Help with math calculation

[lipoprotien]

Hello Aracne and friends,
I need help with a mathaQ
A 53 y/o [5’ 10”, 200 lb =2.11m2 BSA]. His past medical history is significant for CHF.He is to receive 6 cycles of chemotherapy.

Cyclophosphamide 750 mg/m2 IV on day 1.
Doxorubicin 50 mg/m2 IV on day 1.
Vincristine 1.4 mg/m2 IV on day 1.
Prednisone 100 mg po Days 1-5

• What is the max dose for Doxorubicin?
• does the patient exceeds the max dose?
• What do u suggest for CINV prevention?
• What other meds would u concider giving?

My question is the answer for (2) was no, and not yes
My other Q is,if the 2.11m2 BSA is given, why do they give us wt and hight??

Thans a million friends, u have been great help for me, specially in math, my weak point

[Aracne]

look, doxo can be given at 60-75mg/mq and the max lifetime dose i think is 300mg/m2 so nothing wrong there.
the problem is that it's cardiotoxic and I would not recommend it in CHF.
Also dose is usually adjusted when given with Cytoxan
what to give instead? no clue, tell doctor to do his job.
I'd add mesna for the acrolein problem and i think the standard chemo antiemetics are emend and zofran.
as for the wt and ht, it's just part of the profile... sometime you will have to choose what info to pick in order to establish a dose, but in this case it seems just extra info put ther to trick

[resu]

Hi Lipoprotein,

For first question,

Max dose of doxorubicin : 550 mg/m2 (lifetime)

Second question,

I would say no. Because patient is getting 50 mg/m2 ( in total, patient is getting 105.5 mg/2.11 m2/day OR 633 mg/ 2.11 m2/total 6 cycles), which is 300 mg/m2/total 6 cycles. And, which does not exceed total lifetime does/m2.

Third question:

We can use 5-HT 3 receptor antagonist (zofran,anzemet,aloxi-IV ONLY,kytril), neurokinin-1 antagonist ( emend), phenothiazines, butyrophenones( haldol,inapsine), decadron, cannabinoids(marinol,cesamet),
BZ (ativan)....etc

Question four :

if you ask question 4 for giving drugs to prevent infusion site reactions, then patient gets benadryl, H2 receptor blocker,dexamethasone..........

I hope, it will help you.

[ninah]

Question 2's answer is no because although it is 6 cycles alltogether but Doxorubicin is given every 21 days and since each cycle is 5 days so a total of 30 days .Therefore patient will not exceed the max lifetime dose which is 550mg/m2

[Aracne]

I do not think they are giving doxo for 5 days staraight... it's 6 cycles and doxo and cytoxan are given only on day 1 of each cycle
edited..
yes, I misunderstood your comment ninah

[ninah]

Doxo is always given every 21 days,I work at inpatient infusion centre and have never seen doxo more frequent than 21 days.

[lipoprotien]

thanks a bunch friends
your help is appreciated

[nipureddy]

This problem is calculated differently.. As they gave to height and wt of pt you have to do it calulating BSA method .

Here is right procedure for calculation max dose of doxo

Incorporate all values in BSA formula and u will get answer.