cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Simplified biweekly 5-FU & leucovorin (sLV5FU2)==
Original references may be found at simplified biweekly 5-FU & leucovorin (sLV5FU2)
===Example regimen #1===
*Leucovorin (Folinic acid) 400 mg/m2 IV over 2 hours on days 1 & 15, given first
*Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on day 1 after leucovorin
*Fluorouracil (5-FU) 1200 mg/m2/day (total dose of 2400 mg/m2) IV continuous infusion over 46 hours on days 1 to 2, to start after 5-FU bolus
28-day cycles
====Supportive therapy====
*Dexamethasone (Decadron) 12 mg PO once; 30 minutes prior to chemotherapy 
*Ondansetron (Zofran) 16 mg IV 30 minutes prior to chemotherapy 
*Lorazepam (Ativan) 0.5-1 mg PO prn nausea/anxiety, given 30 minutes prior to chemotherapy
Hydration:
*500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.
Monitoring:
*Hold if ANC less than 1500 or platelets less than 75 and notify physician.
*Comprehensive metabolic panel (chem 10 & LFTs) before each treatment
*Monitor for possible hand-foot syndrome
*Assess for mucositis at every visit
Comments:
*My institution administers this regimen in 28-day cycles.
Category:Example chemotherapy order sets
Example orders for trastuzumab emtansine (Kadcyla) in breast cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Trastuzumab emtansine (Kadcyla)==
Published regimens and references can be found on the breast cancer page.
===Example order set #1===
*Trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV over 90 minutes once on cycle 1 day 1; use 0.22 micron inline filter and observe patient for 90 minutes after first dose. Then, Trastuzumab emtansine (Kadcyla) 3.6 mg/kg IV over 30 minutes once on day 1 of subsequent cycles, and observe the patient for 30 minutes after infusion completes.
21-day cycles
====Supportive therapy====
*Acetaminophen (Tylenol) 650 mg PO once; 30 minutes prior to chemotherapy
*Diphenhydramine (Benadryl) 25 mg IV once; 30 minutes prior to chemotherapy
*Ondansetron (Zofran) 8 mg PO once; 30 minutes prior to chemotherapy
Hydration:
*Normal saline IV continuous infusion at 5 mL/H
*Normal saline 25 to 50 mL IV prn flush before and after chemotherapy
Monitoring/precautions:
*Monitor for thrombocytopenia (however, no mandatory mid-cycle check)
Nursing:
*Patients without central lines: insert peripheral IV before therapy. Flush peripheral IV with 10 mL 0.9% normal saline after each day's dose of chemotherapy. Remove peripheral IV when therapy is complete. 
*Patients with central lines: access the central venous access device before therapy. Flush central line according to institutional guidelines after each day's dose of chemotherapy. Deaccess device when therapy is complete.
Category:Example chemotherapy order sets
Example orders for weekly 5-FU & Leucovorin in colon cancer

Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
==Weekly 5-FU & Leucovorin==
Original references may be found at weekly 5-FU & Leucovorin
===Example regimen #1===
*Leucovorin (Folinic acid) 20 mg/m2 IV over 2 hours on days 1, 8, 15, given first
*Fluorouracil (5-FU) 500 mg/m2 IV bolus on days 1, 8, 15, given 1 hour after start of leucovorin
28-day cycles
====Supportive therapy====
*Prochlorperazine (Compazine) 10 mg PO prn nausea
Hydration:
*500 ml NS at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS.
Monitoring:
*Hold if patient has significant diarrhea/mucositis, ANC less than 1000, or platelets less than 100 and notify physician.
Comments:
*My institution administers this regimen with a 3 weeks on, 1 week off schedule for every 28-day cycle.
Category:Example chemotherapy order sets
Exemestane (Aromasin)

==General information==
Class/mechanism: Steroidal aromatase inhibitor; irreversibly binds and inactivates the aromatase enzyme that converts adrenal and ovarian androgens (androstenedione and testosterone) to estrogens (estrone and estradiol) in peripheral tissues.Exemestane (Aromasin) package insert Exemestane (Aromasin) package insert (locally hosted backup)Aromasin manufacturer's website
Route: PO
Extravasation: n/a
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias or the prescribing information. 
==Diseases for which it is used==
*Breast cancer
==Patient drug information==
*Exemestane (Aromasin) package insert 
*Exemestane (Aromasin) patient drug information (Chemocare)Exemestane (Aromasin) patient drug information (Chemocare)
*Exemestane (Aromasin) patient drug information (UpToDate)Exemestane (Aromasin) patient drug information (UpToDate)
==History of changes in FDA indication==
* 1999-10-21: Initial FDA approval for the treatment of advanced breast cancer in postmenopausal women whose disease has progressed following tamoxifen therapy. (Based on Kaufmann et al. 2000)
* 2005-10-05: Approved for adjuvant treatment of postmenopausal women with estrogen receptor positive early breast cancer who have received two to three years of tamoxifen and are switched to AROMASIN for completion of a total of five consecutive years of adjuvant hormonal therapy. (Based on IES)
==History of changes in EMA indication==
The approval of this drug pre-dates the EMA.
*1998-12-16: EURD
==History of changes in Health Canada indication==
*2006-05-12: Initial notice of compliance with conditions
*2008-06-08: Conditions were met
==Also known as==
*Code name: FCE-24304
*Brand names: Aromadex, Aromasin, Aromex, Xtane
==References==
Category:Drugs
Category:Oral medications
Category:Protein expression-specific medications
Category:Aromatase inhibitors, third generation
Category:Breast cancer medications
Category:FDA approved in 1999
Category:EMA approved in 1998
Category:Health Canada approved in 2006