Cancer Medications

Page updated Winter 2021.
DisclaimerMedicine is an ever-changing science.  We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable resources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original resources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.

Prostate Cancer

LHRH Agonists

Leuprolide (Lupron)

7.5 mg IM for 1-Month

22.5 mg  IM for 3-Months

30 mg  IM for 4-Months

45 mg IM for 6-Months

Leuprolide (Eligard)

Same dose as above, SC

Goserelin (Zoladex)

3.6 mg SC- for 1-Month

10.8 mg SC- for 3-Months

Triptorelin (Trelstar)

3.75 mg IM  for 1 Month

11.25 mg IM for 3 Months

22.5 mg IM for 6 Months


LHRH Antagonists 

Degarelix (Firmagon)

Initial dose: 240 SC in 2 divided dose

Then : 80 mg  SC every 28 days

Abarelix (Plenaxis)

100 mg administered intramuscularly to the buttock on day 1, 15, 29 (week 4) and every 4 weeks thereafter.


Non-steroidal Anti-androgens

Bicalutamide (Casodex)

50 mg PO daily for 4 weeks to block LHRH agonists flare-up phenomenon.

Flutamide (Eulexin)

250 mg PO q8hr for 4 weeks to block LHRH agonists flare-up phenomenon.

Nilutamide (Nilandron)

300 mg PO daily for 4 wks to block LHRH agonists flare-up phenomenon.

Treatment Options for Bothersome Hot Flashes

Megestrol acetate: 

20 mg, twice per day. Can be reduced to 5 mg bid.

Cyproterone acetate : 

Start at 50 mg/day. May be titrated to 300 mg/day.

Venlafaxine :

12.5 mg, twice daily

Gabapentin

900 mg daily (300 mg TID).Start with 300 and get to 900 mg on day 3 .
Prostate Cancer

Androgen Synthesis Inhibitors.

Abirateron (Zytiga)

1000 mg PO daily

Add Prednisone 5 mg PO q12hr

Second-Generation Androgen Receptor Antagonists

Enzalutamide (Xtandi)

160 mg PO, daily

Apalutamide (Erleada)

240 mg PO, daily

Chemotherapy Agents

Docetaxel (Taxotere)

75 mg/m2 IV over 1 hr q3 Weeks 

Add Prednisone 5 mg PO q12hr

Cabazitaxel (Jevtana)

20 mg/m2 IV  over 1 hr q3 Weeks

Add Prednisone 10 mg PO q Day

Immunotherapy

Sipuleucel-T (Provenge)

3 doses (>50 million autologous CD54+ activated cells/dose) IV over 60 min at approximately 2-week intervals 

Pembrolizumab (Keytruda)

200 mg IV q3 Weeks OR 400 mg q6 Weeks OR 400 mg q6 Weeks until disease progression, unacceptable toxicity, or up to 24 months without disease progression.

Radiopharmaceuticals

Radium-223 (Xofigo):

50 kBq (1.35 microcurie) per kg  body weight, IV, given at 4 week intervals for 6 injections. 


Prostate Cancer Bone Health

Calcium: 1000-1200 mg per day

Vitamin D: 1000 IU

Zoledronic acid (Zometa, Reclast):

Osteoporosis-related fracture prevention:

Reclast: 5 mg IV over >15 minutes every year

Bone metastasis from solid tumors:

Zometa: 4 mg as a single-use intravenous infusion over > 15 minutes every 3-4 weeks for patients with creatinine clearance of greater than 60 mL/min.

Denosumab (Prolia, Xgeva):

Androgen deprivation induced bone loss:

Prolia: 60 mg SC q6months

Bone metastasis from solid tumors:

Xgeva: 120 mg SC q4Weeks

Intravesical Bladder Cancer Medications

Patients should limit fluid intake the day before and day of treatment.

Use 14 Fr straight catheter (females) and 14 Fr coudé catheter (males).

Empty bladder first.

Insert a catheter tip syringe containing the treatment or the primed tubing attached to medication vial into catheter.

Instill the medication per gravity flow or by gentle push.

Patient should not void for 1 to 2 hours post procedure.

BCG

One vial suspended in 50 mL preservative free saline (0.9%  NaCl)

If not available, candidates may be given a reduced 1/2 to 1/3 dose.

Avoid exposing BCG to direct sunlight.

Patients may use acetaminophen or ibuprofen for fever and body aches and antispasmodic medications for frequency and urgency.

Chemotherapy

Sodium bicarbonate, 1.3 gm PO, may be given night before, morning of, and 30 minutes prior to instillation of chemotherapy agent. 

Mitomycin: 40 mg reconstituted in 20 mL sterile water

Gemcitabine: 1000 mg/ 50 mL normal saline or 2000 mg/ 50-100 mL NaCl

Doxorubicin: 50 mg/50 mL of (0.9% Sodium Chloride)

Epirubicin: 50 mg/50 mL (diluted with saline or distilled sterile water)

Kidney Cancer

Checkpoint Inhibitors Targeting PD-1 

Pembrolizumab (Keytruda)

Pembrolizumab 200 mg IV q3Weeks OR 400 mg q6 weeks  until disease progression, unacceptable toxicity, or  up to 24 months without disease progression. It is given in combination with Axitinib.

Nivolumab (Opdivo)

Nivolumab 3 mg/kg IV q3Weeks

In combination with Ipilimumab. Should  be given on the same day.

After completing 4 doses of combination therapy, give nivolumab 240 mg IV every 2 weeks or 480 mg IV every 4 weeks.

Checkpoint Inhibitors Targeting CTLA-4

Ipilimumab (Yervoy)

1 mg/kg IV q3Weeks

After completing 4 doses of combination therapy with nivolumab, just continue nivolumab.

VEGF Receptor Tyrosine Kinase Inhibitors

Axitinib (Inlyta) :5 mg PO BID (initial dose)

When it is used in combination with pembrolizumab, dose escalation above the initial 5 mg dose may be considered at intervals of six weeks or longer.

Pazopanib (Votrient): 800 mg PO daily on empty stomach

Sunitinib (Sutent): 50 mg PO daily for 4 weeks, then 2 weeks drug-free, then repeat the cycle.

Cabozantinib (Cometriq) : when used as a single agent: 60 mg PO daily