Protocolos de Tratamento

Sociedade Brasileira
de Cancerologia
Guia Prtico para o

Oncologista Clnico
2011
Organizao
Dra. Aline Lauda Freitas Chaves
Dra. Letcia Carvalho Neuenschwander
Reviso
Dr. Amndio Soares Fernandes Jnior
Dr. Enaldo Melo de Lima
Dr. Jos Luiz Miranda Guimares
Srta. Paula Palmeira - Bibliotecria da SBOC
Editorial
Caros Oncologistas Clnicos Associados da SBOC e da SBC;
A SBOC, em conjunto com a SBC, elaborou esse compndio
com os principais protocolos de tumores onco-hematolgicos,
para facilitar a consulta no dia a dia dos esquemas de dose e
frequncia de tratamento.
A confeco e compilao dos dados da literatura mdica
coube s Dras. Aline Lauda Freitas Chaves e Letcia Carvalho
Neuenschwander e, aps a elaborao do guia, foram realizadas
diversas correes no contedo e diagramao, a fim de evitar
informaes incorretas, que pudessem gerar erros de prescrio e
danos aos pacientes. Um esforo considervel foi dispendido para
evitar erros e garantir a acurcia dos regimes apresentados.
Esse guia prtico incorpora os esquemas mais amplamente
utilizados, tanto de monoterapia, como poliquimioterapia,
alm de hormonioterapia, bioterapia, anticorpos monoclonais
e pequenas molculas, que so utilizados na prtica oncolgica
do dia a dia para tratamento de tumores slidos e das neoplasias
hematolgicas.
Ambas as entidades pretendem atualizar, anualmente esse
trabalho, tendo em vista a rpida evoluo da nossa especialidade
e entendem esse trabalho como uma continuidade da prestao
de servio aos associados, com a incorporao de novos esquemas e programas de tratamento.
Cordialmente,
Dr. Enaldo Melo de Lima

Presidente da SBOC
Dr. Roberto Porto Fonseca

Presidente da SBC
Apresentao
Dentro da proposta das atuais diretorias da SBOC e SBC, temos
uma maior aproximao entre essas entidades e seus associados,
principalmente no que tange a facilitar a vida do Oncologista
Clnico no Brasil. Foi dentro desta linha que surgiu este guia
rpido de protocolos, com informaes teis para o dia a dia da
prtica do oncologista. Para mont-lo fizemos inicialmente a
pergunta: O que o oncologista tem que ter em mos no momento
de sua prtica clnica junto ao paciente? Seu intuito, portanto,
ser um guia de consulta prtico, rpido e acessvel. importante
ressaltar que no substitui o raciocnio clnico e nem pode ser
considerado um manual de condutas de tratamento. Justamente
por isso no foram separados subcaptulos de tratamento adjuvante, neoadjuvante, paliativo. Todos os dados aqui apresentados
foram compilados na literatura mdica disponvel, com referncias citadas no final de cada captulo.
Esperamos que seja til a todos.
Dra. Aline Lauda Freitas Chaves

Dra. Letcia Carvalho Neuenschwander
Belo Horizonte - MG
Agosto/2011
Sumrio
Protocolos de Tratamento
Tumor de Stio Primrio Desconhecido
Tumores do Sistema Nervoso Central
Tumores Neuroendcrinos
Cncer Anal
Cncer Colo-retal
Cncer de Intestino Delgado
Cncer de Esfago
Cncer Gstrico e Juno Gastroesofgica
Tumor do Estroma Gastrointestinal (GIST)
Hepatocarcinoma
Cncer de Vias Biliares
Cncer de Pncreas
Cncer de Cabea e Pescoo
Linfoepitelioma Nasofaringe
Cncer de Tireide
Cncer de Glndula Salivar
Cncer de Bexiga
Cncer Renal
Cncer de Prstata
Cncer de Testculo
Cncer de Pnis
Cncer de Endomtrio
Cncer de Colo Uterino
Cncer de Mama
Metstases sseas e/ou Hipercalcemia Maligna
Cncer de Ovrio (Epitelial)
Doena Trofoblstica Gestacional
Cncer de Vulva
Cncer de Pulmo No Pequenas Clulas
Cncer de Pulmo de Pequenas Clulas
.07
.09
.15
.20
.24
.26
.39
.41
.44
.50
.51
.53
.56
.61
.65
.72
.73
.75
.80
.83
.88
.92
.93
.98
.101
.121
.122
.128
.130
.131
.140
Mesotelioma
Timoma
Melanoma Maligno
Linfoma de Hodgkin
Linfoma No-Hodgkin
Linfoma de Grandes Clulas B
Linfoma de Clulas do Manto
Linfoma Primrio do Sistema Nervoso Central
Mieloma Mltiplo
Sndrome Mielodisplsica
Macroglobulinemia de Waldestrn
Leucemia de Clulas Cabeludas (Tricoleucemia)
Leucemias Agudas
Leucemia Mielide Crnica
Leucemia Linftica Crnica
Sarcomas de Partes Moles
Sarcoma de Kaposi
Sarcomas sseos
Feocromocitoma
.144
.147
.149
.154
.160
.171
.172
.176
.179
.185
.187
.188
.190
.194
.195
.200
.206
.208
.212
Escala de Performance
.213
Frmulas teis em Oncologia
.217
Determinao do Clearance de Creatinina

Determinao da rea sobre a curva (AUC)
Clculo da Superfcie Corporal
.219
.219
.220
Correo de Dose para Pacientes

em Hemodilise
.221
Classificao Internacional de
Doenas CID Oncologia
.227
Sites teis em Oncologia
.233
Protocolos de
Tratamento
Guia Prtico para o Oncologista Clnico
Tumor de Stio Primrio

Desconhecido
PCE
Paclitaxel: 200 mg/m2 IV D1
Carboplatina: AUC 6 IV D1
Etoposide: 50 mg alternando com 100 mg VO D1-10
a cada 21 dias
Ref. (1)
EP
Etoposide: 80 a 120 mg/m2 IV D15
Cisplatina: 60 a 100 mg/m2 IV D1
a cada 21 dias
Ref. (2, 4)
PEB
Cisplatina: 20 mg/m2 IV D15
Etoposide: 100 mg/m2 IV D15
Bleomicina: 30 unidades IV D1, 8 e 15
a cada 21 dias
Ref. (3)
GC
Gencitabina 1250mg/m2 IV D1 e D8
Cisplatina 100mg/m2 IV D1
a cada 21 dias
Ref. (5)
IC
Irinotecano 150 mg/m2 IV D1
Cisplatina 80mg/m2 IV D1
a cada 21 dias
Ref. (5)
PCF
Paclitaxel 200mg/m2 IV em 1 hora D1 e D22
Carboplatina AUC 6 IV D1 e D22

5-Fluorouracil: 225mg/m2/dia IV em 24 horas, D1 a D35
a cada 6 semanas
Ref. (6)
GD
Gencitabina: 1000mg/m2 IV D1 e D8
Docetaxel: 75 mg/m2 IV D8 em 1 hora
a cada 21 dias
Ref. (7)
DC
Docetaxel: 75mg/m2 IV D1
Cisplatina: 75mg/m2 IV D1
Ou
10
a cada 21 dias
Ref. (8)
CP
Paclitaxel: 200mg/m2 IV D1 em 3 horas D1
a cada 21 dias
Ref. (9)
GCP
Paclitaxel: 200mg/m2 IV D1
a cada 21 dias
Ref. (10)
CAE
Carboplatina: 400mg/m2 IV D1
Adriamicina: 50mg/m2 IV D1
Etoposide: 100mg/m2 IV D1 a D3
a cada 21 dias
Ref. (11)
GC
a cada 21 dias
Ref. (12)
GCC
Capecitabina: 1600mg/m2 VO D1 a D14
a cada 21 dias
Ref. (13)
IC
Irinotecano: 60mg/m2 IV D1,8 e 15
a cada 28 dias
Ref. (14)
GEMZAR
Gencitabina: 1000mg/m2 D1,D8 e D15 IV a cada 28 dias
Ref. (15)
GI
Irinotecano: 100mg/m2 IV D1 e D8
a cada 21 dias
Ref. (16)
OC
Oxaliplatina: 130mg/m2 IV D1
Capecitabina: 1000mg/m2 duas vezes ao dia VO D1 a D14
a cada 21 dias
Ref. (17)
GCP
Cisplatina: 35mg/m2 IV D1 e D8
Paclitaxel: 70mg/m2 IV D1 e D8
a cada 21 dias
Ref. (18)
11
GCV
Vinorelbina: 25mg/m2 IV D1 e D8
a cada 21 dias
Ref. (18)
1. Hainsworth JD, Erlance JB, Kalman LA, Schreeder MT, Greco

FA. Carcinoma of unknown primary site: treatment with 1hour paclitaxel, carboplatin, extended-schedule etoposide.
J Clin Oncol 1997;15:23852393.
2. Longeval E, et al. Combination chemotherapy with cisplatin
and etoposide in bronchogenic squamous cell carcinoma
adenocarcinoma.A study by the EORTC lung cancer working
party. Cancer1982;50:27512756.
3. Hainsworth JD, et al. Cisplatin-based combination
chemotherapy in the treatment of poorly differentiated
carcinoma and poorly differentiated adenocarcinoma of
unknown primary site: results of a 12-year experience. J Clin
Oncol 1992;10:912922.
4. Sheperd FA. Treatment of advanced non-small cell lung
cancer. Semin Oncol. 1994; 21(suppl 7): 7-18.
5. Culine S; Lortholary A; Voigt JJ; Bugat R; Theodore C; Priou F;
Kaminsky MC; Lesimple T; Pivot X; Coudert B; Douillard JY;
Merrouche Y; Allouache J; Goupil A; Negrier S; Viala J; Petrow
P; Bouzy J; Laplanche A; Fizazi K. Cisplatin in combination
with either gemcitabine or irinotecan in carcinomas of
unknown primary site: results of a randomized phase II
study--trial for the French Study Group on Carcinomas of
Unknown Primary (GEFCAPI 01). J Clin Oncol 2003 Sep
15;21(18):3479-82.
6. Hainsworth JD, Burris HA 3rd, Meluch AA, Baker MN,
Morrissey LH, Greco FA. Paclitaxel, carboplatin, and longterm continuous infusion of 5-fluorouracil in the treatment
of advanced squamous and other selected carcinomas:
results of a Phase II trial. Cancer. 2001 Aug 1;92(3):642-9.
12
7. Pouessel D; Culine S; Becht C; Ychou M; Romieu G; Fabbro M;

