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    Gem Carbo NHS

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    Syed Touseef Ahmed
    1. Gemcitabine and carboplatin is recommended for advanced or metastatic bladder cancer, ureteric cancer or renal pelvis carcinoma where renal function is poor or the patient is not fit for cisplatin. 2. It can also be used in a neo-adjuvant or adjuvant setting for transitional cell carcinoma in high-risk patients not suitable for cisplatin-based treatment. 3. Carboplatin dosing should be based on an EDTA result and recalculated if the creatinine changes by 30%, while gemcitabine is administered on days 1 and 8 of a 3-weekly cycle for up to 6 cycles.

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    Gem Carbo NHS

    Uploaded by

    Syed Touseef Ahmed
    27 views2 pages
    1. Gemcitabine and carboplatin is recommended for advanced or metastatic bladder cancer, ureteric cancer or renal pelvis carcinoma where renal function is poor or the patient is not fit for cisplatin. 2. It can also be used in a neo-adjuvant or adjuvant setting for transitional cell carcinoma in high-risk patients not suitable for cisplatin-based treatment. 3. Carboplatin dosing should be based on an EDTA result and recalculated if the creatinine changes by 30%, while gemcitabine is administered on days 1 and 8 of a 3-weekly cycle for up to 6 cycles.

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    1. Gemcitabine and carboplatin is recommended for advanced or metastatic bladder cancer, ureteric cancer or renal pelvis carcinoma where renal function is poor or the patient is not fit for cisplatin. 2. It can also be used in a neo-adjuvant or adjuvant setting for transitional cell carcinoma in high-risk patients not suitable for cisplatin-based treatment. 3. Carboplatin dosing should be based on an EDTA result and recalculated if the creatinine changes by 30%, while gemcitabine is administered on days 1 and 8 of a 3-weekly cycle for up to 6 cycles.

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    © All Rights Reserved
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    27 views2 pages

    Gem Carbo NHS

    Uploaded by

    Syed Touseef Ahmed
    1. Gemcitabine and carboplatin is recommended for advanced or metastatic bladder cancer, ureteric cancer or renal pelvis carcinoma where renal function is poor or the patient is not fit for cisplatin. 2. It can also be used in a neo-adjuvant or adjuvant setting for transitional cell carcinoma in high-risk patients not suitable for cisplatin-based treatment. 3. Carboplatin dosing should be based on an EDTA result and recalculated if the creatinine changes by 30%, while gemcitabine is administered on days 1 and 8 of a 3-weekly cycle for up to 6 cycles.

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    of 2

    GEMCITABINE AND CARBOPLATIN

    Advanced or metastatic bladder cancer, ureteric cancer or renal pelvis carcinoma, where renal function poor or
    patient not fit for cisplatin
    Neo-adjuvant or adjuvant use in transitional cell carcinoma in high-risk patients not suitable for cisplatin-based
    treatment

    Drug / Dosage: Gemcitabine 1000mg/m2 IV Day 1 and Day 8


    Carboplatin AUC 5 IV Day 1

    Carboplatin dose should be calculated using the Calvert formula:


    Dose = Target AUC x (25 + GFR)

    It is mandatory for the carboplatin dose to be based on the EDTA result, when available.
    Checks should always be made by the prescriber and the screening pharmacist to confirm
    whether an EDTA result is available at the start of treatment.

    If the EDTA result is not available this should be documented on ARIA, by the prescriber,
    before prescribing carboplatin using the Cockcroft & Gault formula to predict creatinine
    clearance.
    When using Cockcroft & Gault, a “cap” of 125 ml/min should be used for carboplatin dose
    calculations.
    Carboplatin dose should be re-calculated using the EDTA result, once available, for
    subsequent cycles (do not “cap”).

    EDTA should only be repeated if there is a 30% change in serum creatinine.

    Administration: Gemcitabine diluted in 250 ml 0.9% sodium chloride and infused over 30 minutes
    Carboplatin diluted in 250 ml 5% glucose and infused over 30 - 60 minutes

    Frequency: 3 weekly cycle


    Neo-adjuvant use: 3 – 4 cycles
    Palliative use: 6 cycles
    Adjuvant use: up to 6 cycles, at discretion of Consultant

    Main Toxicities: myelosuppression; erythematous rash; flu-like syndrome;


    peripheral oedema (mild-moderate & reversible); infertility / ovarian failure

    Anti- emetics: Day 1: highly emetogenic


    Day 8: mildly emetogenic

    Extravasation: non-vesicants

    Regular FBC Day 1 and Day 8


    Investigations: U&Es Day 1
    LFTs Day 1
    EDTA Prior to 1st cycle

    Reason for Update: new EDTA statement added Approved by Consultant: C Mikropoulos
    Version: 6 Approved by Lead Chemotherapy Nurse: E Masters
    Supersedes: Version 5 Date: 23.4.20
    Prepared by: S Taylor Checked by: S Seymour
    Dose Modifications
    Haematological Day 1:
    Toxicity: Neutrophils < 1.5 x 109/l Delay treatment for 1 week. Repeat FBC and, if
    or normal, proceed with treatment*.
    Platelets < 100 x 109/l
    *Reduce the gemcitabine dose to 75% of the original cycle initiation dose (and do not
    increase this dose again) if any of the following have occurred:
     Neutrophils < 0.5 x 109/l for > 5 days
     Neutrophils < 0.1 x 109/l for > 3 days
     Febrile neutropenia
     Platelets < 25 x 109/l
     Cycle delay of more than one week due to toxicity

    Day 8:

    Neutrophils Platelets Gemcitabine


    > 1.5 x 109/l and  100 x 109/l Give 100% of the Day 1
    dose
    1.0 – 1.5 x 109/l or 75 – 100 x 109/l Give 50% of the Day 1 dose

    < 1.0 x 109/l or < 75 x 109/l Omit


    (do not defer)

    If a dose reduction to 50% of the Day 1 dose has been made on Day 8, the dose should be
    increased to 100% again on Day 1 of the next cycle, providing the FBC has returned to
    normal limits.

    Renal Impairment: Carboplatin is contra-indicated if GFR < 20 ml/min.

    If CrCl < 30ml/min, consider gemcitabine dose reduction – clinical decision

    Hepatic Impairment: If bilirubin > 27 μmol/L, initiate treatment with gemcitabine 800mg/m 2

    References: Bamias, A et al; Cancer 2006; 106 (2): 297 – 303


    Linardou, H et al; Urology 2004; 64 (3): 479 - 484
    Dogliotti, L et al; Eur Urol 2007; 52 (1):134 – 41
    Haematological dose modifications advice in line with Gemzar SPC

    Reason for Update: new EDTA statement added Approved by Consultant: C Mikropoulos
    Version: 6 Approved by Lead Chemotherapy Nurse: E Masters
    Supersedes: Version 5 Date: 23.4.20
    Prepared by: S Taylor Checked by: S Seymour

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