108 年癌症治療藥物處方集 - kmsh.org.tw

Breast Cancer______________________________8
Lung Cancer_______________________________20
Hepatocellular carcinoma________________41
(Oral Cavity Cancer)
Neoadjuvant
PF (1)
Cisplatin 60±100 mg/ + N/S 500 mL IVD for 2-4 hrs on D1
5FU 600 ± 1000 mg/ + N/S 500 mL IVD for 12-24 hrs on
D1 ~ D4
TPF (2,3)
Taxotere 60-75 mg/ + N/S 250 mL IVD for 2 hrs on D1
Cisplatin 60-75 mg/+ N/S 250 mL IVD for 2-4 hrs on
D15FU 600-1000mg//day + N/S 500 mL for 12-24 hrs on
D1 ~ D4
operation or CCRT(in
locally advanced HNSCC)
PF (4)
Cisplatin 60±100 mg/ + N/S 500 mL IVD for 6-8 hrs on
D1
5FU 600±1000 mg/ + N/S 500 mL IVD for 12 hrs on D1
~ D4
weekly
x12months
CCRT
(1)Cisplatin 30-40mg/ + N/S 250 mL IVD for 2-4 hrs (7,8)
weekly
1,4,7th week (If Ccr< 60ml/min, use
carboplatin)
250mg/ IVD for 1hrs weekly (9)
weekly
2M
4
(Head and Neck Cancer) 108 4 9

Induction C/T
Cisplatin 60-100mg/ + N/S 500mL IVD for 6-8 hrs on D1
5FU600-1000 mg/ + N/S 500mL IVD for 12-24 hrs on D1~D4 Q3W- Q4W
TPF Q3W- Q4W (10)
Taxotere 60-75 mg/ + N/S 250mL IVD for 2 hrs on D1
Cisplatin 60-75 mg/ + N/S 500mL IVD for 6-8hrs on D1
5FU 600-1000 mg//day + N/S 500mL IVD for 12-24 hrs on
D1~D4
Q3W- Q4W
EPF Q3W- Q4W (11)
Erbitux 400 mg/ IVD for 2hrs in first week, then 250 mg/
IVD for 1hr weekly
Cisplatin 60-75 mg/ + N/S 500mL IVD for 6-8 hrs on D1
5FU 600-1000 mg//day + N/S 500mL IVD for 12-24 hrs on D1
~D4
ETPF Q3W- Q4W (12)
Erbitux 400 mg/ IVD for 2hrs in first week, then 250mg/
IVD for 1hr weekly
Taxotere 60-75 mg/ + N/S 250 mL IVD for 2 hrs on D1
5FU 600-1000 mg//day + N/S 500mL for 4 days on D1~D4
Q3W- Q4W

Cisplatin 30-40 mg/ + N/S 500mL IVD for 2-4 hrs (13)
weekly
Cisplatin 70-100 mg/ + N/S 500mL IVD for 6-8 hrs (14)
Q3W~Q4W
Bio-RT (15)
IVD for 1hr weekly
Cisplatin 30-40 mg/ + N/S 500mL IVD for 2-4 hrs weekly
IVD for 1hr weekly weekly
CCR<60 ml/min,
Cisplatin 60-100 mg/ + N/S 500mL IVD for 6-8hrs on D1
5FU 600-1000 mg/ + N/S 500mL IVD for 12-24 hrs on D1~D4 Q3W~Q4W
EPF Q3W~Q4W (18)
Erbitux 400 mg/ IVD for 2hrs in the first week, then 250 mg/
IVD for 1hr weekly
5FU 600-1000 mg/ + N/S 500mL IVD for 12-24 hrs on D1~D4
Q3W~Q4W
Methotrexate 30-40mg/ + N/S 250mL IVD for 2hrs IV weekly weekly
5-FU Q3W~Q4W (21)
5FU 1000 mg/ + N/S 500mL IVD for 12-24 hrs on D1~D4 Q3W~Q4W
Erbitux QW (22)
IVD for 1hr weekly weekly
UFUR QD (23)
Gemcitabine + vinorelbine Q3W (25)
Vinorelbine 25 mg/ + N/S 250mL IVD 30 min D1.D8
Gemcitabine 1,000 mg/ + N/S 250mL IVD for 30 min D1.D8 Q3W
Gemcitabine Q4W (26)
(NPC)
Gemcitabine 1,000 mg/+ N/S 250mL IVD for 30 min D1.8.15 Q4W

