Chemotherapy Drugs of Choice
Adrenocortical
Anal
Biliary tract
Bladder
superficial
systemic
Brain
anaplastic astrocytoma/gliob
anaplastic oligodendroglioma
medulloblastoma
germ cell tumors
primary CNS lymphoma
Breast
risk reduction
adjuvant
metastatic
Carcinoid
Cervix
locally advanced
metastatic
Choriocarcinoma
Colorectal
adjuvant
metastatic
Endometrial
Esophageal
Ewing's sarcoma
Gastric
Head and neck
Hepatoblastoma
Islet cell
Kaposi's Sarcoma
Leukemias
ALL induction
ALL CNS prophylaxis
ALL maintenance
AML Induction
AML CNS prophylaxis
APL
CLL
CML-CP
CML-AP
CML blast phase (lymph)
CML blast phase (myeloid)
Hairy cell
Liver
Lung
non-small cell
small cell
Melanoma
adjuvant
metastatic
Multiple myeloma
Neuroblastoma
Osteosarcoma
Ovarian
germ cell
epithelial
Pancreatic
adjuvant
localized unresectable
metastatic
Pheochromocytoma
Prostate
Renal
Retinoblastoma
Rhabdomyosarcoma
Sarcoma, soft tissue
Testicular
Thyroid (anaplastic)
Wilms' tumor
Adrenocortical
Mitotane
Cisplatin +/- etoposide
Alternatives:
Doxorubicin
Anal
Fluorouracil + mitomycin
Alternatives:
Cisplatin
Biliary tract
Fluorouracil +/- leucovorin
Alternatives:
Fluorouracil + doxorubicin + mitomycin (FAM)
Cisplatin
Gemcitabine
Bladder (superficial)
BCG instillation
Alternatives:
Instilled mitomycin, doxorubicin, thiotepa, or valrubicin
Bladder (systemic)
MTX + vinblastine + doxorubicin + cisplatin (MVAC)
Alternatives:
Cisplatin + MTX + vinblastine (CMV)
Paclitaxel + carboplatin
Gemcitabine + cisplatin
Ifosfamide + mesna
Gallium nitrate
Anaplastic astrocytoma/glioblastoma
Procarbazine + lomustine + vincristine
Carmustine wafers
Alternatives:
Temozolomide
Carmustine
Cisplatin or carboplatin
Anaplastic oligodendroglioma
Procarbazine + lomustine + vincristine
Alternatives:
Carmustine
Cisplatin
Medulloblastoma/embryonal
Lomustine + cisplatin + vincristine
Vincristine + cisplatin + cyclophosphamide + etoposide
Alternatives:
Lomustine + vincristine + prednisone
Germ cell tumors
Cisplatin + etoposide
Carboplatin + etoposide
Alternatives:
Vinblastine
Bleomycin
Cyclophosphamide
Primary CNS lymphoma
High-dose IV MTX + IT MTX
High-dose IV cytarabine
Alternatives:
BBB disruption w/ IV cyclophosphamide, intra-arterial MTX + leucovorin, and oral procarbazine and dexamethasone
Breast (risk reduction)
Tamoxifen
Breast (adjuvant)
Doxorubicin + cyclophosphamide +/- fluorouracil (AC or CAF), followed by paclitaxel
Cyclophosphamide + MTX + fluorouracil (CMF)
Tamoxifen for ER+ and hormone-responsive
Alternatives:
Cyclophosphamide + epirubicin + fluorouracil (CEF)
Breast (metastatic)
Doxorubicin + cyclophosphamide +/- fluorouracil (AC or CAF)
Cyclophosphamide + MTX + fluorouracil (CMF)
Tamoxifen or toremifene for ER+ and/or hormone responsive
Paclitaxel + trastuzumab for HER2 overexpression
Alternatives:
Paclitaxel
Docetaxel
Capecitabine
Vinorelbine
Mitoxantrone
Epirubicin
Fluorouracil CI
Anastrazole, letrozole, or examustine
Megestrol acetate
Fluoxymesterone
Carcinoid
Fluorouracil + streptozocin
Doxorubicin
Alternatives:
Dacarbazine
Interferon alfa
Octreotide for carcinoid syndrome
Cervix (locally advanced)
Cisplatin +/- fluorouracil
Alternatives:
Carboplatin
Fluorouracil
Epirubicin
Paclitaxel
Doxorubicin
Vinblastine
MTX
Mitomycin
Irinotecan
Cervix (metastatic)
Cisplatin
Ifosfamide with mesna
Bleomycin + ifosfamide/mesna + cisplatin (BIP)
