The correct answer is 4.
Rationale: Mosteller equation (round to 2 decimal places)
G.F’s Previous DOXOrubicin:
DOXOrubicin dose in BRAJAC protocol = 60 mg/m2/cycle x 4 cycles.
60 mg mg/m2 x 1.63 m2 = x 4 cycles = 391 mg.
Alternate method for calculation: 60 mg/m2 x 4 = 240 mg/m2.
It is recommended that cardiac function be monitored when the cumulative dose of DOXOrubicin reaches
300 mg/m2 , as outlined in the Clinical Pharmacy Guide, Appendix C: Guidelines for Anthracycline Monitoring Threshold. Individual protocols may exceed these guidelines, provided that cardiac function is adequate before initiating therapy and monitored during therapy. The LYCHOPR protocol recommends cardiac assessment if the lifetime dose will exceed 450 mg/m2:
450 mg/m2 x 1.63 m2 = 733 mg.
Amount of DOXOrubin G.F. can receive before exceeding the recommended maximum lifetime dose:
Recommended maximum – dose already received = allowable amount remaining
733 mg – 391 mg = 342 mg
Alternate method for calculation: 450 mg/m2 – 240 mg/m2 = 210 mg/m2.
Number of Cycles of LYCHOPR before recommended maximum is reached:
DOXOrubicin dose in LYCHOPR protocol dose is
50 mg/m2 x 1.63 m2 = 81 mg.
The maximum number of cycles before the recommended maximum dose is exceeded = allowable amount remaining ÷ dose per cycle
342 mg ÷ 81mg = 4.2 cycles
Alternate method for calculation:
210 mg/m2 ÷ 50 mg/m2 = 4.2 cycles
Further therapy with DOXOrubicin after the first 4 cycles of LYCHOPR should require that cardiac assessment be performed first, as detailed in the Precautions Section of the LYCHOPR protocol.