Cupissol D; Pinguet F. Gemcitabine and docetaxel as frontline chemotherapy in patients with carcinoma of an
unknown primary site. Cancer 2004 Mar 15;100(6):1257-61.
8. Carcinoma of unknown primary site: phase II trials with
docetaxel plus cisplatin or carboplatin.Greco FA; Erland JB;
Morrissey LH; Burris HA 3rd; Hermann RC; Steis R; Thompson
D; Gray J; Hainsworth JD. Ann Oncol 2000 Feb;11(2):211-5.
9. Briasoulis E; Kalofonos H; Bafaloukos D; Samantas E;
Fountzilas G; Xiros N; Skarlos D; Christodoulou C; Kosmidis P;
Pavlidis Carboplatin plus paclitaxel in unknown primary
carcinoma: a phase II Hellenic Cooperative Oncology Group
Study. J Clin Oncol 2000 Sep;18(17):3101- 7.
10. Greco FA; Burris HA 3rd; Litchy S; Barton JH; Bradof JE;
Richards P; Scullin DC Jr; Erland JB; Morrissey LH; Hainsworth
JD. Gemcitabine, carboplatin, and paclitaxel for patients with
carcinoma of unknown primary site: a Minnie Pearl Cancer
Research Network study. J Clin Oncol 2002 Mar 15;20(6): 1651-6.
11. Piga A, Nortilli R, Cetto GL, Cardarelli N, Fedeli SL, Fiorentini
G, D'Aprile M, Giorgi F, Parziale AP, Contu A, Montironi R,
Gesuita R, Carle F, Cellerino R.Carboplatin, doxorubicin and
etoposide in the treatment of tumours of unknown primary
site. Br J Cancer. 2004 May 17;90(10):1898-904.
12. Pittman KB; Olver IN; Koczwara B; Kotasek D; Patterson WK;
Keefe DM; Karapetis CS; Parnis FX; Moldovan S; Yeend SJ;
Price TJ Gemcitabine and carboplatin in carcinoma of
unknown primary site: a phase 2 Adelaide Cancer Trials and
Education Collaborative study. Br J Cancer. 2006 Nov
20;95(10):1309-13. Epub 2006 Oct 31.
13. Schneider BJ; El-Rayes B; Muler JH; Philip PA; Kalemkerian
GP; Griffith KA; Zalupski MM. Phase II trial of carboplatin,
gemcitabine, and capecitabine in patients with carcinoma
of unknown primary site. Cancer. 2007 Aug 15;110(4):770-5.
14. Yonemori K; Ando M; Yunokawa M; Hirata T; Kouno T;
Shimizu C; Tamura K; Katsumata N; Hirakawa A; Matsumoto
13
K; Yamanaka Y; Arioka H; Fujiwara Y. Irinotecan plus

carboplatin for patients with carcinoma of unknown primary
site. Br J Cancer. 2009 Jan 13;100(1):50-5. Epub 2008 Dec 16.
156. Hainsworth JD; Burris HA 3rd; Calvert SW; Willcutt NT;
Scullin DC Jr; Bramham J; Greco FA. Gemcitabine in the
second-line therapy of patients with carcinoma of unknown
primary site: a phase II trial of the Minnie Pearl Cancer
Research Network. Cancer Invest 2001;19(4):335-9.
16. Hainsworth JD; Spigel DR; Raefsky EL; Kuzur ME; Yost K;
Kommor M; Litchy S; Greco FA. Combination chemotherapy
with gemcitabine and irinotecan in patients with previously
treated carcinoma of an unknown primary site: a Minnie
Pearl Cancer Research Network Phase II trial. Cancer 2005
Nov 1;104(9):1992-7.
17. Hainsworth JD; Spigel DR; Burris HA 3rd; Shipley D; Farley C;
Macias-Perez IM; Barton J; Greco FA. Oxaliplatin and
capecitabine in the treatment of patients with recurrent or
refractory carcinoma of unknown primary site: a phase 2
trial of the Sarah Cannon Oncology Research Consortium.
Cancer. 2010 May 15;116(10):2448-54.
18. Palmeri S; Lorusso V; Palmeri L; Vaglica M; Porta C; Nortilli R;
Ferrau F; Comella G; Massidda B; Danova M Cisplatin and
gemcitabine with either vinorelbine or paclitaxel in the
treatment of carcinomas of unknown primary site : results of
an Italian multicenter, randomized, phase II study. Cancer.
2006 Dec 15;107(12):2898-905.
14
Tumores do Sistema
Nervoso Central
Temozolomida + Radioterapia
Temozolomida: 75 mg/m2 VO ou IV por 6 semanas concomitante
a radioterapia, seguido por 150 mg/m2 VO D15 a cada 28 dias
Dose da Temozolomida aps a radioterapia: 150 a 200 mg/m2
VO D 1-5 a cada 28 dias.
Ref. (1) e Ref. (9)
PCV
Procarbazina: 60 mg/m2 VO D821
Lomustina: 110 mg/m2 VO D1
Vincristina: 1.4 mg/m2 IV D8 e 29
a cada 6 a 8 semanas por 6 a 7 ciclos (2).
BCNu
BCNU: 200 mg/m2 IV D1
a cada 68 semanas por um ano
Ref. (3 ,4,10)
Ou
BCNU: 75100 mg/m2 IV D1 e 2
a cada 68 semanas
Ref. (3)
Procarbazina
Procarbazina: 150 mg/m2 VO diariamente dividido em 3 doses.
Ref. (5)
Temozolomida
Temozolomida: 150 mg/m2 VO ou IV D15
a cada 28 dias
Ref. (6)
15
Irinotecano
Irinotecano: 350 mg/m2 IV em 90 min D1
a cada 3 semanas
Ref. (7)
Ou
Irinotecano: 125 mg/m2 IV semanalmente por 4 semanas
a cada 6 semanas
Ref. (8)
ACE
Bevacizumabe: 10mg/kg IV D2
a cada 3 semanas
Ref. (11)
BCE
BCNU: 200mg/m2 IV D1
Cisplatina: 20mg/m2 IV D1 a D5
a cada 5 semanas, seguido por radioterapia
Ref. (12)
Temozolamida + Cisplatina
Temozolamida: 200 mg/m2/dia VO ou IV por 5 dias
Ref. (13)
Cisplatina + Carmustina
Cisplatina: 100mg/m2 IV D1 a cada 21 dias
Carmustina: 160mg/m2 IV D2 a cada 42 dias
Ref. (14,15)
Temozolamida + Cisplatina
Temozolamida: 150mg/m2 VO ou IV D1 a D5 a cada 21 dias
Ref. (16)
16
Bevacizumabe + Irinotecano
Bevacizumabe: 10mg/kg IV
Irinotecano: 125mg/m2 IV (se paciente no usando antiepilptico)
ou 340mg/m2 IV (se paciente usando antiepiltico)
a cada 15 dias
Ref. (17, 18)
1. Stupp R, et al. Radiotherapy plus concomitant and adjuvant

temozolomide for glioblastoma. N Engl J Med 2005; 352:
987995.
2. Levin VA, et al. Superiority of post-radiotherapy adjuvant
chemotherapy with CCNU, procarbazine, evincristine (PCV)
over BCNU poranaplastic gliomas: NCOG 6G61 final report.
Int J Radiat Oncol Biol Phys 1990; 18:321324.
3. DeAngelis LM, et al. Malignant gliomas: who benefits from
adjuvant chemotherapy? Ann Neurol 1998; 44:691695.
4. Buckner JC, et al. Phase II trial of procarbazine, lomustine,
andvincristine as initial therapy porpatients with low-grade
oligodendrioglioma or oligoastrocytoma: efficacy eassociations
with chromosomal abnormalities. J Clin Oncol 2003; 21:
251255.
5. Yung A, et al. Randomized trial of temodal (TEM) vs.
procarbazine (PCB) in glioblastoma multiforme (GBM) at
first relapse. Proc Am Soc Clin Oncol 1999;18:139a.
6. Yung A, et al. Multicenter phase II trial of temozolomide in
patients with anaplastic astrocytoma or anaplastic
oligoastrocytoma at first relapse. J Clin Oncol 1999; 17:
27622771.
7. Raymond E, et al. Multicenter phase II study and
pharmacokinetic analysis of irinotecan in chemotherapynave patients with glioblastoma. Ann Oncol 2003; 14:
603614.
8. Friedman H, et al. Irinotecan therapy in adults with recurrent
or progressive malignant glioma. J Clin Oncol 1999; 17:
15161525.
17
9. Stupp R; Hegi ME; Mason WP; van den Bent MJ; Taphoorn MJ;
Janzer RC; Ludwin SK; Allgeier A; Fisher B; Belanger K; Hau P;
Brandes AA; Gijtenbeek J; Marosi C; Vecht CJ; Mokhtari K;
Wesseling P; Villa S; Eisenhauer E; Gorlia T; Weller M;
Lacombe D; Cairncross JG; Mirimanoff. Effects of
radiotherapy with concomitant and adjuvant temozolomide
versus radiotherapy alone on survival in glioblastoma in a
randomised phase III study: 5-year analysis of the EORTCNCIC trial. Lancet Oncol. 2009 Mar 6.
10. Stewart LA . Chemotherapy in adult high-grade glioma: a
systematic review and meta-analysis of individual patient
data from 12 randomised trials. Lancet 2002 Mar 23;
359(9311):1011-8.
11. Francesconi AB, Dupre S, Matos M, Martin D, Hughes BG,
Wyld DK, Lickliter JD. .Carboplatin and etoposide combined
with bevacizumab for the treatment of recurrent glioblastoma
multiforme. J Clin Neurosci. 2010 Aug; 17(8): 970-4.
12. Lassen U, Kristjansen PE, Wagner A, Kosteljanetz M, Poulsen
HS. Treatment of newly diagnosed glioblastoma multiforme
with carmustine, cisplatin and etoposide followed by
radiotherapy. A phase II study. J Neurooncol. 1999 Jun;
43(2):161-6.
13. Balaa C, Lpez-Pousa A, Berrocal A, Yaya-Tur R, Herrero A,
Garca JL, Martn-Broto J, Benavides M, Cerd-Nicols M,
Ballester R, Balart J, Capellades J.Phase II study of
temozolomide and cisplatin as primary treatment prior to
radiotherapy in newly diagnosed glioblastoma multiforme
patients with measurable disease. A study of the Spanish
Medical Neuro-Oncology Group (GENOM). J Neurooncol.
2004 Dec;70(3):359-69.
14. Buckner JC, Ballman KV, Michalak JC, Burton GV, Cascino TL,
Schomberg PJ, Hawkins RB, Scheithauer BW, Sandler HM,
Marks RS, O'Fallon JR; North Central Cancer Treatment
Group 93-72-52; Southwest Oncology Group 9503 Trials
Phase III trial of carmustine and cisplatin compared with
18
carmustine alone and standard radiation therapy or

accelerated radiation therapy in patients with glioblastoma
multiforme: North Central Cancer Treatment Group 93-7252 and Southwest Oncology Group 9503 Trials. J Clin Oncol.
2006 Aug 20;24(24):3871-9.
15. Silvani A, Gaviani P, Lamperti EA, Eoli M, Falcone C, Dimeco
F, Milanesi IM, Erbetta A, Boiardi A, Fariselli L, Salmaggi A.
Cisplatinum and BCNU chemotherapy in primary glioblastoma
patients. J Neurooncol. 2009 Aug;94(1): 57-62. Epub 2009
Feb 11.
16. Zustovich F, Lombardi G, Della Puppa A, Rotilio A, Scienza R,
Pastorelli D. A phase II study of cisplatin and temozolomide
in heavily pre-treated patients with temozolomiderefractory high-grade malignant glioma. Anticancer Res.
2009 Oct; 29(10): 4275-9.
17. Vredenburgh JJ, Desjardins A, Herndon JE 2nd, Marcello J,
Reardon DA, Quinn JA, Rich JN, Sathornsumetee S,
Gururangan S, Sampson J, Wagner M, Bailey L, Bigner DD,
Friedman AH, Friedman HS. Bevacizumab plus irinotecan in
recurrent glioblastoma multiforme. J Clin Oncol. 2007 Oct
20; 25(30): 4722-9.
18. Kreisl TN, Kim L, Moore K, Duic P, Royce C, Stroud I, Garren
N, Mackey M, Butman JA, Camphausen K, Park J, Albert PS,
Fine HA. Phase II trial of single-agent bevacizumab followed
by bevacizumab plus irinotecan at tumor progression in
recurrent glioblastoma. J Clin Oncol. 2009 Feb 10;27(5):7405. Epub 2008 Dec 29.
19
Tumores Neuroendcrinos
Adriamicina + Estreptozotocina
Adriamicina: 50 mg/m2 IV D1 e 22
Estreptozotocina: 500 mg/m2/dia IV D15
cada 6 semanas
Ref. (1)
EP
Cisplatina: 45 mg/m2/dia IV por infuso contnua D2 e D3
Etoposide: 130 mg/m2/dia IV por infuso contnua nos D1-3
a cada 21 dias
Ref. (2)
EP
Etoposide: 100 mg/m2 IV D1-3
Cisplatina: 25 mg/m2 IV D1-3
a cada 21 dias
Ref. (3)
Carboplatina + radioterapia
Carboplatina: AUC 2, semanal, durante radioterapia Ref. (6)
Octreotide
Octreotide: 150250 g SC uma a trs vezes por dia Ref. (4)
Octreotide LAR: 20 a 40 mg IM 1x/ms
Ref. (5)
20
5-Fluorouracil + Octreotide
5-Fluorouracil: 200mg/m2 IV diariamente
Octreotide LAR: 20mg IM mensalmente
Ref. (7)
Everolimo + Octreotide
Everolimo: 5 a 10mg/dia VO
Octreotide LAR: 30mg/ms IM
Ref. (8)
PCE
Paclitaxel: 200mg/m2 IV em 1 hora D1
Etoposide VO alternando 50mg e 100mg diariamente , D1 a D10
a cada 21 dias
Ref. (10)
Irinotecano + Cisplatina
a cada 21 dias
Ref. (11)
Temozolamida + Talidomida
Temozolamida: 150mg/m2 VO por 7 dias, a cada 15 dias
Talidomida: 50 a 400mg VO diariamente.
Ref. (12)
Etoposide e Carboplatina associado a Radioterapia
Etoposide: 80mg/m2 D1 a D3 IV
Carboplatina: AUC 4.5 IV
Semanas 1, 4, 7 e 10
Ref. (13)
FDE
Fluorouracil: 500mg/m2 IV D1 a D3
Dacarbazina: 200mg/m2 IV D1 a D3
Epirrubicina: 30mg/m2 IV D1 a D3
a cada 21 dias
Ref. (14)
Interferon alpha 2a
Interferon 6 x 106 UI diariamente x 8 semanas, seguido por 6 x
106 UI , trs vezes por semana
Ref. (15)
Everolimo
10 mg VO dia uso contnuo
Ref. (16)
1. Moertel CG, et al. Streptozocin-Adriamicina, streptozocinfluorouracil,or chlorozotocin in the treatment of advanced

