Skrining Resep (3)

A N D R I U TO M O
D I S A M PA I K A N D I P S PA U BAYA
A N G K ATA N 6 2
Outline
1. Alur dan Skrining resep obat kemoterapi
2. Proses perhitungan dosis kemoterapi
3. Mengkaji rejimen terapi dan prinsip penyesuaian dosis
4. Menentukan pelarut dan mengidentifikasi efek samping serta
interaksi obat
Skrining Resep Obat Kemoterapi
Skrining Resep Obat Kemoterapi (lanj.)
 How to Determine Chemotherapy Dose?

Body weight BSA AUC GFR

• Estimating
• ……mg/kgBB • ……mg/m2 • Target AUC renal function
• Young • adults • Carboplatin • Carboplatin
children & dosing in dosing
infant Adult • dosing
Adjustment
 Body Surface Area (BSA) Formula
• DuBois & DuBois 1916
BSA = 0.20247 x Ht (m) 0.725 x Wt (kg) 0.425
• Boyd 1935
BSA = 0.0003207 x Ht (cm) 0.3 x Wt (g) 0.7285-(0.0188 x log(g)
• Gehan & George 1970
BSA = 0.0235 x Ht (cm) 0.42246 x Wt (kg) 0.51456
• Haycock et al. 1978
BSA = 0.024265 x Ht (cm) 0.3964 x Wt (kg) 0.5378
• Mosteller 1987
BSA = Ht (cm) x Wt (kg) 3600
 BSA, Which Formula Should We
Use?

ASCO No evidence Mosteller

recommends supporting one formula is most
any of the formula over commonly
formula another used
Comparison of BSA Formula Results
 Calculation of Safe Dosage by BSA
• Pasien nama Davi, 7 tahun TB:126 cm BB: 23 kg.

• Mendapatkan R/:Vincristin 1.8 mg IV (jam 10 pagi)

• Dosis yang direkomendasikan 2 mg per m2

• Apakah dosis tepat?

• Berapa ml vincristin yang harus diambil untuk dosis

tersebut?

9
 Calculation of Safe Dosage by BSA (cont.)

10
 Determine BSA
BSA (m2 ) 126  23 2,898 0.805  0.897 m 2
 0.9 m2

 3,600  
3,600
• Calculate recommended dosage
Mg per m2 × m2 = 2 mg per m2 × 0.9 m2 = 1.8 mg

11
 Berapa ml vincristine?
Use ratio-proportion:

1 mg 1.8

mg X1=m1.8
L mL
X mL

12
 What is AUC?
• Myelotoxicity and clinical efficacy of carboplatin
correlate with the clearence of the drug , which is
correlated to the glomerular filtration rate (GFR),
renal function

• AUC is used to determine carboplatin doses

• AUC is the area under curve when the

concentration of a drug in plasma is plotted
against time.

• Target AUC = 4 to 7 mg/ml/minute

 CARBOPLATIN DOSE
CALCULATION

• Ny AD 53 tahun, Ca. Ovarium, mendapatkan kemoterapi

carboplatin, BB = 50 Kg, TB = 160 cm, GFR = 70 ml/min,
target AUC 5. hitung dosis carboplatin !

PERHITUNGAN:
• Dosis carboplatin = 5 x (70+25) = 475 mg
• Berapa ml carboplatin yang harus diambil untuk dosis
tersebut?
CARBOPLATIN DOSE
CALCULATION (cont.)
Anthracycline Cumulative Dose
 Contoh Perhitungan
Pasien Tn. RM dengan Non-Hodgkin’s Lymphoma telah
menjalani 6 x kemo R-CHOP dan 2x IVE, berapa banyak
antrasiklin yang telah digunakan oleh pasien?

R-CHOP, to be repeated every 3 weeks (6 course)

Cyclophosphamide 750mg/m2 i.v d1

Doxorubicin 50 mg/m2 i.v d1

Vincristine 1.4 mg/m2 (max 2 mg) i.v d1

Prednisone 100 mg/m2 p.o d1-5

Rituximab 375 mg/m2 i.v d0

IVE

Ifosfamide 2500 mg/m2 i.v d1-3

Etoposide 150 mg/m2 i.v d1-3

Epirubicin 50 mg/m2 i.v d1

Anthracycline Cumulative Dose
PROTOKOL PERHITUNGAN

6xR-CHOP 6x50 mg/m2 = 300 mg/m2 doxorubicin

˷ 2/3 cumulative anthracycline

2xIVE 2x50 mg/m2 = 100 mg/m2 epirubicin

˷ 1/9 cumulative anthracycline

total 2/3 + 1/9 = 7/9 cumulative anthracyclin

dose
 Golongan Obat Kemoterapi

Agen Pengalkil Anti-Metabolit

Vinca Alkaloid
Cyclophosphamide Methotrexate (MTX)
Vincristine
Ifosfamide 5-Fluorouracil (5-FU)
Vinorelbine
Chlorambucil Cytarabine
Vinblastine
Dacarbazine Gemcitabine

Antibiotik
Taxane Platinum
Bleomycin
Paclitaxel Cisplatin
Doxorubicin
Docetaxel Carboplatin
Epirubicin
Cabazitaxel Oxaliplatin
Mitomycin

Hormonal
Analog
Tamoxifen
Camptothecin
Letrozole
Topotecan
Anastrozole
Irinotecan
Exemestane
Chemotherapy Toxicity/Side Effects
 Chemotherapy Toxicity/Side Effects (Cont.)
Neurologic
◦ CNS: cytarabine, methotrexate, ifosfamide
◦ Peripheral: paclitaxel, oxaliplatin, vincristine

Gastrointestinal
◦ Nausea and vomiting: cisplatin, doxorubicin, cyclophosphamide
◦ Mucositis: methotrexate, melphalan, etoposide, 5-FU

Pulmonary
◦ Methotrexate, bleomycin

Cardiovascular
◦ Anthracyclines
 Chemotherapy Toxicity/Side Effects (Cont.)
Hepatic
◦ busulfan

Metabolic
◦ Ifosfamide, cisplatin

Renal
◦ Hemorrhagic cystitis: cyclophosphamide, ifosfamide
◦ Renal failure: cisplatin

Dermatologic
◦ Hand-foot syndrome: 5-FU, capecitabine, cytarabine

Immune System
◦ Immunosuppression: fludarabine, cyclophosphamide, steroids
◦ Hypersensitivity: paclitaxel, asparaginase, bleomycin
 Chemotherapy Toxicity/Side Effects (Cont.)
Asparaginase
◦ Coagulation disorders
◦ Hyperlipidemia
◦ Hyperglycemia
◦ Pancreatitis

Etoposide
◦ Hypotension, flushing (infusion-related)

Irinotecan
◦ Acute and delayed diarrhea (SN-38 metabolite)
Myelosuppression
Nausea and Vomitting
 Nausea and Vomitting (Cont.)

Substance P Histamine

Emetic
Serotonin Endorphins
Reflex

GABA Acetylcholine

Dopamine