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Case Study 8

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

​A.C. is a 53-year-old male diagnosed with malignant mesothelioma, scheduled to be treated with LUMMPG. The oncologist orders CISplatin on Day 1 and gemcitabine on Days 1 and 8.

Weight: 82 kg Height: 174 cm

Lab results taken 72 hours prior to first treatment:

  • WBC 8.6
  • ANC 3.5
  • Platelets 257
  • Creatinine 130
  • Bilirubin 10
  • Alk Phos 63
  • AST 19
  • LDH 123
1. What dose of cisplatin and gemcitabine should the oncologist prescribe, based on the calculated BSA?
  1. 149 mg CISplatin and 2488 mg gemcitabine 
  2. 89 mg CISplatin and 1493 mg gemcitabine 
  3. 90 mg CISplatin and 2488 mg gemcitabine
  4. 150 mg CISplatin and 1500 mg gemcitabine 
2. What hydration orders should the oncologist prescribe, based on the LUMMPG protocol?
  1. 1000 mL NS over 60 minutes pre-hydration, with CISplatin in 500 mL NS with 20 mEq KCl, 1 g MgSO4 and 30 g mannitol infused over 60 minutes 
  2. 500 mL NS over 60 minutes pre-hydration, with CISplatin in 500 mL NS with 10 mEq KCl, 500 mg MgSO4 and 15 g mannitol over 60 minutes 
  3. 1000 mL NS over one hour post-hydration 
  4. a) and c) 

 

The correct answer is 1.

 

Rationale:


BSA calculation

= square root of ((height x weight) over 3600) = square root of ((174cm x 82kg) over 3600) = 1.99 metres squared 

 

Creatinine clearance =

 

N x (140 – age) x weight (kg) 
Serum creatinine (micromol/L)     N = 1.23 for males

 

     = 1.23 x (140 – 53) x 82 
               130

     = 67.5 mL/min


CISplatin dose calculation = 75 mg/m2 x 1.99 m2 = 149 mg. According to the current LUMMPG protocol, there is no need to reduce the CISplatin dose for creatinine clearance greater than or equal to 60 mL/min.


Gemcitabine dose calculation

     = 1250 mg/m2 x 1.99 m2

     = 2488 mg

 

 

 

The correct answer is 1.


Rationale: The LUMMPG protocol provides details of hydration in the "Treatment" section. As discussed in the Clinical Pharmacy Guide, Step 10: Verify Protocol-Related Supportive Care Provided, IV Hydration section, CISplatin is a drug that can cause renal damage, and with high dose treatment, hydration is an important preventative measure.


SOURCE: Case Study 8 ( )
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