islet-cell carcinoma. N Engl J Med 1992;326:519526.
21
2. Moertel CG, et al. Treatment of neuroendocrine carcinomas

with combined etoposide and cisplatin. Cancer 1991; 68:227232.
3. Longeval E, et al. Combination chemotherapy with cisplatin
and etoposide in bronchogenic squamous cell carcinoma
adenocarcinoma.A study by the EORTC lung cancer working
party. Cancer. 1982; 50:27512756.
4. Saltz L, et al. Octreotide as an antineoplastic agent in the
treatmentof functional and nonfunctional neuroendocrine
tumors. Cancer 1993;72:244.
5. Rubin J. et al Octreotide Acetate Long-Acting Formulation
Versus Open-Label Subcutaneous Octreotide Acetate in
Malignant Carcinoid Syndrome. J Clin Oncol 17:600, 1999.
6. Poulsen M, Walpole E, Harvey J, Dickie G, O'Brien P, Keller J,
Tripcony L, Rischin D. Weekly carboplatin reduces toxicity
during synchronous chemoradiotherapy for Merkel cell
carcinoma of skin. Int J Radiat Oncol Biol Phys. 2008 Nov
15;72(4):1070-4.
7. Brizzi MP, Berruti A, Ferrero A, Milanesi E, Volante M,
Castiglione F, Birocco N, Bombaci S, Perroni D, Ferretti B,
Alabiso O, Ciuffreda L, Bertetto O, Papotti M, Dogliotti L.
Continuous 5-fluorouracil infusion plus long acting
octreotide in advanced well-differentiated neuroendocrine
carcinomas. A phase II trial of the Piemonte oncology
network. BMC Cancer. 2009 Nov 3;9:388.
8. Yao JC, Phan AT, Chang DZ, Wolff RA, Hess K, Gupta S, Jacobs
C, Mares JE, Landgraf AN, Rashid A, Meric-Bernstam F. Efficacy
of RAD001 (everolimus) and octreotide LAR in advanced
low- to intermediate-grade neuroendocrine tumors: results
of a phase II study J Clin Oncol. 2008 Sep 10;26(26):4311-8.
ERRATUM J Clin Oncol. 2008 Dec 1; 26 (34) 5660.
10. Hainsworth JD, Spigel DR, Litchy S, Greco FA. Phase II trial of
paclitaxel, carboplatin, and etoposide in advanced poorly
differentiated neuroendocrine carcinoma: a Minnie Pearl
Cancer Research Network Study. J Clin Oncol. 2006 Aug 1;
24(22):3548-54.
22
11. Kulke MH, Wu B, Ryan DP, Enzinger PC, Zhu AX, Clark JW,
Earle CC, Michelini A, Fuchs CS. A phase II trial of irinotecan
and cisplatin in patients with metastatic neuroendocrine
tumors. Dig Dis Sci, 2006 Jun;51(6): 1033-8.
12. Kulke MH, Stuart K, Enzinger PC, Ryan DP, Clark JW,
Muzikansky A, Vincitore M, Michelini A, Fuchs CS. Phase II
study of temozolomide and thalidomide in patients with
metastatic neuroendocrine tumors. J Clin Oncol. 2006 Jan
20;24(3):401-6.
13. Poulsen M, Rischin D, Walpole E, Harvey J, Mackintosh J,
Ainslie J, Hamilton C, Keller J, Tripcony L; Trans-Tasman
Radiation Oncology Group High-risk Merkel cell carcinoma
of the skin treated with synchronous carboplatin/etoposide
and radiation: a Trans-Tasman Radiation Oncology Group
Study--TROG 96:07. J Clin Oncol. 2003 Dec 1;21(23):4371-6.
14. Bajetta E, Rimassa L, Carnaghi C, Seregni E, Ferrari L, Di
Bartolomeo M, Regalia E, Cassata A, Procopio G, Mariani L. 5Fluorouracil, dacarbazine, and epirubicin in the treatment of
patients with neuroendocrine tumors. Cancer. 1998 Jul 15;
83(2):372-8.
15. Bajetta E, Zilembo N, Di Bartolomeo M, Di Leo A, Pilotti S,
Bochicchio AM, Castellani R, Buzzoni R, Celio L, Dogliotti L, et
al. Treatment of metastatic carcinoids and other
neuroendocrine tumors with recombinant interferonalpha-2a. A study by the Italian Trials in Medical Oncology
Group. Cancer. 1993 Nov 15;72(10):3099-105.
16. Yao, James C. M.D.; Shah, Manisha H. M.D.; Ito, Tetsuhide
M.D. et. al. Everolimus for Advanced Pancreatic
Neuroendocrine Tumors. N Engl J Med. 2011; 364 (6): 514523.
23
Cncer Anal
5-Fluorouracil + Mitomicina C
5-Fluorouracil: 1,000 mg/m2/dia IV por infuso contnua D14 e
D2932 concomitante a radioterapia
Mitomicina C: 15 mg/m2 IV no D1
Ref. (1)
5-Fluorouracil + Mitomicina C
5-Fluorouracil: 750 mg/m2/dia IV infuso contnua D1-5 e
D2933, concomitante a radioterapia
Mitomicina C: 15 mg/m2 IV no D1
Ref. (2)
5-Fluorouracil + Cisplatina
5-Fluorouracil: 1,000 mg/m2/dia IV infuso contnua nos D1 a 5
Ref. (3)
Capecitabina + Mitomicina C
Capecitabina: 825mg/m2 VO BID durante os dias da radioterapia
Mitomicina C: 12mg/m2 IV D1
Ref. (4)
1. Nigro ND, et al. Combined preoperative radiation and

chemotherapy for squamous cell carcinoma of the anal
canal. Cancer 1983;51:18261829.
2. Bartelink H, et al. Concomitant radiotherapy and chemotherapy
is superior to radiotherapy alone in the treatment of locally
advanced anal cancer: results of a phase III randomized trial
of the European Organization por Research e Treatment of
24
Cancer Radiotherapy and Gastrointestinal Cooperative

Groups. J Clin Oncol 1997;15:20402049.
3. Hung A, et al. Cisplatin-based combined modality therapy for
anal carcinoma: a wider therapeutic index. Cancer 2003;
97:11951202.
4. Glynne-Jones R; Meadows H; Wan S; Gollins S; Leslie M;
Levine E; McDonald AC; Myint S; Samuel L; SebagMontefiore D. Multicenter Phase II Study of Chemoradiation
Using a 5 Day per Week Oral Regimen of Capecitabine and
Intravenous Mitomycin C in Anal Cancer. Int J Radiat Oncol
Biol Phys. 2008 May 7.
25
Cncer Colo-retal
5-Fluorouracil + Radioterapia
5-Fluorouracil: 1,000 mg/m2/dia IV infuso contnua D1 a 5
Repetir nas semanas 1 e 5 da radioterapia
5-Fluorouracil: 500 mg/m2 IV contnuo durante 5 dias a cada 28
dias por 4 ciclos
Ref. (1)
Capecitabina + Radioterapia
Capecitabina: 825 mg/m2 VO BID durante toda a radioterapia
Ou
Capecitabina: 9001,000 mg/m2 VO BID D15 de cada semana
da radioterapia
Ref. (2)
5-Fluorouracil + Leucovorin (Mayo Clinic)
5-Fluorouracil: 425 mg/m2 IV D5
Leucovorin: 20 mg/m2 IV D15 (administrado antes do 5Fluorouracil)
a cada 28 dias
Ref. (3)
5-Fluorouracil + Leucovorin (Roswell Park)
5-Fluorouracil: 500 mg/m2 IV semanalmente por 6 semanas
Leucovorin: 500 mg/m2 IV em 2 horas semanalmente por
6 semanas, administrado antes do 5-Fluorouracil
a cada 8 semanas
Ref. (4)
5-Fluorouracil + Leucovorin
Leucovorin: 20 mg/m2 IV semanalmente por 6 semanas,
Administrado antes do 5-Fluorouracil
a cada 8 semanas
Ref. (5)
26
Quasar
5-Fluorouracil: 370mg/m2 IV
Leucovorin: 25 ou 175mg IV (dose fixa)
Uma vez por semana, por 30 semanas (29, 38)
FOLFOX4
Oxaliplatina: 85 mg/m2 IV D1
5-Fluorouracil: 400 mg/m2 IV pulso, seguido por 600 mg/m2
IV infuso contnua por 22 horas D1 e 2
Leucovorin: 200 mg/m2 IV D1 e 2 em uma infuso de 2 horas,
antes do 5-Fluorouracil.
a cada 2 semanas
Ref. (6)
FLOX Nrdico
Oxaliplatina: 85mg/m2 IV em 2 horas D1
5-Fluorouracil: 500mg/m2 IV pulso D1 e D2
Leucovorin: 60mg/m2 IV pulso D1 e D2
Intervalo a cada 14 dias
Ref. (30)
ROX
Oxaliplatina: 85mg/m2 IV 2 horas D1 e D15
Leucovorin: 250mg/m2 IV 2horas D1, 8 e15
5-Fluorouracil: 500mg/m2 IV pulso, D1, 8 e 15 a cada 4 semanas (31)
Capecitabina
Capecitabina: 1,250 mg/m2 VO BID D114
a cada 21 dias
Ref. (7)
Irinotecano + 5-Fluorouracil + Leucovorin (IFL)

Irinotecano: 125 mg/m2 IV em 90 minutos semanalmente por 4
semanas
Leucovorin: 20 mg/m2 IV semanalmente por 4 semanas
a cada 6 semanas
Ref. (8)
27
Irinotecano + 5-Fluorouracil + Leucovorin (IFL) +