1.Bossi P, Lo Vullo S, Guzzo M, et al. Preoperative chemotherapy in advanced resectable OCSCC:long-term
results of a randomized phase III trial. Annals of oncology : official journal of the European Society for
Medical Oncology / ESMO 2014;25:462-6.
2.Lorch JH, Goloubeva O, Haddad RI, et al. Induction chemotherapy with cisplatin and fluorouracil alone or in
combination with docetaxel in locally advanced squamous-cell cancer of the head and neck: long-term results
6
of the TAX 324 randomised phase 3 trial. The lancet oncology 2011;12:153-9.
3.Zhong LP, Zhang CP, Ren GX, et al. Randomized phase III trial of induction chemotherapy with docetaxel,
cisplatin, and fluorouracil followed by surgery versus up-front surgery in locally advanced resectable oral
squamous cell carcinoma. Journal of clinical oncology : official journal of the American Society of Clinical
Oncology 2013;31:744-51.
4.Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus
cisplatin plus paclitaxel in advanced head and neck cancer (E1395): an intergroup trial of the Eastern
Cooperative Oncology Group. Journal of clinical oncology : official journal of the American Society of
Clinical Oncology 2005;23:3562-7.
5.Machiels JP, Haddad RI, Fayette J, et al. Afatinib versus methotrexate as second-line treatment in patients
with recurrent or metastatic squamous-cell carcinoma of the head and neck progressing on or after
platinum-based therapy (LUX-Head & Neck 1): an open-label, randomised phase 3 trial. The lancet oncology
2015;16:583-94.
6.Tsukahara K, Kubota A, Hasegawa Y, et al. Randomized phase III trial of adjuvant chemotherapy with S-1
after curative treatment in patients with squamous-cell carcinoma of the head and neck (ACTS-HNC). PloS
one 2015;10:e0116965.
7.Homma A, Inamura N, Oridate N, et al. Concomitant weekly cisplatin and radiotherapy for head and neck
cancer. Japanese journal of clinical oncology 2011;41:980-6.
8.Tsan DL, Lin CY, Kang CJ, et al. The comparison between weekly and three-weekly cisplatin delivered
concurrently with radiotherapy for patients with postoperative high-risk squamous cell carcinoma of the oral
cavity. Radiation oncology 2012;7:215.
9.Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and
neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced
rash and survival. The lancet oncology 2010;11:21-8.
10.Posner MR, Hershock DM, Blajman CR, et al. Cisplatin and fluorouracil alone or with docetaxel in head and
neck cancer. N Engl J Med 2007;357(17):1705-1715.
11.Vermorken JB, Mesia R, Rivera F. Platinum based chemotherapy plus cetuximab in head and neck cancer. N
Engl J Med. 2008;359:1116–1127.
12.Benoist Chibaudel, Roger Lacave, Marine Lefevre. Induction therapy with cetuximab plus docetaxel,
cisplatin, and 5-fluorouracil (ETPF) in patients with resectable nonmetastatic stage III or IV squamous cell
carcinoma of the oropharynx. A GERCOR phase II ECHO-07 study. Cancer Med. 2015 May; 4(5): 721–731.
13.Beckmann GK, Hoppe F, Pfreundner L, et al. Hyperfractionated accelerated radiotherapy in combination
with weekly cisplatin for locally advanced head and neck cancer. Head Neck 2005;27:36-43.
14.Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three
nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin
Oncol 2013;31:845-852.
15.Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for locoregionally advanced head and
neck cancer: 5-year survival data from a phase 3 randomised trial, and relation between cetuximab-induced
rash and survival. Lancet Oncol 2010;11:21-28.
16.Harari PM, Harris J, Kies MS, et al. Postoperative Chemoradiotherapy and Cetuximab for
High-Risk Squamous Cell Carcinoma of the Head and Neck: Radiation Therapy Oncology Group RTOG-0234.
J Clin Oncol. 2014 Aug 10;32(23):2486-95.
17.Gibson MK, Li Y, Murphy B, et al. Randomized phase III evaluation of cisplatin plus fluorouracil versus
7
cisplatin plus paclitaxel in advanced head and neck cancer (E1395): An Intergroup Trial of the Eastern
Cooperative Oncology Group. J Clin Oncol 2005;23:3562-3567.
18.Vermorken JB, Mesia R, Rivera F, et al. Platinum-based chemotherapy plus cetuximab in head and neck
cancer. N Engl J Med 2008;359:1116-1127.
19.Forastiere AA, Metch B, Schuller DE, et al. Randomized comparison of cisplatin plus flurouracil and
carboplatin plus fluorouracil versus methotrexate in advanced squamous cell carcinoma of the head and neck:
A Southwest Oncology Group Study. J Clin Oncol. 1992;10:1245–1251.
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for recurrent squamous cell carcinoma of the head and neck [corrected]. J Clin Oncol. 2009:27:1864–1 871.
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as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol.
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22.Vermorken JB, Trigo J, Hitt R, et al. Open-label, uncontrolled, multicenter phase II study to evaluate the
efficacy and toxicity of cetuximab as a single agent in patients with recurrent and/or metastatic squamous cell
carcinoma of the head and neck who failed to respond to
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23.Tsukahara K, Kubota A, Hasegawa Y, et al. Randomized phase III trial of adjuvant chemotherapy with S-1
after curative treatment in patients with squamous-cell carcinoma of the head and neck (ACTS-HNC). PLoS
One. 2015 Feb 11;10(2):e0116965.
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protocols in metastatic nasopharyngeal carcinoma. J Cancer Res Clin Oncol. 2012;138(10):1717–25.
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metastatic nasopharyngeal carcinoma pretreated with platinum-based chemotherapy. Oral Oncol.
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advanced nasopharyngeal carcinoma after the failure of platinum-based chemotherapy. Cancer Chemother
Pharmacol. 2008; 61:33–38. Epub 2007 Mar 20.
8
Breast Cancer
1. EC (7,10,64)
Epirubicin ( Pharmorubicin ): 75-90 mg/m² IVD day1 in N/S or 5% Glucose 250ml
Cyclophosphamide ( Endoxan ): 500-600 mg/m² IVD day1 in N/S 250ml
Cycles every 21 days for 4~6 cycles
2. EC +T (3,4,64)
Cycles every 21 days for 4 cycles
Followed by
Docetaxel ( Taxotere ): 75-90 mg/m² IVD day1 in N/S 250ml
3. LC (6,64)
Liposomal Doxorubicin ( Lipo-Dox ): 30-35 mg/m² IVD day1 in 5% Glucose 250ml
Cycles every 21 days for for 4~6 cycles
4. LC +T (3,4,64)
Followed by
5. TC (8,64)
Cycles every 21 days for 4~6 cycles
With Target therapy for HER2-positive
1. EC + Trastuzumab ( Herceptin ) (11,12,13,14,16,17,51,53,54,55,56,58,64)
concurrent or sequential use with
Trastuzumab 8mg/kg IVD week 1Followed by Trastuzuma 6mg/kg IVD every 3 weeks to complete 1
9
or
Trastuzumab 4mg/kg IVD week 1Followed by Trastuzuma 2mg/kg IVD weekly to complete 1 year in
N/S 250ml
Trastuzumab SC 600mg/5mL/Vial every 3 weeks to complete 1 year
2. EC followed by T with Trastuzumab ( Herceptin ) (6,14,17,53,54,58,61,64)
Followed by
Trastuzumab 8mg/kg IVD in N/S 250ml with first dose of Docetaxel ( Taxotere ) in N/S 250ml
Followed by 6mg/kg IVD every 3 weeks to complete 1 year
or
Followed by 2mg/kg IVD weekly
or
3. Any neo-adjuvant regimen with Trastuzumab (Herceptin) (11,12,13,14,16,17,51,53,54,56,58,64)
Any neo-adjuvant regimen
Trastuzumab 8mg/kg IVD week 1Followed by Trastuzumab ( Herceptin ) 6mg/kg IVD every 3 weeks
to complete 1 year in N/S 250ml
or
Trastuzumab 4mg/kg IVD Followed by Trastuzumab ( Herceptin )2mg/kg IVD weekly to complete 1
year in N/S 250ml
4. EC followed by T+ Trastuzumab (Herceptin) ± Pertuzumab ( Perjeta ) (dose as
adjuvant) (6,14,17,53,54,58,61,64)
EC/LC Cycles every 21 days for 3 or 4 cycles
Followed by
Docetaxel ( Taxotere )/Paclitaxel( Taxol ) (dose as adjuvant) Cycles every 21 days for 4 cycles
Trastuzumab 8mg/kg IVD day1 in N/S 250ml Followed by 6mg/kg IVD every 3 weeks to complete 1
year
10
or
And/or
Pertuzumab ( Perjeta )840mg IVDday1 in N/S 250ml Followed by420mg IVD every 3 weeks to
complete 1 year
(dose as adjuvant) (14,15,61,64)
adjuvant) (14,15,61,64)
Adjuvant

1. EC (7,10,64)
2. EC +T (3,4,64)
Followed by
3. LC (6,64)
4. LC +T (3,4,64)
Followed by
5. TC (8,64)
11
Epirubicin ( Pharmorubicin ): 75-90 mg/m² IVD day1 in N/S 250ml
year in N/S 250ml
or
N/S 250ml
2. LC + Trastuzumab ( Herceptin ) (11,12,13,14,16,17,51,53,54,55,56,58,64)
Liposomal Doxorubicin ( Lipo-Dox ): 30-35 mg/m² IVD day1 in 5%Glucose 250ml
year in N/S 250ml
or
N/S 250ml
3. EC followed by T with Trastuzumab ( Herceptin ) (6,14,17,53,54,58,61,64)
Epirubicin ( Pharmorubicin ): 75-90 mg/m² IVD day1 in N/S 250ml
Followed by
Followed by 6mg/kg IVD every 3 weeks to complete 1 year
or
Followed by 2mg/kg IVD weekly
or
4. Any neo-adjuvant regimen with Trastuzumab (Herceptin) (11,12,13,14,16,17,51,53,54,56,58,64)
12
Trastuzumab 8mg/kg IVD week 1Followed by Trastuzumab ( Herceptin ) 6mg/kg IVD every 3 weeks
to complete 1 year in N/S 250ml
or
Trastuzumab 4mg/kg IVD Followed by Trastuzumab ( Herceptin )2mg/kg IVD weekly to complete 1
year in N/S 250ml
5. EC/LC followed by T+ Trastuzumab (Herceptin) ± Pertuzumab ( Perjeta ) (dose as
adjuvant) (6,14,17,53,54,58,61,64)
EC/LC Cycles every 21 days for 3 or 4 cycles
Followed by
Docetaxel ( Taxotere )/Paclitaxel( Taxol ) (dose as adjuvant) Cycles every 21 days for 4 cycles
Trastuzumab 8mg/kg IVD day1 in N/S 250ml Followed by 6mg/kg IVD every 3 weeks to complete 1
year
or
And/or
Pertuzumab ( Perjeta )840mg IVDday1 in N/S 250ml Followed by420mg IVD every 3 weeks to
complete 1 year
(dose as adjuvant) (14,15,61,64)
adjuvant) (14,15,61,64)
Recurrent or Metastatic breast cancer