Alternatives:
Carboplatin
Fluorouracil
Epirubicin
Paclitaxel
Doxorubicin
Vinblastine
MTX
Mitomycin
Irinotecan
Choriocarcinoma
MTX +/- leucovorin
Dactinomycin
Alternatives:
Etoposide + MTX + dactinomycin + cyclophosphamide + vincristine (EMA-CO)
MTX + dactinomycin + cyclophosphamide (MAC)
Cisplatin +/- etoposide
Colorectal (adjuvant)
Fluorouracil + leucovorin
Colorectal (metastatic)
Fluorouracil + leucovorin + irinotecan
Alternatives:
Capecitabine
Oxaliplatin
Tegafur/uracil + leucovorin
Endometrial
Doxorubicin + cisplatin +/- cyclophosphamide
Megestrol or other progestin
Alternatives:
Epirubicin
Tamoxifen
Carboplatin
Paclitaxel
Esophageal
Cisplatin + fluorouracil
Alternatives:
Paclitaxel
Doxorubicin
MTX
Vinorelbine
Bleomycin
Irinotecan
Ewing's sarcoma
Vincristine + doxorubicin + cyclophosphamide, alternating with ifosfamide/mesna + etoposide
Alternatives:
Dactinomycin
Gastric
Fluorouracil +/- leucovorin
Alternatives:
Fluorouracil + doxorubicin + MTX (FAMTX) or mitomycin (FAM)
Infusional fluorouracil + cisplatin
Etoposide
Paclitaxel
Docetaxel
Irinotecan + cisplatin
Head and neck
Cisplatin + fluorouracil or paclitaxel
Alternatives:
Docetaxel
MTX
Bleomycin
Carboplatin
Ifosfamide
Hepatoblastoma
Vincristine + cisplatin + fluorouracil
Cisplatin + doxorubicin
Alternatives:
Etoposide
Carboplatin
Ifosfamide/mesna
Islet cell
Streptozocin + doxorubicin
Alternatives:
Streptozocin + fluorouracil
Chlorozotocin
Dacarbazine
Interferon alpha
Kaposi's Sarcoma
Liposomal doxorubicin or daunorubicin
Doxorubicin + bleomycin + vincristine (ABV)
Alternatives:
Vinblastine
Etoposide
Interferon alpha
Paclitaxel
Vinorelbine
Alitretinoin gel
Leukemias
ALL induction
Vincristine + prednisone + asparaginase + daunorubicin or doxorubicin +/-
cyclophosphamide
Alternatives:
Same, +/- high-dose MTX +/- cytarabine
Tenopiside or etoposide
High-dose cytarabine + mitoxantrone
Ifosfamide/mesna
ALL CNS prophylaxis
IT MTX +/- IT cytarabine +/- IT hydrocortisone +/- high-dose systemic
MTX/leucovorin
ALL maintenance
Mercaptopurine + MTX
Alternatives:
Same, plus monthly vincristine and prednisone
AML induction
Cytarabine + either daunorubicin or idarubicin +/- etoposide
Alternatives:
High-dose cytarabine + daunorubicin or idarubicin
Vincristine, cyclophosphamide, MTX, mitoxantrone, fludarabine, carboplatin,
topotecan, gemtuzumab
AML CNS prophylaxis
IT cytarabine or MTX +/- IT hydrocortisone
AML post-induction
High-dose cytarabine +/- other drugs
Alternatives:
Vincristine, cyclophosphamide, MTX, mitoxantrone, fludarabine, carboplatin,
topotecan, gemtuzumab
APL
Tretinoin +/- further induction therapy
Alternatives:
Arsenic trioxide
CLL
Fludarabine +/- cyclophosphamide
Chlorambucil or cyclophosphamide +/- prednisone
Alternatives:
Cyclophosphamide + vincristine + prednisone +/- doxorubicin
Cladribine
Pentostatin
CML chronic phase
Interferon alfa +/- cytarabine
Alternatives:
Hydroxyurea
Busulfan
Homoharringtonine
CML accelerated phase
Cytarabine + daunorubicin or idarubicin
Alternatives:
Hydroxyurea
Busulfan
Interferon alfa
CML blast phase (lymphoid)
Vincristine + prednisone + asparaginase + doxorubicin or daunorubicin +/-
cyclophosphamide + IT MTX +/- maintenance with mercaptopurine + MTX
Alternatives:
Azacitidine
Vincristine +/- plicamycin
STI-571
CML blast phase (myeloid)