Bevacizumabe (BV)
Irinotecano: 125 mg/m2 IV em 90 minutos semanalmente por
4 semanas (D1, 8, 15, 22)
5-Fluorouracil: 500 mg/m2 IV semanalmente por 4 semanas (D1,
8, 15, 22)
Leucovorin: 20 mg/m2 IV semanalmente por 4 semanas (D1,
8,15, 22)
Bevacizumabe: 5 mg/kg IV a cada 2 semanas D1,15
a cada 6 semanas
Ref. (9)
IFL (Regime de Douillard)
Irinotecano: 180 mg/m2 IV D1
IV infuso contnua por 22 horas D1 e 2
Leucovorin: 200 mg/m2 IV D1 e 2 em 2 horas (infundir antes do
5-Fluorouracil)
a cada 2 semanas
Ref. (11)
FOLFIRI
5-Fluorouracil: 400 mg/m2 IV pulso D1, seguido por
2.400 mg/m2 IV infuso contnua por 46 horas.
Leucovorin: 200 mg/m2 IV D1 em 2 horas (infundir antes do 5Fluorouracil)
a cada 2 semanas
Ref. (12)
FOLFOX6
2.400 mg/m2 IV por infuso contnua em 46 horas.
a cada 2 semanas
Ref. (13)
28
m FOLFOX6
Oxaliplatina: 85 mg/m2 IV em 2 horas D1
Leucovorin: 350 mg/m2 IV em 2 horas D1
2.400 mg/m2 IV em infuso contnua de 46 horas.
a cada 2 semanas por 12 ciclos
Ref. (39)
FOLFOX7
5-Fluorouracil: 2.400 mg/m2 IV infuso contnua D1 e 2 por 46
horas.
a cada 2 semanas
Ref. (13)
FOLFOXIRI
Irinotecano: 150mg/m2 IV D1
Leucovorin: 200mg/m2 IV D2 e D3
5-Fluorouracil: 400mg/m2 IV pulso D2 e D3
5-Fluorouracil: 600mg/m2 IV em infuo contnua D2 e D3
a cada 15 dias
Ref. (32)
Cetuximabe + Irinotecano
Cetuximabe: 400 mg/m2 IV dose de ataque, seguido de
250 mg/m2
IV semanalmente
a cada 21 dias
Ref. (14)
XELOX
Capecitabina + Oxaliplatina
a cada 21 dias
29
Capecitabina: 1.750 mg/m2 VO BID D17

a cada 14 dias
Ref. (15)
XELIRI
a cada 21 dias
Ref. (16)
IROX
Oxaliplatina + Irinotecano
a cada 3 semanas
Ref. (17)
Raltitrexede + Oxaliplatina
Raltitrexede: 2,5mg/m2 IV em 15 minutos D1
Oxaliplatina: 100mg/m2 IV em 180 minutos D1
a cada 3 semanas
Ref. (33)
Raltitrexede: 3mg/m2 IV D1
a cada 4 semanas
Ref. (34)
Ou
Raltitrexede: 3mg/m2 IV D1 a cada 3 semanas
Mitomicina C: 7mg/m2 IV D1 a cada 6 semanas
Ref. (35)
Ou
Raltitrexede: 3mg/m2 IV D1
a cada 3 a 4 semanas
30
Ref. (28)
5-Fluorouracil + Leucovorin + Bevacizumabe

Leucovorin: 500 mg/m2 IV semanalmente por 6 semanas,
Administrado antes do 5-Fluorouracil
Bevacizumabe: 5 mg/kg IV a cada 2 semanas
a cada 8 semanas
Ref. (18)
de Gramont Regimen
5-Fluorouracil: 400 mg/m2 IV seguido de 600 mg/m2 IV por
22 horas D1 e D2
Leucovorin: 200 mg/m2 IV D1 e 2 em infuso de 2 horas
a cada 2 semanas
Ref. (19)
FOLFOX4 + Bevacizumabe
IV por infuso contnua D1 e D2
Leucovorin: 200 mg/m2 IV D1 e 2 em infuso de 2 horas antes do
5-Fluorouracil
Bevacizumabe: 10 mg/kg IV a cada 2 semanas
a cada 2 semanas
Ref. (20)
Capecitabina + Oxaliplatina (XELOX) + Bevacizumabe
Capecitabina: 850 mg/m2 VO BID D114
Bevacizumabe: 7.5 mg/kg a cada 3 semanas
a cada 21 dias
Ref. (21)
FLOX
Oxaliplatina: 85mg/m2 IV em duas horas D1,15,29
Leucovorin: 500mg/m2 IV D1, 8, 15, 22, 29, 36
5-Fluorouracil: 500mg/m2 IV D1, 8, 15, 22, 29, 36
Ref. (27)
31
Capecitabina
a cada 21 dias
Ref. (22)
Irinotecano (CPT11) (semanal)

Irinotecano: 125 mg/m2 IV em 90 minutos semanalmente
por 4 semanas.
a cada 6 semanas
Ref. (23)
Irinotecano: 125 mg/m2 IV em 90 minutos semanalmente por
2 semanas. A cada 3 semanas.
Irinotecano: 175 mg/m2 IV D1 e 10
a cada 3 semanas
Ref. (24)

a cada 3 semanas
Ref. (25)
Cetuximabe
Cetuximabe: 400 mg/m2 IV dose de ataque, seguido por
250 mg/m2
IV semanalmente
Ref. (26)
Cetuximabe + Irinotecano
Irinotecano: 180mg/m2 IV D1
Cetuximabe: 500mg/m2 IV D1
a cada 15 dias
b-Fol
Oxaliplatina: 85mg/m2 D1 e 15
Leucovorin: 20mg/m2 D1, 8 e 15
5-Fluorouracil: 500mg/m2 D1, 8 e 15
a cada 28 dias
Ref. (40)
32
Ref. (36, 37)
uFT
Leucovorin: 90 mg/dia
VO D1 a D28
2
UFT: 100 mg/m trs vezes ao dia VO D1 a D28 a cada 35 dias
Ref. (41)
FOLFIRI com bevacizumabe
Irinotecano:180 mg/m2
IV
D1
Leucovorin: 200 mg/m2
IV
D1
2
5-Fluorouracil: 400 mg/m IV pulso
D1
5-Fluorouracil: 2400 mg/m2 IV em infuso de 46 horas D1
Bevacizumabe: 5 mg/kg IV
D1
a cada 14 dias
Ref. (42)
1. Sauer R, et al. Preoperative versus postoperative

chemoradiotherapy for rectal cancer. N Engl J Med
2004;351:17311740.
2. Minsky BD. Combined modality therapy of rectal cancer with
oxaliplatin-based regimens. Clin Colorectal Cancer 2004; 4
Suppl 1:S2936.
3. OConnell MJ, et al. Controlled trial of fluorouracil and lowdose leucovorin given por6 months as postoperative
adjuvant therapy for colon cancer. J Clin Oncol 1997; 15:
246250.
4. Wolmark N, et al. The benefit of leucovorin-modulated
fluorouracil as postoperative adjuvant therapy for primary
colon cancer: results from National Surgical Adjuvant Breast
eBowel Project Protocol C-03. J Clin Oncol 1993; 11:
18791887.
5. Benson AB, et al. NCCN practice guidelines for colorectal
cancer. Oncology 2000;14:203212.
6. de Gramont A, et al. Oxaliplatin/5-FU/LV in adjuvant colon
cancer: results of the international randomized mosaic trial.
Proc Am Soc Clin Oncol 2003;22:253 (abstract 1015).
33
7. Cassidy J, et al. Capecitabine (X) vs. bolus 5-FU/leucovorin

(LV) as adjuvant therapy porcolon cancer (the X-ACT study):
positive efficacy results of a phase III trial. Proc Am Soc Clin
Oncol 2004;23:(abstract3509).
8. Saltz LB, et al. Irinotecan plus fluorouracil eleucovorin pormetastatic
colorectal cancer. N Engl J Med 2000; 343: 905914.
9. Hurwitz H, et al. Bevacizumab plus irinotecan, fluorouracil,
and leucovorin pormetastatic colorectal cancer. N Engl J
Med 2004;350: 23352342.
10. Hwang JJ, et al. Capecitabine-based combination chemotherapy.
Am J Oncol Rev 2003;2 (Suppl 5):1525.
11. Douillard JY, et al. Irinotecan combined with fluorouracil
compared with fluorouracil alone as first-line treatment for
metastatic colorectal cancer: a multicentre randomized trial.
Lancet 2000; 355: 10411047.
12. Andre T, et al. CPT-11 (irinotecan) addition to bimonthly,
highdose leucovorin ebolus econtinuous-infusion 5fluorouracil (FOLFIRI) porpretreated metastatic colorectal
cancer. GERCOR. Eur J Cancer 1999;35:13431347.
13. de Gramont A, et al. Leucovorin efluorouracil with ewithout
oxaliplatin as first-line treatment in advanced colorectal
cancer. J Clin Oncol 2000;18:29382947.
14. Cunningham D, et al. Cetuximab monotherapy ecetuximab
plus irinotecan in irinotecan-refractory metastatic colorectal
cancer. N Engl J Med 2004;351:337345.
15. Scheithauer W, et al. Randomized multicenter phase II trial
of two different schedules of capecitabine plus oxaliplatin
as first-line treatment in advanced colorectal cancer. J Clin
Oncol 2003;21: 13071312.
16. Kerr D. Capecitabine/irinotecan in colorectal cancer: European
early-phase data eplanned trials. Oncology 2002;16 (Suppl
14):1215.
17. Goldberg RM, et al. A randomized controlled trial of
fluorouracil plus leucovorin, irinotecan, and oxaliplatin
combinations in patients with previously untreated
34
metastatic colorectal cancer. J Clin Oncol 2004;22:2330.

18. Kabbinavar F, et al. Results of a randomized phase II
controlled trial of bevacizumab in combination with 5fluorouracil eleucovorin as first-line therapy in subjects with
metastatic CRC. Proc Am Soc Clin Oncol 2004;23:Abstract
3516.
19. de Gramont A, et al. Randomized trial comparing monthly
lowdose leucovorin efluorouracil bolus with bimonthly
high-dose leucovorin
and fluorouracil bolus plus
continuous infusion for advanced colorectal cancer: a
French Intergroup study. J Clin Oncol 1997;15:808815.
20. Mitchell EP, et al. High-dose bevacizumab in combination
with FOLFOX4 improves survival in patients with previously
treated advanced colorectal cancer: results from the Eastern
Cooperative Oncology Group (ECOG) study E3200.
Presented at the 2005 American Society of Clinical
Oncology Gastrointestinal Cancers Symposium; January
2729, 2005 Hollywood, FL (abstract 169a).
21. Hochster HS, et al. Bevacizumab (B) with oxaliplatin (O)based chemotherapy in the first-line therapy of metastatic
colorectal cancer (mCRC): Preliminary results of the randomized
TREE-2 trial. Presented at the American Society of Clinical
Oncology Gastrointestinal Cancers Symposium; January
2729, 2005 Hollywood, FL (abstract 241).
22. Hoff P, et al. Comparison of oral capecitabine versus
intravenous fluorouracil plus leucovorin as first-line
treatment in 605 patients with metastatic colorectal cancer:
results of a randomized phase III study. J Clin Oncol
2001;15:22822292.
23. Pitot HC, et al. Phase II trial of irinotecan in patients with
metastatic colorectal carcinoma. J Clin Oncol 1997; 15: 29102919.
24. Ulrich-Pur H, et al. Multicenter phase II trial of dosefractionated irinotecan in patients with advanced colorectal
cancer failing oxaliplatin- based first-line combination
chemotherapy. Ann Oncol 2001; 12:12691272.
35
25. Rougier P, et al. Phase II study of irinotecan in the treatment