1. EC (6.18,64)
Cycles every 21 days
2. LC (6.18,64)
Cycles every 21 days
Single Agent
1. Epirubicin (20,64)
: 75-90 mg/m² IVD day1 Cycle every 21 days in N/S or 5% Glucose 250ml
2. Lipo-dox (6,64)
: 30-35 mg/m² IVD day1 Cycle every 21 days in 5% Glucose 250ml
13
3. Paclitaxel ( Taxol ) (21,22,64)
: 175 mg/m² IVD day1 Cycle every 21 days in N/S 250ml
or
Paclitaxel ( Taxol ): 80 mg/m² IVD weekly in N/S 250ml
4. Docetaxel ( Taxotere ) (27,28,29,64)
: 75-100 mg/m² IVD day1 Cycle every 21 days in N/S 250ml
or
Docetaxel ( Taxotere ): 20-40 mg/m² IVD weekly in N/S 150ml
5. Vinorelbine ( Navelbine ) (23,64)
: 25-35 mg/m² IVD in N/S 50ml for 30 mins or po 60mg/m² weekly
6. Capecitabine ( Xeloda )500mg/tab (22,64)
: 800-1000 mg/m² po twice daily days1-14 Cycles every
21days
7. Gemcitatabine ( Gemzar ) (25,64)
: 800-1200 mg/m² IVD day1,8 Cycle every 21 days in N/S 250ml
8. Eribulin ( Halaven ) (26,64)
: 1.4 mg/m² IVD day1,8 Cycle every 21 days in N/S 50ml for 5-15mins
9.Cisplatin (30,31,64)
:75 mg/m² IVD day1Cycle every 21 days in N/S 500ml
10.Carboplatin (30,31,64)
:AUC of 2 IVD day1,8 & 15 Cycle every 28 days in N/S 500ml
Other Combinations
Paclitaxel ( Taxol ): 175 mg/m² IVD day1 in N/S 250ml
Gemcitabine ( Gemzar ): 1000 mg/m² IVD day1 in N/S 250ml
Cycle every 21 days
2. P+G weekly
Gemcitabine ( Gemzar): 800 mg/m² IVD day1 in N/S 250ml
Cycle every 21 days
3. T+G (34,64)
Docetaxel ( Taxotere ): 75 mg/m² IVD day1 in N/S 250ml
Gemcitabine ( Gemzar ): 800~1000 mg/m² IVD day1 in N/S 250ml
Cycle every 21 days
4. T+C (21,22,32,64)
Docetaxel ( Taxotere ): 75 mg/m² IVD day1 in N/S 250ml
Cycle every 21 days
5. G+Cis or G+Car: Gemcitabine/Cisplatin or Gemcitabine/Carboplatin (35,64)
Gemcitatabine ( Gemzar ): 800-1200 mg/m² IVD day1&8 in N/S 250ml
Cisplatin (30,31,64)
:75 mg/m² IVD day1Cycle every 21 days in N/S 500ml
or
Carboplatin (30,31,64)
: AUC of 2 IVD day1,8 & 15 Cycle every 28 days in N/S 500ml Cycle every 21
days
14
: 5-10mg/kg IVD day1 Cycle every 21 days in N/S 250ml
For HER2-positive disease
Capecitabine ( Xeloda ) 500mg/tab1000-1250 mg po bid twice daily Days1-14
Lapatinib ( Tykerb) 250mg/tab1250mg po daily Days1-21
2. Trastuzumab ( Herceptin ) + Capecitabine( Xeloda ) (41,39,46,47,64)
Capecitabine1000 mg po bid twice daily Days1-14
Trastuzumab 8mg/kg with first dose in N/S 250ml Followed by 6mg/kg IVD every 3 weeks to
complete 1 year
or
Trastuzumab 4mg/kg with first dose in N/S 250ml Followed by 2mg/kg IVD weekly
or
Lapatinib( Tykerb)1000 mg po daily
Trastuzumab 8mg/kg IVD day1in N/S 250ml Followed by 6mg/kg IVD every 3 weeks
or
Trastuzumab 4mg/kg IVD in N/S 250ml Followed by 2mg/kg IVD weekly
or
4. Pertuzumab ( Perjeta ) + Trastuzumab ( Herceptin ) + any other regimes (48,49,64)
Pertuzumab 840mg IVD day1 in N/S250mlFollowed by 420mg IVD every 3wweks
Trastuzumab 8mg/kg day1 in N/S 250ml Followed by 6mg/kg IVD every 3 weeks
or
Followed by any other regimes
5. EC/LC/TC followed by T + concurrent or sequential use with trastuzumab ( Herceptin ) ±
Pertuzumab ( Perjeta ) (6,53,54,57,58,59,61,64)
6. TCH ± Pertuzumab (48,49,50,64)
Docetaxel ( Taxotere ): 60~75 mg/m² IVD day1 in N/S 250ml
Carboplatin ( Kemocarb ): AUC of 2 IVD day1,8 & 15 Cycle every 28 days
Trastuzumab ( Herceptin ): 6mg/kg q3wk
Trastuzumab ( Herceptin ): 4mg/kg with first dose then 2mg/kg
or
15

1. Levine MN, Bramwell VH, Pritchard KI, et al: Randomized trial of intensive cyclophosphamide,
epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in
premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials
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2. Martin, Pienkowski T, Mackey J, et al: Adjuvant docetaxel for node-positive breast cancer. N
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phase III trial of pegylated liposomal doxorubicin HCl (CAELYX/Doxil) versus conventional
doxorubicin for first-line treatment of metastatic breast cancer. Ann Oncol 2004;15:440-449.
7. Citron ML, Berry DA, Cirrincione C, et al: Randomized trial of dose-dense versus
conventionally scheduled and sequential versus concurrent combination chemotherapy as
postoperative adjuvant treatment of node-positive primary breast cancer: First report of
intergroup trial C9741/cancer and leukemia group B trial 9741. J Clin Oncol 2003;
21:1431-1439.
8. Jones S, Holmes F, O’Shaughnessey J, et al. Docetaxel with cyclophosphamide is associated
with an overall survival benefit compared with doxorubicin and cyclophosphamide: 7-year
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9. Buzdar AU, Kau SW, Smith TL, Hortobagyi GN. Ten-year results of FAC adjuvant
8. Ado-trastuzumab emtansine ( T-DM1 ) (51,64)
Ado-trastuzumab emtansine 3.6mg/kg IVD day1 in N/S250ml every 3 weeks

