The correct answer is 4.
Based on the GIPGEM protocol, the dose for gemcitabine in Cycle 1 and subsequent cycles is 1000 mg/m2/week x 3 weeks, followed by 1 week rest.
Calculation of acceptable dose:
The dose based on our calculated BSA (from question 1): 1000 mg/m2 x 1.34 m2 is 1340 mg gemcitabine. The dose ordered by the physician is 1400 mg, which is correct because the initial BSA of 1.39 should continue to be used for subsequent cycles, as per BC Cancer Policy III-10. Dose recalculation for subsequent cycles only needs to be considered if the patient’s weight changes by greater than 10%, or results in a dose discrepancy of greater than 5%, or if the patient’s clinical status warrants a dose adjustment.
Calculation of acceptable interval:
Patient has already received Cycle 1 as 3 weeks of gemcitabine (September 3, 10 and 17). According to the protocol treatment plan, she should be scheduled for a one week rest period before resuming treatment. Therefore, the patient should not be receiving any treatment on September 24. Next scheduled treatment date should be October 1. The patient should be rebooked for the following week with updated bloodwork to be drawn within 48 hours of treatment date.