Nasopharyngeal carcinoma medical therapy: Difference between revisions

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==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with nasopharyngeal carcinoma, [disease subclass 2], and [disease subclass 3].
*Pharmacologic medical therapies for nasopharyngeal carcinoma include Cisplatin and 5-Fluorouracil.
*Pharmacologic medical therapies for nasopharyngeal carcinoma include (either) [therapy 1], [therapy 2], and/or [therapy 3].
*Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
*Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
Cisplatin


Standard dosage :The standard dose for use in nasopharyngeal carcinoma is 80 mg/m2 to 100 mg/m2,(slow intravenous) with good hydration. Repeat every 3 weeks.
* '''Cisplatin:'''
** Preferred regimen: 80- 100 mg/m<sup>2</sup>  slow IV with enough hydration.Repeat every 3 weeks
** Contraindications:
*** Hypersensitivity to platinum-containing compounds
*** Renal function impairment
*** Hearing impairment
*** Myelosuppressed patients
*** Nursing or pregnant women
** Side effects:
*** Nephrotoxicity
*** Ototoxicity
*** Myelosuppression
*** Gastrointestinal problems like acute and delayed nausea and vomiting and diarrhea
*** Electrolyte disturbance:
**** [[Hypomagnesemia]]
**** [[Hypocalcemia]]
**** [[Hyponatremia]]
**** [[Hypokalemia]]
**** [[Hypophosphatemia]]
*** Irreversible paresthesias
*** Anaphylaxis
'''Note (1):''' Urine output should be maintain more than 100-150 ml/ hr.


Contraindications: Contraindicated in patients with known hypersensitivity to platinum compounds,impaired renal function, impaired hearing, myelosuppression, and women who are
'''Note (2):''' Anti-emetic treatment should be done in all patients.


nursing or pregnant. Caution should be exercised when using other ototoxic and nephrotoxic drugs.
* '''5-Fluorouracil:'''
** Preferred regimen: 1000 mg/m<sup>2</sup>/day IV infusion for 4-5 days and repeated every 3 weeks.
** Contraindications:
*** Hypersensitivity
*** Liver diseases
*** Renal function impairment
*** Myelosuppressed patients
*** myelosuppression
*** Unstable angina
** Side effects:
*** Myelosuppression
*** Gastrointestinal problems like nausea and vomiting and diarrhea
*** Mucositis
*** Angina
*** Alopecia
*** Hand-foot syndrome


Main drug interactions: Ototoxicity increases when given with loop diuretics. Renal toxicity increases withaminoglycosides and decreases the effect of phenytoin.
* Main drug interactions: Not compatible with diazepam and droperidol.


Main side effects: Myelosuppression, dose dependency, severe acute and delayed nausea, cumulative renal toxicity, potassium and magnesium wasting, irreversible paresthesias,
* Main side effects: Myelosuppression, dose-dependent nausea and vomiting, mucositis, angina, alopecia, hand-foot syndrome, and diarrhea.
'''Note (1):''' In patients with liver disease dose reduction should be considered.


anaphylaxis, and ototoxicity.
'''Note (2):''' Using this drug in familial pyrimidenemia patients, can cause fatal neurotoxicity.


Special points: Cisplatin administration has to be done in a supervised setting and by persons familiar with chemotherapy drugs. Vigorous hydration is essential and attention


to electrolyte imbalance is important. Mannitol diuresis may be necessary. Maintain urine output at greater than 100 mL/hour to 150 mL/hour. Aggressive anti-emetic treatment is recommended.
*
 
**
5-Fluorouracil
 
Standard dosage: The standard dosage for nasopharyngeal carcinoma is 1000 mg/m2/day, continuous
 
infusion for 4 to 5 days. This dose is repeated every 3 weeks.
 
Contraindications: Contraindicated in patients with known hypersensitivity, hepatic and renal
 
diseases, myelosuppression, and unstable angina.
 
Main drug interactions: Not compatible with diazepam and droperidol.
 
Main side effects: Myelosuppression, dose-dependent nausea and vomiting, mucositis, angina, alopecia, hand-foot syndrome, and diarrhea.
 