1. Tamoxifen ( Nolvadex ):10mg POBID
2. Letrozole ( Femara ):2.5mg POQD
3. Exemestane ( Aromasin ):25mg POQD
4. Fulvestrant ( Faslodex ):250mg IM(500 mg-Q2W /1 st month500 mg-Q1M /2
nd month)
6. Leuprorelin ( Leuplin Depot ):3.75mg SCQM or Q3M
7.CDK4/6 inhibitor (64)
:
IBRANCE (palbociclib) 125mg POQD 3 1 or
Kisqali (ribociclib) 200mg/1#600mg POQD 3 1 or
Verzenio (abemaciclib) 50mg/1#150mg~200mg POBID ± Femara or Fulvestrant
8. Everolimus (Afinitor)10mg po qd + Exemestane (Aromasin)25mg po qd
16
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node-positive breast cancer. J Clin Oncol 2001;19:3103-3110.
11. Romond EH, Perez EZ, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable
HER2 positive breast cancer. N Engl J Med 2005;353:1673-1684.
12. Dang C, Fornier M, Sugarman S, et al: The safety of dose-dense doxorubicin and
cyclophosphamide followed by paclitaxel with trastuzumab in HER-2/neu
overexpressed/amplified breast cancer. J Clin Oncol 2008;26(8):1216-22.
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in patients with HER2-amplified early stage breast cancer: a singlegroup, open-label, phase 2
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20
Gemcitabine (Gemzar ® )
Gemcitabine (Gemzar ®
) 1000mg/ D1,D8,D15
)1000mg/ D1,D8,D15
Vinorelbine (Navelbine ® )
Vinorelbine (Navelbine ®
Q28days 4-6 cycles CCr60
Paclitaxel (Intaxel)
Paclitaxel 60-100mg/ D1,D8,D15
Docetaxel (Taxotere ® )
Docetaxel (Taxotere® ) 30-35mg/ D1,D8,D15
+Cisplatin 60-75mg/ D1 (6)
Docetaxel (Taxotere ® ) 30-35mg/ D1,D8,D15
Docetaxel (Taxotere ® ) 60-75mg/ m
Pemetrexed (Alimta ® )
21

Adjuvant
) 1000mg/ D1,D8,D15
)1000mg/ D1,D8,D15
Vinorelbine (Navelbine ® )
80mg/m2
IIIIIA
22
Pemetrexed (Alimta ® ) 500mg/ m

Crizotinib(Xalkori)250mg Bid ALK
200 mg BID
Indication: Adeno, pT2
years
Metastasis
) 1000mg/ D1,D8,D15
)1000mg/ D1,D8,D15
Vinorelbine (Navelbine® )
IIIIIA
Paclitaxel 60-100mg/ D1,D8,D15 Q28days 4-6 cycles CCr60
23
Pemetrexed (Alimta® )
Pemetrexed (Alimta ® ) 500mg/ m

Crizotinib(Xalkori)250mg Bid ALK
200 mg BID
Indication: Adeno, pT2
years
24
Etoposide(VP-16) 100 mg/m2 D1-D3
+Cisplatin 60-75mg/m2 D1 (12)
Etoposide(VP-16) 100 mg/m2 D1-D3
Q21-28 days 6 cycles Ccr60
Topotecan(Hycamtin® )1.5mg/m 2

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26
+[ Cisplatin 30 mg/m 2 + N/S 500ml keep 2hrs] Q1Week
(if CCr < 60 ml/min, Cisplatin [Carboplatin ((CCr+25)x3~5mg) + N/S 500ml keep 2hrs]
Q3Week )
CCRT[4]
[5-FU (200mg/m 2 /day x1~5days) + N/S 250ml keep1~5days+ Bloodlet(Calcium
folinate15mg) 2# PO Bid×1~5days] Q1Week+[Cisplatin 25mg/m 2
+ N/S 500ml keep 2hrs]
Q1Week
Q3Week )
Combined with Platium/5FU [7, 8,9]
[Taxotere ( 40 mg/m 2 ) + N/S 250ml keep 2hrs ]+ [Cisplatin (30 mg/m
2 ) + N/S 500ml keep
2 + N/S 250ml keep 24hrs ] Q2Week
[Paclitaxol(70 mg/m 2 ) + N/S 250ml keep 2hrs ]+ [Cisplatin (30
mg/m
2 + N/S 250ml keep 24hrs ] Q2Week
Q2Week )
Single Irinotican [6]
Irinotican (Campto) (150~180mg/ m 2 ) + N/S 250ml keep 2hrs Q2week
Combine Platium [10]
[Irinotican (Campto) (150~180mg/m 2 ) + N/S 250ml keep 2hrs]+ [Cisplatin(30 mg/m
2 ) + N/S
500ml keep 2hrs] Q2week
Q2Week )
27