of advanced colorectal cancer in chemotherapy-nave
patients and patients pretreated with fluorouracil-based
chemotherapy. J Clin Oncol 1997;15:251260.
26. Saltz LB, et al. Phase II trial of cetuximab in patients with
refractory colorectal cancer that expressed the epidermal
growth factor receptor. J Clin Oncol 2004;22:12011208.
27. Kuebler JP et al: Oxaliplatin combined with weekly bolus of
fluorouracil and leucovorin as surgical adjuvant
chemotherapy for stage II and III colon cancer: results from
NSABP C07. J Clin Oncol. 2007; 25:2198-2204.
28. Murad AM, Aragao BC, Guimares RC. Phase II Trial of the
Use of Raltitrexed and Mitomycin-C in the Treatment of
Advanced Colorectal Cancer after 5FU Failure: Final Results.
Proc Am Soc Clin Oncol, 2001 (20) abst 2188.
29. D. J. Kerr, R. Gray, C. McConkey & J. Barnwell for the QUASAR
Colorectal Cancer Study Group. Adjuvant chemotherapy
with 5-fluorouracil, L-folinic acid and levamisole for patients
with colorectal cancer: Non-randomised comparison of
weekly versus four-weekly schedules - less pain, same gain.
Ann Oncol (2000) 11 (8): 947-955.
30. Srbye H, Glimelius B, Berglund A, Fokstuen T, Tveit KM,
Braendengen M, greid D, Dahl O. Multicenter phase II
study of Nordic fluorouracil and folinic acid bolus schedule
combined with oxaliplatin as first-line treatment of metastatic
colorectal cancer. J Clin Oncol. 2004 Jan 1; 22(1): 31-8.
31. Yamada Y, Ohtsu A, Boku N, Miyata Y, Shimada Y, Doi T, Muro
K, Muto M, Hamaguchi T, Mera K, Yano T, Tanigawara Y,
Shirao K. Phase I/II study of oxaliplatin with weekly bolus
fluorouracil and high-dose leucovorin (ROX) as first-line
therapy for patients with colorectal cancer. Jpn J Clin Oncol.
2006 Apr; 36(4):218-23.
32. Souglakos J, Androulakis N, Syrigos K, Polyzos A, Ziras N,
Athanasiadis A, Kakolyris S, Tsousis S, Kouroussis Ch,
Vamvakas L, Kalykaki A, Samonis G, Mavroudis D,
36
Georgoulias V. FOLFOXIRI (folinic acid, 5-fluorouracil,

oxaliplatin and irinotecan) vs FOLFIRI (folinic acid, 5fluorouracil and irinotecan) as first-line treatment in
metastatic colorectal cancer (MCC): a multicentre randomised
phase III trial from the Hellenic Oncology Research Group
(HORG). Br J Cancer. 2006 Mar 27; 94(6):798-805.
33. Cortinovis D, Bajetta E, Di Bartolomeo M, Dognini G, Beretta
E, Ferrario E, Ricotta R, Buzzoni R. Raltitrexed plus oxaliplatin
in the treatment of metastatic colorectal cancer. Tumori.
2004 Mar-Apr; 90(2):186-91.
34. Rosati G, Rossi A, Germano D, Reggiardo G, Manzione L.
Raltitrexed and mitomycin-C as third-line chemotherapy for
colorectal cancer after combination regimens including 5fluorouracil, irinotecan and oxaliplatin: a phase II study.
Anticancer Res. 2003 May-Jun; 23(3C):2981-5.
35. Michels J, Geldart T, Darby A, Craddock L, Iveson A,
Richardson L, Iveson T. The combination of raltitrexed
(Tomudex) and mitomycin-C in the treatment of advanced
colorectal cancer - a phase II study. Clin Oncol (R Coll Radiol).
2006 Aug;18(6):431-5.
36. P Martn-Martorell1, S Rosello 1, E Rodrguez-Braun1, I
Chirivella1, A Bosch1 and A Cervantes 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
British Journal of Cancer (2008) 99, 455458.
37. Pfeiffer P., D. Nielsen, J. Bjerregaard, C. Qvortrup, M. Yilmaz
& B. Jensen. Biweekly cetuximab and irinotecan as third-line
therapy in patients with advanced colorectal cancer after
failure to irinotecan, oxaliplatin and 5-fluorouracil Annals of
Oncology 19: 11411145, 2008
38. Gray R, Barnwell J, McConkey C et al. Quasar Collaborative
Group. Adjuvant chemotherapy versus observation in
patients with colorectal cancer: a randomised study. Lancet.
2007 Dec 15;370(9604):2020-9.
37
39. Hochster HS, Hart LL, et al. Safety and Efficacy of Oxaliplatin
and Fluoropyrimidine Regimens With or Without
Bevacizumab as First-Line Treatment of Metastatic
Colorectal Cancer: Results of the TREE Study. J Clin Oncol;
2008:26:3523-3529.
40. H. S. Hochster, A. Chachoua, J. Speyer, et al. Oxaliplatin with
weekly bolus 5FU and low-dose leucovorin (bFOL) as firstline therapy of colorectal cancer; a phase II study.
41. Lembersky BC, et al. Oral Uracil and Tegafur Plus Leucovorin
Compared With Intravenous Fluorouracil and Leucovorin in
Stage II and III Carcinoma of the Colon: Results From
National Surgical Adjuvant Breast and Bowel Project
Protocol C-06. J Clin Oncol 2006;24:2059-64.
42. Kopetz SM, et al., Preliminary results from a phase II study of
infusional 5-FU, leucovorin, and irinotecan (FOLFIRI) plus
bevacizumab as first-line treatment for metastatic colorectal
cancer (mCRC), ASCO Annual Meeting Proceedings Part I, J
Clin Oncol, 2006; 24, No 18S (Supplement): (Abstract 3579).
38
Cncer de Intestino Delgado

CAPOX
Capecitabina: 750mg/m2 VO BID D1 a D14
Ref. (1)
FAM
5-Fluorouracil: 600mg/m2 IV D1,8,29 e 36.
Doxorrubicina: 30mg/m2 IV D1 e D29
Ref. (2)
a cada 28 dias
Ref. (5)
FOLFOX
Oxaliplatina: 85 ou 100 ou 135mg/m2 IV em 2 horas D1
Leucovorin: 400mg/m2 IV em 2 horas D1
5-Fluorouracil: 400mg/m2 IV em pulso D1
5-Fluorouracil: 2400mg/m2 IV em 48 horas, infuso contnua
a cada 15 dias
Ref. (3, 4)
FOLFIRI
Irinotecano: 180mg/m2 IV em 90 minutos D1
5-Fluorouracil: 400mg/m2 IV em pulso D1
5-Fluorouracil: 2400mg/m2 IV em 48 horas, infuso contnua
a cada 15 dias
Ref. (4, 5)
1. Overman MJ, Varadhachary GR, Kopetz S, Adinin R, Lin E,

Morris JS, Eng C, Abbruzzese JL, Wolff RA. Phase II study of
39
capecitabine and oxaliplatin for advanced adenocarcinoma

of the small bowel and ampulla of Vater. J Clin Oncol. 2009
Jun 1;27(16):2598-603.
2. Gibson MK, Holcroft CA, Kvols LK, Haller D. Phase II study of
5-fluorouracil, doxorubicin, and mitomycin C for metastatic
small bowel adenocarcinoma. Oncologist. 2005;10(2):132-7.
3. Overman MJ, Kopetz S, Wen S, Hoff PM, Fogelman D, Morris J,
Abbruzzese JL, Ajani JA, Wolff RA. Chemotherapy with 5fluorouracil and a platinum compound improves outcomes
in metastatic small bowel adenocarcinoma. Cancer. 2008;
113(8):2038-45.
4. Kocher C, Malka D, Boige V, Lebray P, Elias D, Lasser P, Ducreux
M. Combination chemotherapy in advanced small bowel
adenocarcinoma. Oncology. 2005;69(4):290-4.
5. Fishman PN, Pond GR, Moore MJ, Oza A, Burkes RL, Siu LL,
Feld R, Gallinger S, Greig P, Knox JJ. Natural history and
chemotherapy effectiveness for advanced adenocarcinoma
of the small bowel: a retrospective review of 113 cases. Am
J Clin Oncol. 2006;29(3):225-31.
40
Cncer de Esfago
5-Fluorouracil + Cisplatina + Radioterapia
5-Fluorouracil: 1.000 mg/m2/dia IV infuso contnua D1 a D4
Cisplatina: 75 mg/m2 IV no D1
Repetir nas semanas 1, 5, 8, e 11
Ref. (1)
5-Fluorouracil + Cisplatina + Radioterapia
(Esquema Hopkins/Yale)
5-Fluorouracil: 225 mg/m2/dia IV infuso contnua D1 a D30
Cisplatina: 20 mg/m2/dia IV D15 e 2630
Paclitaxel: 135 mg/m2 IV em 24 horas D1
a cada 21 dias por 3 ciclos
Ref. (2)
5-Fluorouracil + Cisplatina
5-Fluorouracil: 1.000 mg/m2/dia IV infuso contnua D1 a D5.
Semanas 1, 5, 8, e 11
Ref. (3)
Irinotecano: 65 mg/m2 IV semanalmente por 4 semanas
Cisplatina: 30 mg/m2 IV semanalmente por 4 semanas
a cada 6 semanas
Ref. (4)
Paclitaxel + Cisplatina
a cada 21 dias
Ref. (5)
Paclitaxel
a cada 21 dias
Ref. (6)
41
ECF
Epirrubicina: 50mg/m2 IV D1
5-Fluorouracil: 225 mg/m2/dia IV D1 ao D21
a cada 21 dias
Ref. (7)
Oxaliplatina e Capecitabina
Capecitabina: 1700mg/m2/dia VO D1 a D14
a cada 21 dias
Ref. (8)
EP
Cisplatina: 30 mg/m2 IV D1 a D4
Etoposide: 120 mg/m2 IV D1 a D4
a cada 28 dias
Ref. (9)
Paclitaxel, Carboplatina e 5-Fluorouracl
Paclitaxel: 200 mg/m2
IV
D1 e D22
Carboplatina: AUC6
IV
D1 e D22
2
5-Fluorouracil: 225 mg/m /dia
IV contnuo
D1 a D42
* Regime aplicado junto com a radioterapia no pr-operatrio.
A cirurgia realizada 4 a 5 semanas aps o trmino do
tratamento combinado.
Ref. (10)
Gencitabina, 5-Fluorouracil e Leucovorin
Gencitabina: 1000 mg/m2 IV
D1, D8 e D15
2
5-Fluorouracil: 600 mg/m IV
D1, D8 e D15
Leucovorin: 25 mg/m2
IV
D1, D8 e D15 a cada 28 dias
Ref. (11)
42
1. Herskovic A, et al. Combined chemotherapy eradiotherapy

compared with radiotherapy alone in patients with cancer
of the esophagus. N Engl J Med 1992;326:15931598.
2. Heath El, et al. Phase II evaluation of preoperative chemoradiation
and postoperative adjuvant chemotherapy porsquamous
cell and adenocarcinoma of the esophagus. J Clin Oncol
2000;18:868876.
3. Kies MS, et al. Cisplatin e5-fluorouracil in the primary management
of squamous esophageal cancer. Cancer 1987;60:21562160.
4. Ilson DH, et al. Phase II trial of semanalmente irinotecan plus
cisplatin in first line advanced esophageal cancer. J Clin
Oncol 1999;17: 32703275.
5. Ilson DH, et al. Phase II trial of paclitaxel, fluorouracil,
ecisplatin in patients with advanced carcinoma of the
esophagus. J Clin Oncol 1998;16:18261834.
6. Ajani JA, et al. Paclitaxel in the treatment of carcinoma of the
esophagus. Semin Oncol 1995;22 (Suppl 6):3540.
7. Cunningham D et al. Perioperative Chemotherapy versus
Surgery Alone for Resectable Gastroesophageal Cancer. N
Engl J Med. 2006; 355:11-20.
8. Jatoi A et al. Oxaliplatin and capecitabine in patients with
metastatic adenocarcinoma of the esophagus, gastroesophageal
junction and gastric cardia: a phase II study from the North
Central Cancer Treatment Group. Ann Oncol. 2006. 17; 29-34.
9. Hejna M, Kornek GV et al. Effective radiochemotherapy with
cisplatin and etoposide for the management of patients
with locally inoperable and metastatic esophageal carcinoma.
Cancer 1996 15(78): 1646-50.
10. Melucti M,et al. Preoperative therapy with concurrent paclitaxel/
carboplatin/infusional 5-FU and radiation therapy in locoregional
esophageal cancer: final results of a Minnie Pearl Cancer
Research Network phase II trial. Canicer J 2003;9:251-60.
11. Morgan-Meadows, et al. A phase II trial of gemcitabine, 5fluorouracil and leucovorin in advanced esophageal carcinoma.
Oncology 2005;69:130-4.
43
Cncer Gstrico e Juno