Special points: Dose reduction is necessary in patients with liver disease. Avoid use in patients with familial pyrimidenemia, because it can lead to fatal neurotoxicity.
 
===Disease Name===
*'''1 Stage 1 - Name of stage'''
**1.1 '''Specific Organ system involved 1'''
***1.1.1 '''Adult'''
****Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)'''
****Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
****Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
****Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
***1.1.2 '''Pediatric'''
****1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
*****Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
*****Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
*****Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
*****Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
**1.2 '''Specific Organ system involved 2'''
***1.2.1 '''Adult'''
****Preferred regimen (1): [[drug name]] 500 mg PO q8h
***1.2.2  '''Pediatric'''
****Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
 
*2 '''Stage 2 - Name of stage'''
**2.1 '''Specific Organ system involved 1 '''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.1.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.1.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
**2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**:'''Note (1):'''
**:'''Note (2)''':
**:'''Note (3):'''
***2.2.1 '''Adult'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
*****Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
****Oral regimen
*****Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
*****Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
*****Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
*****Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days
*****Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
*****Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
***2.2.2 '''Pediatric'''
****Parenteral regimen
*****Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
*****Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
*****Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
****Oral regimen
*****Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
*****Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
*****Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
*****Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
*****Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 17:49, 18 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Homa Najafi, M.D.[2]Faizan Sheraz, M.D. [3]

Overview

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy, supplemented in some cases with chemotherapy.

Medical Therapy

The mainstay of therapy for nasopharyngeal carcinoma is external beam radiotherapy.

  • Standard treatments for patients with nasopharyngeal carcinoma include:[1]
    • External beam radiation therapy alone
    • Concurrent chemoradiation followed by adjuvant chemotherapy
    • Chemotherapy alone for metastatic disease
  • Undifferentiated subtype of nasopharyngeal carcinoma is highly radiosensitive

Treatment according to Stages
Stage Treatment

Stage 1

  • External beam radiation

Stage 2

  • Chemotherapy given with radiation therapy, followed by more chemotherapy
  • Radiation therapy to the tumor and lymph nodes in the neck

Stage 3

  • Chemotherapy given with radiation therapy, which may be followed by more chemotherapy
  • Radiation therapy
  • Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy

Stage 4

  • Chemotherapy given with radiation therapy, followed by more chemotherapy
  • Radiation therapy
  • Radiation therapy followed by surgery to remove cancer -containing lymph nodes in the neck that remain or come back after radiation therapy
  • Chemotherapy for cancer that has metastasized (spread) to other parts of the body

Medical Therapy

  • Pharmacologic medical therapies for nasopharyngeal carcinoma include Cisplatin and 5-Fluorouracil.
  • Cisplatin:
    • Preferred regimen: 80- 100 mg/m2 slow IV with enough hydration.Repeat every 3 weeks
    • Contraindications:
      • Hypersensitivity to platinum-containing compounds
      • Renal function impairment
      • Hearing impairment
      • Myelosuppressed patients
      • Nursing or pregnant women
    • Side effects:

Note (1): Urine output should be maintain more than 100-150 ml/ hr.

Note (2): Anti-emetic treatment should be done in all patients.

  • 5-Fluorouracil:
    • Preferred regimen: 1000 mg/m2/day IV infusion for 4-5 days and repeated every 3 weeks.
    • Contraindications:
      • Hypersensitivity
      • Liver diseases
      • Renal function impairment
      • Myelosuppressed patients
      • myelosuppression
      • Unstable angina
    • Side effects:
      • Myelosuppression
      • Gastrointestinal problems like nausea and vomiting and diarrhea
      • Mucositis
      • Angina
      • Alopecia
      • Hand-foot syndrome
  • Main drug interactions: Not compatible with diazepam and droperidol.
  • Main side effects: Myelosuppression, dose-dependent nausea and vomiting, mucositis, angina, alopecia, hand-foot syndrome, and diarrhea.

Note (1): In patients with liver disease dose reduction should be considered.

Note (2): Using this drug in familial pyrimidenemia patients, can cause fatal neurotoxicity.


References

  1. ↑ http://www.cancer.gov/types/head-and-neck/hp/nasopharyngeal-treatment-pdq#section/_50

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