Cytarabine + daunorubicin or idarubicin
Hairy cell
Cladribine
Pentastatin
Alternatives:
Interferon alfa
Liver
Hepatic intra-arterial floxuridine, cisplatin, doxorubicin, or mitomycin
Alternatives:
Doxorubicin
Fluorouracil
Lung (non-small cell)
Paclitaxel + cisplatin or carboplatin
Cisplatin + vinorelbine
Gemcitabine + cisplatin
Alternatives:
Mitomycin + vinblastine + cisplatin (MVP)
Mitomycin + ifosfamide/mesna + cisplatin (MIC)
Docetaxel
Irinotecan
Cisplatin + etoposide
Vinorelbine
Lung (small cell)
Cisplatin or carboplatin + etoposide (PE)
Alternatives:
Topotecan
Cyclophosphamide + doxorubicin + vincristine (CAV)
Melanoma (adjuvant)
Interferon alpha
Melanoma (metastatic)
Dacarbazine
Alternatives:
Dacarbazine + cisplatin + vinblastine +/- interferon alpha + interleukin-2
Multiple myeloma
Melphalan or cyclophosphamide + prednisone
Vincristine + doxorubicin + dexamethasone (VAD)
Alternatives:
Vincristine + carmustine + melphalan + cyclophosphamide + prednisone (VBMCP)
Etoposide + dexamethasone + cytarabine +cisplatin (EDAP)
High-dose dexamethasone
Interferon alpha
Thalidomide
Neuroblastoma
Doxorubicin + cyclophosphamide + cisplatin + etoposide or teniposide
Alternatives:
Carboplatin
Vincristine
Topotecan
Osteosarcoma
High-dose MTX + doxorubicin + cisplatin
Alternatives:
Doxorubicin + cisplatin + MTX + ifosfamide/mesna
Etoposide + ifosfamide/mesna
Ifosfamide/mesna + cisplatin + etoposide (ICE)
Dactinomycin
Vincristine
Ovarian (germ cell)
Bleomycin + etoposide + cisplatin (BEP)
Alternatives:
Vincristine + dactinomycin + cisplatin
Etoposide + cisplatin or carboplatin
Ovarian (epithelial)
Cisplatin or carboplatin + paclitaxel
Alternatives:
Topotecan
Cyclophosphamide
Ifosfamide/mesna
Tamoxifen
Melphalan
Altretamine
Oral etoposide
Docetaxel
Liposomal doxorubicin
Gemcitabine
Interferon gamma
Pancreatic (adjuvant)
Fluorouracil
Alternatives:
Doxorubicin
Mitomycin
Pancreatic (localized unresectable)
Fluorouracil
Alternatives:
Doxorubicin
Mitomycin
Pancreatic (metastatic)
Gemcitabine
Pheochromocytoma
Cyclophosphamide + vincristine + dacarbazine (CVD)
Alternatives:
Streptozocin
Prostate
Leuprolide or goserelin +/- flutamide or bicalutamide or nilutamide
Alternatives:
Mitoxantrone + prednisone
Estramustine + docetaxel or vinblastine or paclitaxel
Doxorubicin + ketoconazole
Ketoconazole + prednisone
Megestrol acetate
Renal
Interleukin-2
Alternatives:
Interferon alpha
Retinoblastoma
Doxorubicin + cyclophosphamide +/- vincristine +/- cisplatin +/- etoposide
IT MTX +/- cytarabine +/- hydrocortisone
Alternatives:
Carboplatin
Ifosfamide/mesna
Rhabdomyosarcoma
Vincristine + dactinomycin + either cyclophosphamide (VAC ) or ifosfamide/mesna
Alternatives:
Doxorubicin
Melphalan
Cisplatin
Etoposide
Sarcoma, soft tissue
Ifosfamide/mesna + doxorubicin +/- dacarbazine
Alternatives:
Doxorubicin + cisplatin + mitomycin
Vincristine
Cyclophosphamide
Epirubicin
Testicular
Cisplatin + etoposide +/- bleomycin (PEB)
Alternatives:
Ifosfamide/mesna + cisplatin + etoposide or vinblastine
Gemcitabine
Paclitaxel
Thyroid (anaplastic)
Doxorubicin
Cisplatin
Wilms' tumor
Dactinomycin + vincristine +/- doxorubicin +/- cyclophosphamide
Alternatives:
Ifosfamide/mesna
Etoposide
Carboplatin or cisplatin
Adapted from: The Medical Letter; Vol 42(1087-1088), September 18, 2000
© 2000-2006 Pharmacy OneSource, Inc.