Gastroesofgica
Quimioterapia concomitante a radioterapia
(Esquema de MacDonald)
5-Fluorouracil: 425 mg/m2 IV D1 a D5
Leucovorin: 20 mg/m2 IV D1 a D5
Radioterapia iniciando no D28 do primeiro ciclo associada a 2
ciclos de quimioterapia conforme abaixo:
5-Fluorouracil: 400 mg/m2 IV D1-4 e D23-25 da radioterapia
Leucovorin: 20 mg/m2 IV D1-4 e D23-25 da radioterapia
Aps trmino da radioterapia repetir mais dois ciclos de
5-Fluorouracil: 425 mg/m2 IV D1 a D5
Leucovorin: 20 mg/m2 IV D1 a D5
Ref. (1)
DCF
Docetaxel: 75 mg/m2 IV D1
Cisplatina: 75 mg/m2 IV em 3 horas D1
a cada 21 dias
Ref. (2)
CF
Cisplatina: 100 mg/m2 IV em 3 horas D1
5-Fluorouracil: 1.000 mg/m2/dia IV por infuso contnua D1 a D5
a cada 28 dias
Ref. (2)
ECF
Epirubicina: 50 mg/m2 IV D1
5-Fluorouracil: 200 mg/m2/dia IV infuso contnua por 21 dias
a cada 21 dias
Ref. (4)
44
ELF
Etoposide: 120 mg/m2 IV D1 a 3
Leucovorin: 300 mg/m2 IV D1 a 3
5-Fluorouracil: 500 mg/m2 IV D1 a 3
a cada 28 dias
Ref. (5)
IP
Irinotecano: 70 mg/m2 IV D1 e 15
a cada 28 dias
Ref. (6)
FAM
5-Fluorouracil: 600 mg/m2 IV D1, 8, 29 e 36
Mitomicina-C: 10 mg/m2 IV D1
a cada 8 semanas
Ref. (7)
FAMTX
5-Fluorouracil: 1.500 mg/m2 IV D1, iniciando 1 hora aps o
Methotrexate
Leucovorin: 15 mg/m2 VO a cada 6 horas por 12 doses,
iniciando 24 horas aps incio do Methotrexate
Adriamicina: 30 mg/m2 IV D15
Methotrexate: 1.500 mg/m2 IV D1
a cada 28 dias
Ref. (8)
FAP
a cada 5 semanas
Ref. (9)
Docetaxel + Cisplatina
a cada 21 dias
Ref. (10)
45
5-Fluorouracil
a cada 28 dias
Ref. (11)
Docetaxel
a cada 21 dias
Ref. (12)
Ou
Docetaxel: 35 mg/m2 IV semanalmente por 6 semanas
a cada 8 semanas
Ref. (12)
Capecitabina
Capecitabina: 2000mg/m2/dia VO D1 a D14, ciclos a cada 21 dias.
Ref.(13)
Cisplatina + Irinotecano
Cisplatina: 30 mg/m2 IV
Irinotecano: 60 mg/m2 IV
Semanal x 3 semanas a cada 4 semanas
Ref. (14)
FOLFOXIRI
Irinotecano: 165mg/m2 IV em 90 min D1
5-Fluorouracil 3200mg/m2 IV em 48 horas, infuso contnua
a cada 15 dias
Ref. (15)
EOX
Epirrubicina: 50mg/m2 IV D1 a cada 3 semanas
Oxaliplatina: 130mg/m2 IV D1 a cada 3 semanas
Capecitabina: 625mg/m2 VO, BID, durante todo o tratamento
por 8 ciclos
Ref. (16)
ECX
Capecitabina: 1000mg/m2 VO, BID D1 a D14
46
Ref. (17)
EXE
Oxaliplatina: 130mg/m2 IV D1 a cada 3 semanas
Capecitabina: 1000mg/m2 VO, BID, continuamente
Epirrubicina: 50mg/m2 IV D1 a cada 3 semanas
Ref. (18)
PELF
Epirrubicina: 30mg/m2 IV D1 e D5
Leucovorin: 100mg/m2 IV D1 a D4
Fluorouracil: 300mg/m2 IV D1 a D4
a cada 21 dias, total de 4 ciclos
Ref. (19)
DF
5-Fluorouracil: 200mg/m2 IV D1 a D21
a cada 3 semanas
Ref. (20)
ECR
Epirrubicina: 60 mg/m2 IV D1
Raltitrexede: 1mg/m2 IV D1 e D8
a cada 3 semanas
Ref. (21)
Estudo ToGA
Trastuzumabe: 8 mg/Kg dose inicial IV Dia 1 seguido por 6 mg/kg
a cada 21 dias, at a progresso ou toxicidade intolervel, associado a:
Cisplatina: 80 mg/m2 Dia 1 a cada 21 dias +
5-Fluorouracil: 800 mg/m2 Dias 1 a 5 em infuso contnua a cada 21 dias
Ou
Capecitabina: 1g/ m2 / VO 2 x ao dia Dias 1 a 14 a cada 21 dias
por 6 ciclos.
Ref. (22)
1. MacDonald JS, et al. Chemoradiotherapy after surgery compared
with surgery alone poradenocarcinoma of the stomach or
gastroesophageal junction. N Engl J Med 2001; 345: 725730.
2. Ajani JA, et al. Docetaxel (D), cisplatin, 5-fluorouracil compare
47
to cisplatin (C) e5-fluorouracil (F) porchemotherapy-nave

patients with metastatic or locally recurrent, unresectable gastric
carcinoma (MGC): interim results of a randomized phase III trial
(V3325). Proc Am Soc Clin Oncol 2003;22:249 (abstract 999).
4. Findlay M, et al. A phase II study in advanced gastro-esophageal
cancer using epirubicin ecisplatin in combination with continuous
infusion 5-fluorouracil (ECF). Ann Oncol 1994; 5:609616.
5. Wilke M, et al. Preliminary analysis of a randomized phase III
trial of FAMTX versus ELF versus cisplatin/FU in advanced
gastric cancer. A trial of the EORTC Gastrointestinal Tract
Cancer Cooperative Group ethe AIO. Proc Am Soc Clin Oncol
1995;14:206a.
6. Shirao K, et al. Phase III study of irintoecan hydrochloride
combined with cisplatin in patients with advanced gastric
7. MacDonald JS, et al. 5-Fluorouracil, Adriamicina, emitomycin
(FAM) combination chemotherapy poradvanced gastric
cancer. Ann Intern Med 1980;93:533536.
8. Kelsen D, et al. FAMTX versus etoposide, Adriamicina, and cisplatin:
a random assignment trial in gastric cancer. J Clin Oncol
1992; 10:541548.
9. Cullinan SA, et al. Controlled evaluation of three drug
combination regimens versus fluorouracil alone porthe
therapy of advanced gastric cancer. North Central Cancer
Treatment Group. J Clin Oncol 1994;12:412416.
10. Ajani JA, et al. Multinational randomized trial of docetaxel,
cisplatin with or without 5-fluorouracil in patients with
advanced gastric or GE junction adenocarcinoma. Proc Am
Soc Clin Oncol 2000;20: 165a (abstract 657).
11. OConnell MJ. Current status of chemotherapy poradvanced
pancreatic egastric cancer. J Clin Oncol 1985;3:10321039.
12. Ajani JA. Docetaxel porgastric eesophageal carcinomas.
Oncology 2002;16 (Suppl 6):8996.
13. Hong S et al: A phase II trial of capecitabine in previously
untreated patients with advanced and/or metastatic gastric
cancer. Ann Oncol 15:1344,2004.
48
14. Pozzo C et al: Irinotecan in combination with Fluorouracil

and acid folinic or with cisplatin in patients with advanced
gastric cancer , Ann Oncol 2004 Dec; 15 (12) : 1773-81.15.
Cao W, Yang W, Lou G, Jiang J, Geng M, Xi W, Li H, Ma T, Jin
Y.Phase II trial of infusional fluorouracil, leucovorin, oxaliplatin,
and irinotecan (FOLFOXIRI) as first-line treatment for advanced
gastric cancer. Anticancer Drugs. 2009 Apr; 20(4): 287-93.
16. Cunninghan D, Starling N et al. Capecitabine and Oxaliplatin
for Advanced Esophagogastric Cancer. N Engl J Med 2008; 358:36-46.
17. Yun J, Lee J, Park SH, Park JO, Park YS, Lim HY, Kang WK. A
randomised phase II study of combination chemotherapy with
epirubicin, cisplatin and capecitabine (ECX) or cisplatin and
capecitabine (CX) in advanced gastric cancer. Eur J Cancer.
2010 Mar; 46(5):885-91.
18. Schnnemann KR, Jensen HA, Yilmaz M et al. Phase II study
of short-time oxaliplatin, capecitabine and epirubicin (EXE)
as first-line therapy in patients with non-resectable gastric
cancer. Br J Cancer. 2008 Sep 16;99(6):858-61.
19. Di Costanzo F, Gasperoni S, Manzione L, Bisagni G, Labianca
R, Bravi S, Cortesi E et al. Adjuvant chemotherapy in completely
resected gastric cancer: a randomized phase III trial conducted by
GOIRC. J Natl Cancer Inst. 2008 Mar 19;100(6):388-98. Epub 2008 Mar 11.
20. Thuss-Patience PC, Kretzschmar A, Repp M, Kingreen D,
Hennesser D, Micheel S, Pink D, Scholz C, Drken B, Reichardt
P. Docetaxel and continuous-infusion fluorouracil versus epirubicin,
cisplatin, and fluorouracil for advanced gastric adenocarcinoma:
a randomized phase II study. J Clin Oncol. 2005 Jan 20;23(3):494-501.
21. Ferrari VD, Amoroso V, Valcamonico F et al. Epirubicin, cisplatin,
and raltitrexed in patients with advanced gastric and hepatobiliary
carcinoma: a phase II study. Am J Clin Oncol. 2004 Oct;27(5):445-8.
22. Bang, YJ, Van Cutsem, E, Feyereislova, A, et. al. Trastuzumab in
combination with chemotherapy versus chemotherapy alone for
treatment of HER2-positive advanced gastric or gastro-oesophageal
junction cancer (ToGA): a phase 3, open-label, randomised
controlled Trial. Lancet. 2010;376:687-697.
49
Tumor do Estroma
Gastrointestinal (GIST)
Imatinibe
Imatinibe: 400 mg/dia VO
Ref. (1)
Imatinibe: 400 mg VO BID
Ref. (2)
Sunitinibe
Sunitinibe: 50mg/dia VO por 4 semanas a cada 6 semanas
Ref.(3)
Nilotinibe
Nilotinibe: 400mg VO BID
Ref. (4)
1. Demetri GD, et al. Efficacy and safety of imatinib mesylate in