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28
Gastric cancer
High risk group :With lymph node(+) or T3(+)or ECOG performance status 0-2
Neo-adjuvant chemotherapy
1. TS-1 ± R/T :
TS-1 40-60mg PO BID x 14 days, 7 days off Cycled every 6 weeks
2. Xeloda ± R/T :
Capecitabine 850-1000 mg/m 2 PO BID x 14 days, 7 days off Cycled every 3 weeks
3. UFUR ± R/T :
4. XELOX ± R/T :
Oxaliplatin130 mg/m 2 in 5%G/W 250 ml IVD 2hrs.
Capecitabine 850-1000 mg/m 2 PO BID x 14 days, 7 days off
Cycled every 3 weeks
5. FOLFOX4 ± R/T :
Oxaliplatin 85 mg/m 2 in 5%G/W 250 ml IVD 2hrs.
Leucovorin200mg/m 2 inN/S 250ml IVD 2hrs on Day 1 and Day 2
Day 1 Oxaliplatin Day 2 5-FU 400 mg/m 2
5-FU400mg/m 2 inN/S 250ml IVD 2hrs on Day 1 and Day 2
5-FU 600mg/m 2 in N/S500ml IVD 22hrs onDay 1 and Day 2
Adjuvant chemotherapy
1. FOLFOX4:
5-FU400mg/m 2 inN/S 250ml IVD 2hrs on Day 1 and Day 2
2. XELOX:
3. UFUR:
29
4. TS-1 TNM Stage II( T1)IIIA IIIB
Metastatic/Locally Advanced/Recurrent chemotherapy
2 in 5%G/W 250 ml IVD 2hrs.
5-FU400mg/m 2 in N/S 250ml IVD 2hrs on Day 1 and Day 2
2. XELOX
Oxaliplatin130 mg/m 2 in 5%G/w 250 ml IVD 2hrs.
3. UFUR
Tegafur 200-400 mg PO BID.
Tegafur 100-200 mg PO TID.
4. TS-1 TNM Stage II( T1)IIIA IIIB
6. DCF:
Cisplatin 75 mg/m 2 inN/S500ml IVD 4hrs Day1
5-FU 750 mg/m 2 in N/S500ml IVD 24hrs onDay 1-5
Q3 weeks x8 cycles
Cisplatin 60 mg/m 2 inN/S500ml IVD 4hrs
5-FU 200 mg/m 2 in N/S500ml IVD 24hrs onDays 1-21
Cycled every 21 days
5-FU 200 mg/m 2 in N/S500ml IVD 24hrs onDays 1-21
9. ECX:
Epirubicin 50 mg/m 2 inN/S 250ml IVD 2hrs on Day 1
Cisplatin 60 mg/m 2 inN/S500ml IVD 4hrs Day 1
Capecitabine625 mg/m 2 PO BID Day 1-21
10. EOX:
Epirubicin 50 mg/m 2 inN/S 250ml IVD 2hrs on Day 1
Capecitabine625 mg/m 2 PO BID Day 1-21
11. FLO:
Oxaliplatin 85 mg/m 2 in 5%G/w 250 ml IVD 2hrs on Day 1
Leucovorin200mg/m 2 inN/S 250ml IVD 2hrs on Day 1
5-FU 2600mg/m 2 in N/S1000ml IVD 24hrs on Day 1
12. Taxane
Docetaxel 75-100 mg/m 2 inN/S 250ml IVD 1hr Cycled every 21 days
Paclitaxel 135-250 mg/m 2 inN/S 250ml IVD 1hr Cycled every 21 days
Paclitaxel 80 mg/m 2 inN/S 250ml IVD 1hr weekly Cycled every 28 days
Paclitaxel 80 mg/m 2 inN/S 250ml IVD 1hr on Days 1, 8, and 15 Cycled every 28 days
13. Irinotecan
Irinotecan 250–350 mg/m 2 IVD on Day 1 Cycled every 21 days
Irinotecan 150–180 mg/m 2 IVD on Day 1 Cycled every 14 days
Irinotecan 125 mg/m 2 IVD on Days 1 and 8 Cycled every 21 days
14. FOLFIRI Irinotecan 180 mg/m
2 in N/S500 ml IVD 2hrs
Leucovorin 400mg/m 2 inN/S 250ml IVD 2hrsIrinotecan Leucovorin
5-FU400mg/m 2 in N/S 250ml IVD 2hrs
5-FU 2400 mg/m 2 in N/S500ml IVD keep 46hrs
Repeat every 2 weeks
1. Ramucirumab
Ramucirumab 8 mg/kg IVD in N/S 250ml IVD 1hr Cycled every 14 days
2. Ramucirumab and Paclitaxel
Ramucirumab 8 mg/kg IVD in N/S 250ml IVD 1hr on Days 1 and 15
Paclitaxel 80 mg/m 2 inN/S 250ml IVD 1hr on Days 1, 8, and 15 Cycled every 28 days
31
3. Trastuzumab (with chemotherapy) HER2: IHC 3+or IHC 2+ and FISH(+)
Trastuzumab is not recommended for use with anthracyclines
Trastuzumab 8mg/kg IVD loading dose on Day 1 of cycle 1, then Trastuzumab 6mg/kg IVD every 21
days
Trastuzumab 6mg/kg IVD loading dose on Day 1 of cycle 1, then Trastuzumab 4mg/kg IVD every 14
days
1. Cycles 1, 3, and 4 (before and after radiation)
Leucovorin20mg/m 2 IV Push on Days 1-5
5-FU 425 mg/m 2 IV Push daily on Days 1-5
Cycles 2 (with radiation)
Leucovorin20mg/m 2 IV Push on Days 1-4 and 31-33
5-FU 425 mg/m 2 IV Push daily on Days 1-4 and 31-33
35-day cycle
Capecitabine750-1000 mg/m 2 PO BID Day 1-14
Leucovorin 400mg/m 2 IVD on Days 1 and 15 OR Days 1, 2, and 15, and 16
5-FU 400mg/m 2 IV Push on Days 1 and 15 OR Days 1, 2, and 15, and 16
5-FU 600mg/m 2 IVD over 22 hours daily on Days 1, 2, 15, and 16
With radiation
5-FU 200-250 mg/m 2 IVD over 24 hours daily on Days 1-5 or 1-7
Weekly for 5 weeks
Capecitabine625-825 mg/m 2 PO BID on Days 1-5 or 1-7
Weekly for 5 weeks
Tegafur 200-400 mg PO BID on Days 1-5 or 1-7
Weekly for 5 weeks
Tegafur 100-200 mg PO TID on Days 1-5 or 1-7
Weekly for 5 weeks
Immuno-oncology 8 (Metastatic/Locally Advanced/Recurrent)
1. Pembrolizumab (Keytruda ® ) 200mg IV on Day 1 Cycled every 21 Days
32

1. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus
surgery alone for resectablegastroesophageal cancer. N Engl J Med 2006;355:11-20.
2. Sumpter K, Harper-Wynne C, Cunningham D, et al. Report of two protocol planned
interim analyses in a randomized multicentre phase III study comparing capecitabine with fluorouracil and
oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer
2005;92:1976-1983.
3. Ychou M, Boige V, Pignon J-P, et al. Perioperative chemotherapy compared with
surgery alone for resectablegastroesophageal adenocarcinoma: an FNCLCC and FFCD multicenter phase III
trial. J ClinOncol 2011;29:1715-1721.
4. Guimbaud R, Louvet C, Ries P, et al. Prospective, Randomized, Multicenter, Phase
III Study of Fluorouracil,Leucovorin, and Irinotecan Versus Epirubicin,
Cisplatin,andCapecitabine in Advanced Gastric Adenocarcinoma: A French
Intergroup (Fédération Francophone de Cancérologie Digestive, Fédération
Nationale des Centres de LutteContre le Cancer, and GroupeCoopérateur
Multidisciplinaire en Oncologie) Study. J ClinOnc 2014;32:3520-3526.
5. Sasako M, Sakuramoto S, Katai H, et al. Five-Year Outcomes of a Randomized
Phase III Trial Comparing Adjuvant Chemotherapy With S-1 Versus Surgery Alone in Stage II or III Gastric
Cancer. J ClinOncol 2011; 29:4387-4393.
6. Sakuramoto S, Sasako M, Yamaguchi T, et al. Adjuvant Chemotherapy for Gastric
Cancer with S-1, an Oral Fluoropyrimidine. The NEW ENGLAND JOURNAL of MEDICINE 2007;
357:1810-1820.
7. Hironaka S, Ueda S, Yasui H, et al. Randomized, openlabel, phase study comparing irinotecan with
paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior
combination chemotherapy using fluoropyrimidine plus platinum: WJOG 4007 trial. J ClinOncol 2013;
31:4438-4444.
33
Colon cancer and Rectum Cancer
Neo-adjuvant chemotherapy (T3 or N+ in rectal cancer or T4 in colon cancer)
1. FOLFOX4 1 ± R/T
Leucovorin 200 mg/m 2 in N/S 250 ml IVD 2hrs on Day 1 and Day 2
5-FU 400 mg/m 2 in N/S 250 ml IVD 2hrs on Day 1 and Day 2
2. XELOX 7 ± R/T
3. Xeloda 3 ± R/T
4. UFUR 23
5. mFOLFOX6 1,2,3
± R/T
Leucovorin 400 mg/m 2 in N/S 250ml IVD 2hrs
5-FU 400 mg/m 2 in N/S 250 ml IVD 2hrs
5-FU 2400 mg/m 2 in N/S 500 ml IVD keep 46hrs
Adjuvant chemotherapy
1. 5-FU/leucovorin-5-FU/LV (sLV5FU2)
Leucovorin 400 mg/m 2 in N/S 250 ml IVD 2hrs
Repeat every 2 weeks.
3. Xeloda 3
( T3, N0, M0, Stage II At high-risk feature for systemic recurrence or T4, N0, M0)
3. Xeloda 3(stage II )
4. FOLFOX4 1(stage II )
5-FU 400 mg/m 2 in N/S 250ml IVD 2hrs on Day 1 and Day 2
5-FU 600 mg/m 2 in N/S 500ml IVD 22hrs on Day 1 and Day 2
5. mFOLFOX6 1,2,3(stage II )
Leucovorin 400 mg/m 2 in N/S 250ml IVD 2hrs
6. XELOX 7(stage II )
35
1. FOLFOX4 1
2. mFOLFOX6 1,2,3
3. Xeloda 3
6. XELOX 7
1. FOLFOX4 1
2. mFOLFOX6 1,2,3
3. FOLFIRI 8,9
Irinotecan 180 mg/m 2 IV in N/S 500 ml IVD 2hrs
Leucovorin 400 mg/m 2 in N/S 250 ml IVD 2hrsIrinotecan Leucovorin
4. XELOX 7
Oxaliplatin 130 mg/m 2 in 5%G/w 250 ml IVD 2hrs.
5. Xeloda 3
6. UFUR 23
7. FOLFOXIRI 16
in N/S 500 ml IVD 2hrs Day 1,
Oxaliplatin 85 mg/ m 2 in 5%G/W 250 ml IVD 2hrs Day 1,
37
Leucovorin 400 mg/m 2 in N/S 250 ml IVD 2hrs 2hrs Day 1, (Oxaliplatin Leucovorin )
8. Trifluridine + tipiracil (Lonsurf) 22
Trifluridine + tipiracil 35 mg/m
2 up to a maximum dose of 80 mg per
dose (base on the trifluridine component) PO twice daily on days 1-5 and 8-12 repeat every 28 days
(With Target therapy)
1. FOLFOX + bevacizumab4
Bevacizumab 5 mg/kg IVD, Day 1 Repeat every 2 weeks
2. FOLFOX + Cetuximab 6 (RAS WT only)
Cetuximab 400 mg/m 2 IVD over 2 hours first infusion,
then 250 mg/m 2 IVD over 60 minutes weekly
11
or Cetuximab 500 mg/m 2 IVD over 2 hours, Day 1, every 2 weeks
12
3. FOLFOX + panitumumab 5 (RAS WT only)
Panitumumab 6 mg/kg IVD over 60 minutes, Day 1 Repeat every 2 weeks
4. FOLFIRI + bevacizumab 10
5. FOLFIRI + cetuximab (RAS WT only) Cetuximab 400 mg/m
2 IVD over 2 hours first infusion, then 250 mg/m
2 IVD over 60 minutes
weekly 11
2 IVD over 2 hours, Day 1, every 2 weeks
12
(RAS WT only)
Panitumumab 6 mg/kg IVD over 60 minutes, Day 1 Repeat every 2 weeks
7. FOLFIRI + ziv-aflibercept 14
(only with FOLFIRI)
Ziv-aflibercept 4 mg/kg IVD over 60 minutes, Day 1 Repeat every 2 weeks
8. FOLFIRI + ramucirumab 15
Ramucirumab 8 mg/kg IVD over 60 minutes, Day 1 Repeat every 2 weeks
9. FOLFOXIRI + bevacizumab 17
10. Cetuximab (RAS WT only) Cetuximab 400 mg/m
2 first infusion, then 250 mg/m
2 IVD weekly
25
or Cetuximab 500 mg/m 2 IVD over 2 hours, Day 1, every 2 weeks
12
38
11. Panitumumab 19
(RAS WT only) Panitumumab 6 mg/kg IVD over 60 minutes every 2 weeks
12. Regorafenib 20
(Stivarga) Regorafenib 160 mg PO daily days 1–21 Repeat every 28 days
or
First cycle: Regorafenib 80 mg PO daily on days 1-7,then 120 mg PO daily on days 8-14, then 160 mg PO
daily on days 15-21
Subsequent cycles: Regorafenib 160 mg PO daily on days 1-21
Repeat every 28 days
2. XRT+ Xeloda
3. XRT+ continuous infusion 5-FU
5-FU 225 mg/m 2 over 24 hours 5 or 7 days/week during XRT
4. XRT+5-FU/Leucovorin
5-FU 400mg/m 2
IV bolus + Leucovorin 20 mg/m 2 IV bolus for 4 days during week 1 and 5 of XRT

1. deGramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as
first-line treatment in advanced rectal cancer. J Clin Oncol 2000;18:2938-2947.
2. Cheeseman SL, Joel SP, Chester JD, et al. A ‘modified de Gramont’ regimen of fluorouracil, alone and
with oxaliplatin, for advanced colorectal cancer. Br J Cancer 2002;87:393-399.
3. Maindrault-Goebel F, deGramont A, Louvet C, et al. Evaluation of oxaliplatin dose intensity in bimonthly
leucovorin and 48-hour 5-fluorouracil continuous infusion regimens (FOLFOX) in pretreated metastatic
colorectal cancer. Ann Oncol 2000;11:1477-1483.
4. Emmanouilides C, Sfakiotaki G, Androulakis N, et al. Front-line bevacizumab in combination with
oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) in patients with metastatic colorectal cancer: a
multicenter phase II study. BMC Cancer 2007;7:91.
5. Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional
fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in
patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol
2010;28:4697-4705.
6. Venook AP, Niedzwiecki D, Lenz H-J, et al. CALGB/SWOG 80405: Phase III trial of
irinotecan/5-FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab
or cetuximab for patients with KRAS wild-type untreated metastatic adenocarcinoma of the colon or
rectum [abstract]. ASCO Meeting Abstracts 2014;32:LBA3.
7. Saltz LB, Clarke S, Diaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin-based
chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J
39
Clin Oncol 2008;26:2013-2019.
8. Andre T, Louvet C, Maindrault-Goebel F, et al. CPT-11 (irinotecan) addition to bimonthly, high-dose
leucovorin and bolus and continous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic
colorectal cancer. Eur J Cancer 1999;35(9):1343-7.
9. Fuchs CS, Marshall J, Mitchell E, et al. Randomized, controlled trial of irinotecan plus infusional, bolus,
or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C
Study. J Clin Oncol 2007;25:4779-4786.
10. Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus
bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a
randomized, open-label, phase 3 trial. Lancet Oncol 2014.
11. Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in
irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004;351:337-345.
12. Martín-Martorell P, Roselló S, Rodríguez-Braun E, et al. Biweekly cetuximab
and irinotecan in advanced colorectal cancer patients progressing after at least one previous line of
chemotherapy: results of a phase II single institution trial. Br J Cancer 2008;99:455-458.
13. Peeters M, Price TJ, Cervantes A, et al. Randomized phase III study of panitumumab with
fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line
treatment in patients with metastatic colorectal cancer. J Clin Oncol 2010;28:4706-4713.
14. Van Cutsem E, Tabernero J, Lakomy R, et al. Addition of Aflibercept to Fluorouracil, Leucovorin,
and Irinotecan Improves Survival in a Phase III Randomized Trial in Patients With Metastatic
Colorectal Cancer Previously Treated With an Oxaliplatin-Based Regimen. J Clin Oncol
2012;30:3499-3506.
15. Tabernero J, Yoshino T, Cohn AL, et al. Ramucirumab versus placebo in combination with
second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or
after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a
randomized, double-blind, multicentre, phase 3 study. Lancet Oncol 2015;16:499-508.
16. Falcone A, Ricci S, Brunetti I, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin,
and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan
(FOLFIRI) as first-line treatment for metastatic colorectal cancer: The Gruppo Oncologico Nord
Ovest. J Clin Oncol 2007;25(13):1670-1676.
17. Cremolini C, Loupakis F, Antoniotti C, et al. FOLFOXIRI plus bevacizumab versus FOLFIRI plus
bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall
survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol
2015;16:1306- 1315.
18. Van Cutsem E, Tejpar S, Vanbeckevoort D, et al. Intrapatient cetuximab dose escalation in metastatic
colorectal cancer according to the grade of early skin reactions: The Randomized EVEREST Study. J
Clin Oncol 2012;30:2861-2868.
19. Van Custem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive
care compared with best supportive care alone in patients with chemotherapy-refractory metastatic
colorectal cancer. J Clin Oncol 2007;25:1658-1664.
20. Grothey A, Van Cutsem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic
colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3
trial. Lancet 2013;381:303-312.
40
21. Bekaii-Saab, TS, Ou F-S, Anderson DM, et al. Regorafenib dose optimization study (ReDOS):
Randomized phase II trial to evaluate dosing strategies for regorafenib in refractory metastatic colorectal
cancer (mCRC)—An ACCRU Network study. J Clin Oncol 2018;36(suppl 4S;abstr 611).
22. Mayer RJ, Van Cutsem E, Falcone A, et al. Randomized Trial of TAS-102 for Refractory Metastatic
Colorectal Cancer (RECOURSE). N Engl J Med 2015;372:1909-19.
23. Huang W-Y, Ho C-L, Lee C-C, Hsiao C-W, Wu C-C, Jao S-W, et al. (2017) Oral tegafur-uracil as
metronomic therapy following intravenous FOLFOX for stage III colon cancer. PLoS ONE 12(3):
e0174280. https://doi.org/10.1371/journal.pone.0174280
Hepatocellular carcinoma

