Case Study 1

For each question, choose the answer you think is correct. Answers are provided at the end of the page.

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

Lab results taken 24 hours prior to first treatment:

  • WBC 8.4 (x 109/L)
  • ANC 6.2 (x 109/L)
  • Hgb 149 (​g/L)
  • Platelets 149 (x 109/L)

Weight: 87 kg Height: 160 cm

1. Which of the following best describes the BC Cancer benefit status of CISplatin and etoposide?
  1. They are both Class I drugs and do not require special approval prior to dispensing. 
  2. They are both Class I drugs and require special approval prior to dispensing.
  3. They are both Restricted drugs and case-by-case Compassionate Access Program (CAP) approval must be obtained prior to dispensing.
  4. CISplatin is Class I drug, but etoposide is Restricted and requires special approval prior to dispensing. 
2. What is the patient’s BSA, using the Mosteller equation?
  1.   1.97 m2 
  2.   1.9 m2 
  3.   1.96 m2 
  4.   2 m2 
3. Given the calculated BSA, what should the dosing regimen be?
  1.  49 mg CISplatin IV and 197 mg etoposide IV daily × 3 days 
  2.  48 mg CISplatin IV and 190 mg etoposide IV daily × 3 days 
  3.  49 mg CISplatin IV and 196 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 continue with his current dose of etoposide?
  1. ANC greater than 1.5 (x 109/L) and platelets greater than 100 (x 109/L)
  2. ANC less than 1.5 (x 109/L)and platelets less than 100 (x 109/L)
  3. ANC greater than 1.0 (x 109/L) and platelets greater than 75 (x 109/L)
  4. ANC = 1.5 (x 109​/L) and platelets = 100 (x 109/L)
6. ​After receiving 6 cycles of LUSCPE, the pharmacist receives orders for a 7th cycle of treatment. How should the pharmacist proceed? 

  1. Proceed with treatment as ordered, as long as the dose interval and doses ordered are acceptable.
  2. J.P. has completed the maximum 6 cycles recommended in the protocol, so the pharmacist should contact the physician and arrange for a rest period before J.P. can continue treatment.
  3. J.P. has completed the maximum 6 cycles as recommended in the protocol, so the pharmacist should contact the physician and confirm if another cycle is needed, in which case Compassionate Access Program (CAP) approval must be requested if the intention is to proceed beyond 6 cycles. Approval must be granted before proceeding.
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Answer 1
​The correct answer is 1.

Rationale: According to the BC Cancer Benefit Drug List, CISplatin and etoposide are both Class I drugs. They are approved for use in the LUSCPE cancer treatment protocol, and the patient fits the protocol eligibility requirements. 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. If a protocol requires CAP approval the eligibility section of the protocol usually states this. 
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Answer 2
The correct answer is 1. 

Rationale: Mosteller equation (round to 2 decimal places)

(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
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Answer 3
The correct answer is 1. 

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

CISplatin      25 mg/m2/day x 3 days (days 1-3)
                           25 mg/m2/day x 1.97 m2= 49.25 mg/day x 3 days

Etoposide    100 mg/m2/day x 3 days (days 1-3)
                           100 mg/m2/day x 1.97 m2= 197 mg/day x 3 days
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Answer 4
​The correct answer is 3. 

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

Answer 5
​The correct answer is 4. 

Rationale: Based on the LUSCPE protocol Dose Modifications section, patients can receive 100% of the calculated dose of etoposide as long as the ANC is greater than or equal to 1.5 (x 109/L) and Platelets are greater than or equal to 100 (x 109/L).

​​

Answer 6
​The correct answer is 3.

Rationale:  Based on LUSCPE protocol Treatment section, the maximum number of treatment cycles is 6.  Any further treatments would be considered a deviation from the protocol, and would require approval from the BC Cancer Compassionate Access Program (CAP) prior to J.P. receiving Cycle 7. 
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