advancedgastrointestinal stromal tumors. N Engl J Med
2002;347: 472480.
2. Verweij J, Casali P et al. Progression-free survival in
gastrointestinal stromal tumours with high-dose imatinib:
randomised trial Lancet 364:1127,2004.
3. Demetri GD et al.: Efficacy and safety of sunitinib in patients
with advanced gastrointestinal stromal tumors after failure
of imatinib: a randomized controlled trial. Lancet 368:1329,
2006.
4. Montemurro M, Schffski P, Reichardt P, Gelderblom H,
Schtte J, Hartmann JT, et al. Nilotinib in the treatment of
advanced gastrointestinal stromal tumours resistant to both
imatinib and sunitinib. Eur J Cancer. 2009 Sep; 45(13): 2293-7.
50
Hepatocarcinoma
Adriamicina
Adriamicina: 2030 mg/m2 IV semanalmente
Ref. (1)
Cisplatina
Cisplatina: 80 mg/m2 IV D1, a cada 28 dias
Ref. (2)
Capecitabina
a cada 21 dias
Ref. (3)
Sorafenibe
Sorafenibe: 400mg VO BID por dia
Ref. (4)
Capecitabina + Cisplatina
Capecitabina: 2000mg/m2/dia, BID, VO, D1 a D14
a cada 3 semanas
Ref. (5)
PIAF
Interferon alfa 2b 5MU/m2 SC D1 a D4
Doxorrubicina: 40mg/m2 IV D1
a cada 3 semanas.
Ref. (6)
Tamoxifeno
Tamoxifeno: 20mg VO por dia
Ref. (7)
1. Venook AP. Treatment of hepatocellular carcinoma: too many

options? J Clin Oncol 1994;12:13231334.
51
2. Okada S, et al. A phase 2 study of cisplatin in patients with

hepatocellular carcinoma. Oncology 1993;50:2226.
3. Aguayo A, et al. Nonsurgical treatment of hepatocellular
carcinoma. Semin Oncol 2001;28:503513.
4. llovet JM. Sorafenib in advanced hepatocellular Carcinoma. N
Engl J Med 2008; 359:378-390.
5. Lee JO, Lee KW, Oh DY, Kim JH, Im SA, et al.Combination
chemotherapy with capecitabine and cisplatin for patients
with metastatic hepatocellular carcinoma. Ann Oncol. 2009
Aug; 20(8):1402-7.
6. Yeo W, Mok TS, Zee B, Leung TW et al. A randomized phase III
study of doxorubicin versus cisplatin/interferon alpha-2b/
doxorubicin/fluorouracil (PIAF) combination chemotherapy
for unresectable hepatocellular carcinoma. J Natl Cancer
Inst. 2005 Oct 19;97(20):1532-8.
7. Barbare JC, Bouch O, Bonnetain F, Raoul JL, Rougier P,
Abergel A, Boige V, Denis B, Blanchi A, Pariente A, Milan C,
Bedenne L. Randomized controlled trial of tamoxifen in
advanced hepatocellular carcinoma. J Clin Oncol. 2005 Jul 1;
23(19):4338-46.
52
Cncer de Vias Biliares

Gencitabina
Gencitabina: 1000mg/m2 IV D1,8,15 , a cada 28 dias Ref.(1)
Cisplatina + Gencitabina
a cada 21 dias
Ref.(2)
GEMOX
Gencitabina: 1000mg/m2 IV D1
a cada 14 dias
Ref. (3)
GEMCAP
Capecitabina: 1300mg/m2/dia VO D1 a D14
a cada 21 dias
Ref. (4)
Capecitabina: 1250mg/m2 VO BID por 14 dias
a cada 3 semanas
Ref.(5)
Mitomicina + 5-Fluorouracil + Leucovorin

a cada 4 semanas
Ref. (6)
53
5-Fluorouracil: 500mg/m do D1 a D3 IV pulso na 1 e 5 semana
da radioterapia
Ou
5-Fluorouracil: 400mg/m e Leucovorin: 20mg/m, ambos do
D1 a D4 em pulso na 1 e 5 semana da radioterapia
Radioterapia: concomitante ao 5-Fluorouracil na dose de 45 Gy
em fraes de 180cGy + boost de 5,4-9,0Gy (dose total 54Gy).
Ref. (7)
Capecitabina + Radioterapia (M. D. Anderson)
Capecitabina: 1500mg/m/dia VO duas vezes ao dia de segunda
a sexta-feira durante todo o tratamento radioterpico.
Radioterapia: concomitante a capecitabina na dose de 45 Gy
com boost de 10Gy.
Ref. (8)
CAPOX
Oxaliplatina: 130mg/m IV em 2 horas no D1
Capecitabina: 1000mg/m VO duas vezes ao dia do D1 ao D14
a cada 21 dias
Ref. (9)
1. Gebbia V et al. Treatment of Inoperable and/or Metastatic

Biliary Tree Carcinomas With Single-Agent Gemcitabine or
in Combination With Levofolinic Acid and Infusional
Fluorouracil: Results of a Multicenter Phase II Study. J Clin
Oncol, 2001; 19: 4089-91.
2. Kim ST et al. A Phase II study of gemcitabine and cisplatin in
advanced biliary tract cancer. Cancer , 2006: 106:1339-46
54
3. Andre T, et al. Gemcitabine combined with oxaliplatin

(GEMOX) in advanced biliary tract adenocarcinoma: a
GERCOR study. Ann Oncol. 2004; 15: 1339-43.
4. Knoxx JJ et al. Combining Gemcitabine and Capecitabine in
Patients With Advanced Biliary Cancer: A Phase II Trial. J Clin
Oncol. 2005; 23:2332-8.
5. Kim TW, Chang HM, Kang HJ, Lee JR, Ryu MH, Ahn JH, Kim JH,
Lee JS, Kang YK. Phase II study of capecitabine plus cisplatin
as first-line chemotherapy in advanced biliary cancer. Ann
Oncol. 2003 Jul;14(7):1115-20.
6. Polyzos A, Nikou G, Giannopoulos A et al. Chemotherapy of
biliary tract cancer with mitomycin-C and 5-fluorouracil
biologically modulated by folinic acid. A phase II study.Ann
Oncol. 1996 Aug;7(6):644-5.
7. Kresl JJ, Schild SE, Henning GT, Gunderson LL, Donohue J,
Pitot H, Haddock MG, Nagorney D. Adjuvant external beam
radiation therapy with concurrent chemotherapy in the
management of gallbladder carcinoma. Int J Radiat Oncol
Biol Phys 2002: 52: 167.
8. Borghero Y, Crane, CH, Szklaruk J, Oyarzo M, et al.
Extrahepatic Bile Duct Adenocarcinoma: Patients at HighRisk for Local Recurrence Treated with Surgery and Adjuvant
Chemoradiation Have an Equivalent Overall Survival to
Patients with Standard-Risk Treated with Surgery Alone.
Annals of Surgical Oncology. 2008: 15(11):31473156.
9. Capecitabine plus oxaliplatin as First-line treatment in
patients with advanced biliary sysstem adenocarcinoma: a
prospective multicentre phase II trial. Br J Cancer 2008: 98:
309-315.
55
Cncer de Pncreas
5-Fluorouracil: 500 mg/m2/dia IV D1 a 3 e D29 a 31
seguido de 5-Fluorouracil semanal iniciando no D71 Ref. (1)
5-Fluorouracil + Leucovorin
Leucovorin: 20 mg/m2 IV D1 a 5
a cada 28 dias
Ref. (2)
Gencitabina + Capecitabina
Gencitabina: 1.000 mg/m2 IV D1 e 8
Capecitabina: 650 mg/m2 VO BID D1 a 14
a cada 21 dias
Ref. (3)
Gencitabina + Cisplatina
Gencitabina: 1.000 mg/m2 IV D1, 8 e 15
Cisplatina: 50 mg/m2 IV D1 e15
a cada 28 dias
Ref. (4)
GEMOX
Gencitabina: 1.000 mg/m2 IV a 10 mg/m2/min D1
Oxaliplatina: 100 mg/m2 IV em 2 horas D2
a cada 2 semanas
Ref. (5)
Gencitabina + Irinotecano
Gencitabina: 1.000 mg/m2 IV em 30 minutos D1 e 8
Irinotecano: 100 mg/m2 IV em 90 minutos D1 e 8
a cada 21 dias
Ref. (6)
FAM
5-Fluorouracil: 600 mg/m2 IV D1, 8, 29 e 36
56
Mitomicina-C: 10 mg/m2 IV D1
a cada 56 dias
Ref. (7)
Gencitabina + Erlotinibe
Gencitabina: 1.000 mg/m2 IV semanalmente por 7 semanas,
seguida por uma semana de descanso e ciclos subsequentes
com Gencitabina 1.000 mg/m2 IV semanalmente por 3 semanas
com uma semana de descanso
Erlotinibe: 100 mg VO diariamente
Repetir o ciclo de 3 semanas a cada 28 dias
Ref. (8)
Gencitabina
Gencitabina: 1,000 mg/m2 IV semanalmente por 7 semanas,
seguido por uma semana de descanso
Com ciclos subsequentes de 1.000mg/m2, IV semanalmente por
3 semanas com uma semana de descanso
Repetir o ciclo de 3 semanas a cada 28 dias
Ref. (9)
Ou
Gencitabina: 1.000 mg/m2 IV a 10 mg/m2/min D1, 8 e15
a cada 28 dias
Ref. (10)
Capecitabina
Capecitabina: 1.250 mg/m2 VO BID D1 a 14
a cada 21 dias
Ref. (11)
FOLFOX6
Leucovorin: 400mg/m2 IV D1
5-Fluorouracil: 400mg/m2 IV pulso D1
5-Fluorouracil: 3000mg/m2 IV em 46 horas.
a cada 15 dias
Ref. (12)
57
Gencitabina + Docetaxel + Capecitabina (GTX)

Gencitabina: 750 mg/m IV no D4 e D11
Docetaxel: 30 mg/m IV no D4 e D11
Capecitabina: 1000-1500 mg/m VO duas vezes ao dia do D1 ao
D14
a cada 2 semanas
Ref. (13)
FOLFIRINOX
Oxaliplatina: 85mg/m IV em 2h D1
Irinotecano: 180mg/ m IV em 30 a 90 minutos D1
Leucovorin: 400mg/ m IV D1 seguido de
5-Fluorouracil 400mg/ m em pulso D1, seguido de 5Fluorouracil 2400 mg/m2 IV contnuo em 46 horas.
a cada 2 semanas
Ref. (14)
Irinotecano
Irinotecano: 350 mg/m2
Ref. (15)
IV
D1
21 dias
Docetaxel
Docetaxel: 75 mg/m2
Ref. (16)
IV
D1
21 dias
1. Gastrointestinal Tumor Study Group. Comparative therapeutic

trial of radiation with or without chemotherapy in
pancreatic carcinoma. Int J Radiat Oncol Biol Phys 1979; 5:
16431647.
2. DeCaprio JA, et al. Fluorouracil ehigh-dose leucovorin in
previously untreated patients with advanced adenocarcinoma
of the pancreas: results of a phase II trial. J Clin Oncol 1991;
9: 21282133.
3. Hess V, et al. Combining capecitabine and gemcitabine in
patients with advanced pancreatic carcinoma: a phase I/II
trial. J Clin Oncol 2003;21:6668.
58
4. Philip PA, et al. Phase II study of gemcitabine ecisplatin in the