TACE
Stivarga( regorafenib)40mg 4# qd()
Immunotherapy (5.6) (Palliative)
OPDIVD (Nivolumab)- anti-PD-1
Nivoluma (3mg/kg)+N/S 250CC run 60 min was given every 2 -3 weeks
(Child-PughClass Aor B7only)
Keytruda(pembrolizumab)- anti-PD-1
Pembrolizumab (2mg/kg) +N/S 100CC run 30 min was given every 3 weeks
(Child-PughClass A only)

1. Kim, J. H., Sinn, D. H., Shin, S. W., Cho, S. K., Kang, W., Gwak, G. Y., ... & Choi, M. S. (2017). The role of
scheduled second TACE in early-stage hepatocellular carcinoma with complete response to initial
TACE. Clinical and Molecular Hepatology, 23(1), 42-50.
2. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers, version 2.2019.

42
3. Siddique, O., Yoo, E. R., Perumpail, R. B., Perumpail, B. J., Liu, A., Cholankeril, G., & Ahmed, A.
(2017). The importance of a multidisciplinary approach to hepatocellular carcinoma. Journal of
Multidisciplinary Healthcare,10, 95.
4. Zhu, Y. J., Zheng, B., Wang, H. Y., & Chen, L. (2017). New knowledge of the mechanisms of sorafenib
resistance in liver cancer. Acta Pharmacologica Sinica.
5.El-Khoueiry AB, Sangro B, Yau T, et al. Nivolumab in patients with advanced hepatocellular carcinoma
(CheckMate 040): an open-label, non-comparative, phase 1/2 dose escalation and expansion trial. Published
Online 2017 April 20 ; S0140-6736(17)31046-2.
6.Zhu, P.A., Finn,R. S., Edeline,J., Cattan,S.,Ogasawara, S.,Palmer, P.D.,et al. Pembrolizumab in patients with
advanced hepatocellular carcinoma previously treated with sorafenib (KEYNOTE-224): a non-randomised,
open-label phase 2 trial. Articles .2018. Vol. 19 (7),P940-952.
43
Urinary tract Cancer
Bladder Cancer
Regimen1(Ccr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose)
) 1000mg/+ N/S 200ml IVD D1, D8, D15Cisplatin 70mg/m 2 + N/S
500ml IVD D2
Regimen2: Ccr50
)1000mg/m 2 + N/S 200ml IVD D1, D8, D15Carboplatin 300mg/m
2 +
Regimen3: ( CCr >90: 100% dose; 70-90: 70% dose; 50-70:50% dose)
MTX 30mg/m 2 ; Vinblastin 3mg/m
2 ; Epirubicin 30mg/m
2 ; Cisplatin 70mg/m
2 ; Carboplatin 300mg/m
) 1000mg/+ N/S 200ml IVD D1, D8, D15Cisplatin 70mg/m 2 + N/S
500ml IVD D2
Regimen2: Ccr50
2 +
Regimen2
Regimen3

Chemotherapy drug for Small ()
Regimen1
Etoposide 80-100mg/m 2 + NS 500 ml IVD 1hr D1-D3
Cisplatin 75mg/m 2 or Carboplatin (AUC=5) + N/S 500 mL IVD D1
Repeat every 21-28days for 6 cycles
Metastatic

Systemic
) 1000mg/ m 2 + N/S 200ml IVD D1, D8, D15Cisplatin 70mg/m
2 +
45
2 +
Regimen1
Etoposide 80-100mg/m 2 + NS 500 ml IVD 1hr D1-D3
Cisplatin 75mg/m 2 or Carboplatin (AUC=5) + N/S 500 mL IVD D1
Repeat every 21-28days for 6 cycles
Immunotherapy Adjuvant/Metastatic
Regimen1(1,8,9)
Atezolizumab 1200 mg+N/S 250ml IVD 1 hr Repeat every 21 days
Regimen2: (1,8,9)
Pembrolizumab 2 or 200 mg/kg+N/S 100ml IVD 0.5 hr Repeat every 21 days
Regimen3: (1,8,9)
Nivolumab 3mg/kg+N/S 100ml (D5W) IVD 1hr Repeat every 14 days

1. NCCN Clinical Practice Guidelines in Oncology: Bladder Cancer V. 3, 2019.
2. Bamias, A., Moulopoulos, L. A., Koutras, A., Aravantinos, G., Fountzilas, G., Pectasides, D., ... &
Kalofonos, H. P. (2006). The combination of gemcitabine and carboplatin as firstline treatment in
patients with advanced urothelial carcinoma. Cancer, 106(2), 297-303.
3.Wosnitzer, M. S., Hruby, G. W., Murphy, A. M., Barlow, L. J., CordonCardo, C., Mansukhani, M., ...
& McKiernan, J. M. (2012). A comparison of the outcomes of neoadjuvant and adjuvant
chemotherapy for clinical T2T4aN0N2M0 bladder cancer. Cancer, 118(2), 358-364.
4. von der Maase, H., Sengelov, L., Roberts, J. T., Ricci, S., Dogliotti, L., Oliver, T., . & Arning, M.
(2005). Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with
methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. Journal of
Clinical Oncology, 23(21), 4602-4608.
5. Roberts, J. T., von der Maase, H., Sengeløv, L., Conte, P. F., Dogliotti, L., Oliver, T., ... & Arning, M.
(2006). Long-term survival results of a randomized trial comparing gemcitabine/cisplatin and
methotrexate/vinblastine/doxorubicin/cisplatin in patients with locally advanced and metastatic bladder
cancer. Annals of oncology, 17(suppl 5), v118-v122.
6. Van Der Meijden, A. P., Brausi, M., Zambon, V., Kirkels, W., De Balincourt, C., Sylvester, R., &
46
Calmette-Guerin and bacillus Calmette-Guerin plus isoniazid for intermediate and high risk Ta, T1
papillary carcinoma of the bladder: a European Organization for Research and Treatment of Cancer
genito-urinary group randomized phase III trial. The Journal of urology, 166(2), 476-481.
7. Shelley, M. D., Wilt, T. J., Court, J., Coles, B., Kynaston, H., & Mason, M. D. (2004). Intravesical
bacillus CalmetteGuérin is superior to mitomycin C in reducing tumour recurrence in highrisk
superficial bladder cancer: a metaanalysis of randomized trials. BJU international, 93(4), 485-490.
8. Balar AV, Galsky MD, Rosenberg JE, et al. Atezolizumab as first-line treatment in cisplatin-ineligible
patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial.
Lancet 2018;389:67-76.
9. Balar AV, Castellano DE, O’Donnell PH, et al. Pembrolizumab as first-line therapy in cisplatin-ineligible
advanced urothelial cancer: Results from the total KEYNOTE-052 study population [abstract]. J Clin Oncol
2018;6S:Abstract 284.
Prostate Cancer

