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Case Study 1

For each question, choose the answer you think is correct. See the end of this page for the answers.

​J.P. is a 57-year-old male, diagnosed with small cell lung cancer. Treatment plan is for the patient to start on the LUSCPE protocol.

Lab results taken 24 hours prior to first treatment:

  • WBC 8.4
  • ANC 6.2
  • Hgb 149
  • Platelets 149

Weight: 87 kg Height: 160 cm

1. What best describes the status of CISplatin and etoposide?
  1. They are both Class I drugs and do not require approval prior to dispensing. 
  2. They are both Class I drugs and require approval prior to dispensing.
  3. Case-by-case Compassionate Access Program (CAP) approval must be obtained prior to dispensing.
  4. CISplatin is Class I, but etoposide is Restricted. 
2. What is the patient’s BSA, using the Mosteller equation?
  1. 1.97 m2 
  2. 1.90 m2 
  3. 1.95 m2 
  4. 2 m2 
3. Given the calculated BSA, what dose should the oncologist write?
  1. 49 mg CISplatin IV and 197 mg etoposide IV daily × 3 days 
  2. 38 mg CISplatin IV and 190 mg etoposide IV daily × 3 days 
  3. 49 mg CISplatin IV and 195 mg etoposide IV daily × 5 days 
  4. 50 mg CISplatin IV and 200 mg etoposide IV daily × 5 days 
4. Based on the protocol, when should J.P. receive his second cycle of chemotherapy?
  1. In one week 
  2. In two weeks 
  3. In three weeks 
  4. In four weeks 
5. What are the minimum hematologic lab values J.P. would have to exhibit to be able to continue with this dose of etoposide?
  1. ANC greater than 1.5 and platelets less than 100 
  2. ANC less than 1.5 and platelets less than 100 
  3. ANC less than 1.49 and platelets = 100 
  4. ANC = 1.5 and platelets = 100 

The correct answer is 1.

Rationale: According to the BC Cancer Agency Benefit Drug List, CISplatin and etoposide are both Class I drugs. A drug designated as Class I is used in the active treatment of cancer or for a specific purpose which is defined in an approved treatment protocol. No prior approval is required for CISplatin and etoposide in this case because they are Class I and are being used in an approved cancer treatment (protocol LUSCPE). If a protocol requires CAP approval the eligibility section of the protocol usually states this. 

The correct answer is 1. 

 

Rationale: Mosteller equation

 

 (BSA in metres squared) = square root of ((height x weight) divided by 3600) = square root of ((160cm x 87kg) divided by 3600) = 1.97 metres squared

 

The correct answer is 1. 

Rationale: Based on LUSCPE protocol, doses for CISplatin and etoposide are:

CISplatin25 mg/m2/day x 3 days (days 1-3)
25 mg/m2/day x 1.97 m2= 49.25 mg/day x 3 days
Etoposide100 mg/m2/day x 3 days (days 1-3)
100 mg/m2/day x 1.97 m2= 197 mg/day x 3 days

The correct answer is 3. 

Rationale: Based on LUSCPE protocol "Treatment" plan, doses are to be repeated every 21 days for a total of 4 - 6 cycles.

The correct answer is 4. 

Rationale: Based on LUSCPE protocol, "Dose modifications," patient can receive 100% of the calculated dose of etoposide as long as the ANC is greater than or equal to 1.5 and Platelets are greater than or equal to 100.

SOURCE: Case Study 1 ( )
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