REVIEW ARTICLE Chemotherapy Administration Sequence

Figure Chemotherapy Sequencing Chart

Second
S Chemotherapy Agent Second Chemotherapy Agent Base Solutions

Paclitaxel (Abraxane)
Doxorubicin (Liposomal)
SEQUENCE

Dextrose 5% Water
Cyclophosphamide

Fluorouracil (5-FU)

Mechlorethamine

Lactated Ringers
Sodium Chloride
LEGEND

Bendamustine

Panitumumab
Dactinomycin

Temsirolimus
Bevacizumab

Methotrexate
Daunorubicin

Mitoxantrone

Trastuzumab
Streptozocin
Gemcitabine
Dacarbazine

Pemetrexed
Doxorubicin
PD= Pharmacodynamic/Efficacy

Fludarabine
Carmustine

Ixabepilone
Carboplatin

Pentostatin

Vinorelbine
Vinblastine
Leucovorin
Cetuximab

Cytarabine

Ifosfamide

Mitomycin
Bleomycin

Vincristine
Oxaliplatin

Topotecan
Melphalan

Rituximab
Epirubicin

Irinotecan
Docetaxel

Idarubicin
Etoposide

Paclitaxel
PK= Pharmacokinetic

Cisplatin
T= Toxicity

Mesna
ND= No difference

D
Bendamustine Bendamustine
B
B Bevacizumab Bevacizumab
B
B Bleomycin Bleomycin
B
T1, C2
C Carboplatin ND ND ND
N ND
T Carboplatin
C
C Carmustine Avoid PVC DHEP Carmustine
C
C Cetuximab Cetuximab
C
G1, C2 C1, I2 P1. C2 T1, C2
C Cisplatin ND ND
PD/T PD T T Cisplatin
C
C1, P2
C Cyclophosphamide T Cyclophosphamide
C
F1,C2
C Cytarabine PD Cytarabine
C
D Dacarbazine Dacarbazine
D
D Dactinomycin Dactinomycin
D
D Daunorubicin Daunorubicin
D
Dox 1 LD1-D2 I1, D2 D1, T2 D1, V2
D Docetaxel ND ND
T T
ND ND
T PK/T PK/T Avoid PVC DHEP Docetaxel
D
Dox 1 D1, P2
D Doxorubicin T
ND N
ND
PK/T Doxorubicin
D
LD1-D2 LD1-V2
D Doxorubicin (Liposomal) T
ND T Doxorubicin
D (Liposomal)
E1, P2
EEpirubicin ND
PK/T E
Epirubicin
<0.4 <0.4 <0.4
EEtoposide ND ND mg/ml mg/ml mg/ml E
Etoposide
F1,C2
FFludarabine PD F
Fludarabine
I1, F2 L1, F2
L1 F1, M2
FFluorouracil (5-FU) ND ND
PD/T P
PD PD Fluorouracil
F (5-FU)
G1, C2 P1. G2 P1, G2
GGemcitabine ND
PD/T
ND ND
PD/T PD/T Gemcitabine
G

First Chemotherapy Agent

First Chemotherapy Agent

IIdarubicin Idarubicin
I
I1, D2
IIfosfamide T
* Ifosfamide
C1, I2 I1, F2
Irinotecan PD PD/T
ND ND
N Irinotecan
Ixabepilone Avoid PVC DHEP Ixabepilone
I
L1, F2 M1, L2
LLeucovorin PD PD Leucovorin
L
Mechlorethamine
M Mechlorethamine
M
For
Melphalan
M < 1hr Melphalan
M
Mesna
M * Mesna
F1, M2 M1, L2
Methotrexate ND
PD P
PD Methotrexate
M
Mitomycin
M Mitomycin
M
Mitoxantrone
M Mitoxantrone
M
Flush lines Flush lines
Oxaliplatin
O ND with D5W with D5W Oxaliplatin
O
P1. C2 C1, P2 D1, P2 E1, P2 P1. G2
PPaclitaxel ND
T T PK/T PK/T
ND
PD/T Avoid PVC DHEP Paclitaxel
P
PPaclitaxel (Abraxane) ND Paclitaxel (Abraxane)
Panitumumab Panitumumab
P
P1, G2
PPemetrexed PD/T Pemetrexed
P
PPentostatin Pentostatin
P
R
Rituximab Rituximab
R
Streptozocin
S Streptozocin
S
T
Temsirolimus Avoid PVC DHEP TTemsirolimus
T1, C2 T1, C2 D1, T2
T
Topotecan T T PK/T
ND ND Topotecan
Trastuzumab TTrastuzumab
V
Vinblastine VVinblastine
V
Vincristine VVincristine
D1, V2 LD1-V2
V
Vinorelbine PK/T T VVinorelbine
BASE LEGEND
Doxorubicin (Liposomal)

*Follow published guidelines

Paclitaxel (Abraxane)

Dextrose 5% Water
Cyclophosphamide

Fluorouracil (5-FU)

Mechlorethamine

Lactated Ringers
Sodium Chloride
SAME DRUG LINE Y-SITE COMPATIBLE
Bendamustine

Panitumumab
Dactinomycin

THERAPEUTIC

Temsirolimus
Bevacizumab

Methotrexate
Daunorubicin

Mitoxantrone

Trastuzumab
Y-SITE

Streptozocin
Gemcitabine
Dacarbazine

Pemetrexed
DUPLICATION
Doxorubicin

Fludarabine
Carmustine

Ixabepilone
Carboplatin

Pentostatin
INCOMPATIBLE

Vinorelbine
Vinblastine
Leucovorin
Cetuximab

Cytarabine

Ifosfamide

Mitomycin
Bleomycin

Vincristine
Oxaliplatin

Topotecan
Melphalan

Rituximab
Epirubicin

Irinotecan
Docetaxel

Idarubicin
Etoposide

Y-SITE COMPATIBLE

Paclitaxel
VARIABLE
Cisplatin

Y-SITE INCOMPATIBLE
Mesna

NOT TESTED
NOT TESTED
B

Second Chemotherapy Agent Second

S Chemotherapy Agent Base Solutions

20 l Journal of Hematology Oncology Pharmacy l www.JHOPonline.com March 2011 l Vol 1, No 1 Vol 1, No 1 l March 2011 www.JHOPonline.com l Journal of Hematology Oncology Pharmacy 21
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