1. Papandreou, C. N., Daliani, D. D., Thall, P. F., Tu, S. M., Wang, X., Reyes, A., ... & Logothetis, C. J.
(2002). Results of a phase II study with doxorubicin, etoposide, and cisplatin in patients with fully
characterized small-cell carcinoma of the prostate. Journal of clinical oncology, 20(14), 3072-3080.
2. Noda, K., Nishiwaki, Y., Kawahara, M., Negoro, S., Sugiura, T., Yokoyama, A., ... & Yamamoto, S.
(2002). Irinotecan plus cisplatin compared with etoposide plus cisplatin for extensive small-cell lung
cancer. New England Journal of Medicine, 346(2), 85-91.
3. Machiels, J. P., Mazzeo, F., Clausse, M., Filleul, B., Marcelis, L., Honhon, B., ... & Verhoeven, D.
(2008). Prospective randomized study comparing docetaxel, estramustine, and prednisone with
docetaxel and prednisone in metastatic hormone-refractory prostate cancer. Journal of clinical
oncology, 26(32), 5261-5268.
4. Osanto, S., & Luelmo, S. A. C. (2017). Chemotherapy and Androgen Receptor-Directed Treatment of
Castration Resistant Metastatic Prostate Cancer. In Management of Prostate Cancer (pp. 327-342).
Springer International Publishing.
5. de Morrée, E. S., Vogelzang, N. J., Petrylak, D. P., Budnik, N., Wiechno, P. J., Sternberg, C. N., ... &
Choudhury, A. (2017). Association of Survival Benefit With Docetaxel in Prostate Cancer and Total
Number of Cycles Administered: A Post Hoc Analysis of the Mainsail Study. JAMA oncology, 3(1),
68-75.
6. Osanto, S., & Luelmo, S. A. C. (2017). Chemotherapy and Androgen Receptor-Directed Treatment of
Castration Resistant Metastatic Prostate Cancer. In Management of Prostate Cancer (pp. 327-342).
Springer International Publishing.

Systemic
Regimen1
Repeat for up to 10 cycles if tolerated.
48
Gynecologic oncology
(1)Paclitaxel 175mg/ + N/S 500 ml IVD 3hours
Cisplatin 60mg/ or Carboplatin (AUC=5–6) + N/S 500 ml IVD 2 hours
Repeat cycle every 3 weeks for 6 to 9cycles.
(2)Paclitaxel 60mg/ + N/S 250 ml IVD 1hour
Carboplatin AUC 2 + N/S 250 ml IVD 30mins Repeat cycle every one week
For18cycles.
Doxorubicin 60mg/ + N/S 500 ml IVD 2hours
Cisplatin 50mg/ + N/S 500 ml IVD 2 hours Repeat every 3 weeks for maximum of 7cycles.
Cisplatin + Doxorubicin + Paclitaxel (4,5)
Cisplatin 50mg/ + N/S 500 ml IVD 2hours on D1
Paclitaxel 160mg/ + N/S 500 ml IVD 3hours on D2
Repeat every 3 weeks for 6–7cycles.
Carboplatin + Docetaxel (6,7,8)
Repeat every 3 weeks for 6cycles.
Cisplatin (11)
Cisplatin 50mg/ + N/S 500 ml IVD 2hours,Repeat cycle every 3weeks.
Carboplatin (12)
Carboplatin 400mg/ + N/S 500 ml IVD 1hour,Repeat cycle every 3 weeks
Doxorubicin (13)
Repeat cycle every 3–4weeks.
Liposomal doxorubicin (14)
Repeat cycle every 4weeks.
Topotecan 1.2–1.5mg/ + N/S 500 ml IVD1hour on D1–5
Docetaxel (Category 2B) (18)
Docetaexel 36mg/ + N/S 250 ml IVD1hour on D1 and D8 and D15
Cisplatin + Doxorubicin + Cyclophosphamide (22)
Cyclophosphamide 500mg/+ N/S 500ml IVD 2hours
Gemcitabine + Docetaxel (for leiomyosarcoma) (24-26)
Gemcitabine 675 ~900 mg/ + N/S 500 ml IVD over 90 mins on D1 and D8
Docetaxel 75~100 mg/ + N/S 500 ml IVD over 1 hour on D8
Hormonal Therapy for RecurrentMetastaticHigh-risk Endometrial Carcinoma

Tamoxifen(19)
Anastrozole(20)
Tamoxifen + Megestrol(21)
Megestrol 80mg PO twice daily for 3 weeks alternating with
tamoxifen 20mg PO twice daily
Repeat cycle every 3 weeks.
Megestrol(21)
Medroxypngesterone 200mg PO QID

Paclitaxel 175 mg/ + N/S 500 ml IVD 3hours
Carboplatin (AUC=5–6) + N/S 500 ml IVD 1hour
Bevacizumab 7.5 mg/kg + N/S 250 ml IVD 30–90 minutes
Repeat every 3 weeks for 6cycles.
(Continue bevacizumab for up to 12 additional cycles if necessary)

1.Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology™. Uterine
Neoplasms.v 2.2019. Available at:
http://www.nccn.org/professionals/physician_gls/pdf/uterine.pdf.AccessedAprilFebruary2, 2019.
2.Miller D, FiliaciV, Fleming G, et al. Randomized phase III noninferiority trial of first line chemotherapy for
metastatic or recurrent endometrial carcinoma: a Gynecologic Oncology Group study [abstract].
GynecolOncol.2012:125:771.
3.Sorbe B, Andersson H, Boman K, et al. Treatment of primary advanced and recurrent endometrial carcinoma
with a combination of carboplatin and paclitaxel-long-termfollow-up.
Int J Gynecol Cancer. 2008;18(4):803–808.
4.FlemingGF, Brunetto VL, Cella D, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel
plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J
ClinOncol.2004;22(11):2159–2166.
5.Homesley HD, FiliaciV, Gibbons SK, et al. A randomized phase III trial in advanced endometrial carcinoma
of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A
Gynecologic Oncology Group study. GynecolOncol.2009;112(3):543–552.
6.Scribner DR Jr, Puls LE, Gold MA. A phase II evaluation of docetaxel and carboplatin followed by tumor
volume directed pelvic plus or minus paraaortic irradiation for stage III endometrial cancer.
GynecolOncol.2012;125(2):388–393.
7.Geller MA, Ivy JJ, Ghebre R, et al. A phase II trial of carboplatin and docetaxel followed by radiotherapy
given in a “Sandwich” method for stage III, IV, and recurrent endometrial
cancer.GynecolOncol.2011;121(1):112–117.
8.Nomura H, Aoki D, Takahashi F, et al. Randomized phase II study comparing docetaxel plus cisplatin,
docetaxel plus carboplatin, and paclitaxel plus carboplatin in patients with advanced or recurrent endometrial
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