treatment of patients with advanced pancreatic carcinoma.
J Clin Oncol 2001; 92:569577.
5. Louvet C, et al. Gemcitabine combined with oxaliplatin in
advanced pancreatic adenocarcinoma: final results of a
GERCOR multicenter phase II study. J Clin Oncol 2002; 20:
15121518.
6. Rocha-Lima C, et al. Irinotecan plus gemcitabine induces
both radiographic and CA19-9 tumor marker responses in
patients with previously untreated advanced pancreatic
7. Leonard RC, et al. Chemotherapy prolongs survival in
inoperable pancreatic carcinoma. Br J Cancer 1994; 81: 882885.
8. Moore MJ, et al. Erlotinib plus gemcitabine compared to
gemcitabine alone in patients with advanced pancreatic
cancer. A phase III trial of the NCIC-CTG. J Clin Oncol 2005;
23:16S (abstract 1).
9. Burris HA, et al. Improvements in survival and clinical benefit
with gemcitabine as first-line therapy porpatients with
advanced pancreas cancer: a randomized trial. J Clin Oncol
1997;15:24032413.
10. BreR, et al. A phase I trial of semanalmente gemcitabine
administered as a prolonged infusion in patients with
pancreatic cancer eother solid tumors. Invest New Drugs
1997;15:331341.
11. Cartwright TH, et al. Phase II study of oral capecitabine in
patients with advanced or metastatic pancreatic cancer. J
Clin Oncol 2002; 20:160164.
12. Ghosn M, Farhat F, Kattan J, Younes F, Moukadem W, Nasr F,
Chahine G. FOLFOX-6 combination as the first-line
treatment of locally advanced and/or metastatic pancreatic
cancer. Am J Clin Oncol. 2007 Feb;30(1):15-20.
13. Fine RL, et al. The GTX regimen: a biochemically synergistic
combination for advanced pancreatic cancer (PC). Proc Am
Soc Clin Oncol 2003;22:281 (abstract 1129).
59
14. T. Conroy, F. Desseigne, et al. Randomized phase III trial

comparing FOLFIRINOX (F: 5FU/leucovorin [LV], irinotecan
[I], and oxaliplatin [O]) versus gemcitabine (G) as first-line
treatment for metastatic pancreatic adenocarcinoma (MPA):
Preplanned interim analysis results of the PRODIGE 4/ACCORD
11 trial. J Clin Oncol 28:15s, 2010 (suppl; abstr 4010).
15. Wagener DJ, et al. Phase II trial of CPT-11 in patients with
advanced pancreatic cancer, an EORTC early clinical trials
group study. Ann Oncol 1995:6:129-32.
16. Lenzi RL, et al. Phase II study of docetaxel in patients with
pancreatic cancer previously untreated with cytotoxic
chemotherapy. Cancer Invest 2002; 20: 464-72. Cncer
Invest 2002;20:464-72.
60
Cncer de Cabea e Pescoo

Cisplatina concomitante a radioterapia
Cisplatina: 100mg/m2 IV em 2 horas nos D1,22, 43
Ref. (1)
Cetuximabe concomitante a radioterapia
Cetuximabe: 400mg/m2 (dose de ataque na primeira semana)
seguido por 250mg/m2 por semana durante a radioterapia
Ref. (2)
TPF
Docetaxel: 75 mg/m2 IV em 1 hora D1
Cisplatina: 75mg/m2 IV em 1 hora D1
5-Fluorouracil: 750 mg/m2 em 24 horas D1 a 5
a cada 21 dias
Ref. (3)
TIP
Ifosfamida: 1.000 mg/m2 IV em 2 horas D1 a 3
Mesna: 400 mg/m2 IV antes da Ifosfamida e 200 mg/m2 IV,
4 horas aps Ifosfamida
a cada 2128 dias
Ref. (4)
TIC
Ifosfamida: 1.000 mg/m2 IV em 2 horas D13
Mesna: 400 mg/m2 IV antes da Ifosfamida e 200 mg/m2 IV, 4
horas aps Ifosfamida
a cada 2128 dias
Ref. (5)
61
Paclitaxel + Carboplatina
Carboplatina: AUC 6 IV no dia 1
a cada 21 dias
Ref. (6)
G-CSF: 5 g/kg/dia SC D410
a cada 21 dias
Ref. (7)
PF
5-Fluorouracil: 1.000 mg/m2/dia IV infuso contnua D1 a D5
a cada 2128 dias
Ref. (8)
PFL
Leucovorin: 50 mg/m2 VO a cada 6 horas D15
a cada 21 dias
Ref. (9)
62
Carboplatina + 5-Fluorouracil
Carboplatina: 300400 mg/m2 IV D1
5-Fluorouracil: 600 mg/m2 IV D1
a cada 21 dias
Ref. (13)
VP
Vinorelbina: 25 mg/m2 IV D1 e 8
a cada 21 dias
Ref. (14)
Docetaxel
Docetaxel: 100 mg/m2 IV em 1 hora D1
a cada 21 dias
Ref. (15)
Paclitaxel
Paclitaxel: 250 mg/m2 IV em 24 horas D1 a cada 21 dias Ref. (16)
Ou
a cada 21 dias
Ref. (16)
Methotrexate
Methotrexate: 40 mg/m2 IV or IM semanalmente
Ref. (17)
Vinorelbina
Vinorelbina: 30 mg/m2 IV semanalmente
Ref. (18)
PF + Cetuximabe
Cisplatina: 100mg/m2 IV em 1 hora D1
Fluorouracil: 1000mg/m2 IV em 24horas D1 a D4
Cetuximabe: 400mg/m2 (dose de ataque) seguido por 250mg/m2
IV por semana. A cada 21 dias, por 6 ciclos.
Ref. (19)
Gencitabina
Gencitabina: 1250mg/m2, IV , D1 e D8, a cada 21 dias. Ref. (20)
Capecitabina
a cada 21 dias
Ref. (21)
Ifosfamida
Ifosfamida: 3g/m2 IV D1 a D3
Mesna: 1800mg/m2 IV D1 a D3
a cada 3 semanas
Ref. (22)
Cisplatina + 5-Fluorouracil + Radioterapia

5-Fluorouracil: 1000 mg/m2 D1 a 5 em infuso contnua
Radioterapia concomitante.
a cada 21 a 28 dias no total de 3 ciclos
Ref. (32)
63
Cisplatina + Radioterapia
Cisplatina: 100 mg/m2 D1, 22 e 43
Radioterapia concomitante
Ref. (33)
Cisplatina + 5-Fluorouracil + Docetaxel

Cisplatina: 75 mg/m2
IV D1
2
5-Fluorouracil: 750mg/m /dia IV D1 a D5 Infuso contnua
Docetaxel: 75mq/m2
IV D1 a cada 21 dias por 3 ciclos
O regime acima administrado antes da cirugia e seguido por
quimio-radioterapia, com o regime abaixo:
Ref. (34)
Cisplatina + 5-Fluorouracil + Paclitaxel
IV D2
5-Fluorouracil: 500 mg/m2/dia IV D2 a D6 Infuso contnua
O regime acima administrado antes da cirugia e seguido por
quimio-radioterapia, com o regime abaixo:
Ref. (35)
Paclixatel + Doxorrubicina peguilada
IV
D1
21 dias
2
Doxorrubicina: 40 mg/m IV lipossomal peguilada D1
28 dias
Ref. (40)
Paclitaxel + Gencitabina
IV
2
Gencitabina: 1000 mg/m IV
Ref. (41)
64
D1
D1 e D8 a cada 21 dias
Linfoepitelioma
Nasofaringe
Quimioterapia + Radioterapia
Cisplatina: 100 mg/m2 IV D1, 22 e 43 durante radioterapia
Aps o trmino da quimio e radioterapia a quimioterapia segue
com o seguinte protocolo:
5-Fluorouracil: 1,000 mg/m2/dia IV infuso contnua D1-4
a cada 28 dias por um total de 3 ciclos
Ref. (12)
PBF
Bleomicina: 15 mg IV D1
Bleomicina: 16mg/m2/dia em infuso contnua D1 a D5
Fluorouracil 650mg/m2/dia IV D1 a D5
a cada 28 dias
Ref. (23)
Paclitaxel concomitante a radioterapia
Paclitaxel: 35mg/m2 IV semanal por 6 semanas
Aps trmino da radioterapia:
Ref. (24)
Cisplatina + Epirrubicina
Epirrubicina: 90mg/m2 IV D1 a cada 21 dias
Repetir por 3 ciclos seguidos por radioterapia concomitante a
Cisplatina: 100mg/m2 IV a cada 21 dias
Ref. (25)
65
a cada 3 semanas
Ref. (26)
Gencitabina
Gencitabina: 1000mg/m2 IV D1,8,15
a cada 4 semanas
Ref. (27)
a cada 3 semanas
Ref. (28)
Gencitabina: 1000mg/m2 IV D1,8,15
a cada 28 dias
Ref. (29)
Ifosfamida + 5-Fluorouracil + Leucovorin
Ifosfamida: 1.200 mg/m2 (associado a Mesna) IV D1 a D5
a cada 21 dias
Ref. (30)
BEC
Bleomicina: 15mg IV D1 seguido por 12mg/m2/dia em infuso
contnua D1 a D5
a cada 3 semanas
Ref. (31)
66
Carboplatina + 5-Fluorouracil
Carboplatina: 300 mg/m2 IV D1
5-Fluorouracil: 1000 mg/m2 IV D1 a D3 Infuso contnua
Ref. (36)
Carboplatina + Paclitaxel
Carboplatina: AUC 6
IV pulso D1
2
Paclitaxel: 135 mg/m
IV
D1 a cada 21 dias por 6 ciclos
Ref. (37)
Cisplatina + Epirrubicina + Bleomicina (BEC)
IV
D1
Epirrubicina: 80 mg/m2
IV
D1
Bleomicina: 15 mg
IV pulso D1
Bleomicina: 16 mg/m2
IV
D1 a D5 Infuso
contnua
Ref. (38)
Docetaxel semanal
Docetaxel: 40 mg/m2
Ref. (39)
IV
D1
Semanal
1. Forastiere AA. et al. Concurrent Chemotherapy and

Radiotherapy for Organ Preservation in Advanced Laryngeal
Cancer. N Engl J Med 349:2091, 2003.
2. Bonner JA. et al Radiotherapy plus Cetuximab for SquamousCell Carcinoma of the Head and Neck. N Engl J Med 2006;
354:567-578.
3. Vermorken JB et al. Cisplatin, Fluorouracil, and Docetaxel in
Unresectable Head and Neck Cancer. N Engl J Med 357: 1695,2007.
4. Shin DS, et al. Phase II trial of paclitaxel, ifosfamide, and
cisplatin in patients with recurrent head eneck squamous
cell carcinoma. J Clin Oncol 1998;16:1325-1330.
67
5. Shin DM, et al. Phase II study of paclitaxel, ifosfamide, and

carboplatin in patients with recurrent or metastatic head
eneck squamous cell carcinoma of the head eneck (SCCHN).
Cancer 1999; 91:1316-1323.
6. Fountzilas G, et al. Paclitaxel and carboplatin in recurrent or
metastatic head and neck cancer: a phase II study. Semin
Oncol 1997; 24 (Suppl 2):65-67.
7. Hitt R, et al. A phase I/II study of paclitaxel plus cisplatin as
firstline therapy fo rhead and neck cancer. Semin Oncol
1995;22 (Suppl 15):50-54.
8. Kish JA, et al. Cisplatin and 5-fluorouracil infusion in patients
with recurrent and disseminated epidermoid cancer of the
head and neck. Cancer 1984;53:1819-1824.
9. Vokes EE, et al. Cisplatin, 5-fluorouracil, and high-dose oral
leucovorin for advanced head and neck cancer. Cancer
1989;63 (Suppl 6):10481053.
10. Veterans Affairs Laryngeal Cancer Study Group. Induction
chemotherapy plus radiation compared with surgery plus
radiation in patients with advanced laryngeal cancer. N Engl
J Med 1991;324: 1685-1690.
11. Forastiere AA, et al. Concurrent chemotherapy and
radiotherapy for organ preservation in advanced laryngeal
cancer. N Engl J Med 2003;349:2091-2098.
12. Al-Sarraf M, et al. Chemoradiotherapy versus radiotherapy
in patients with advanced nasopharyngeal cancer: phase III
randomized intergroup study 0099. J Clin Oncol
1998;16:1310-1317.
13. Forastiere AA, et al. Randomized comparison of cisplatin
plus fluorouracil and carboplatin plus fluorouracil versus
methotrexate in advanced squamous-cell carcinoma of the
head eneck: a Southwest Oncology Group study. J Clin
Oncol 1992;10:12451251.
14. Gebbia V, et al. Vinorelbine plus cisplatin in recurrent or
previously untreated unresectable squamous cell carcinoma
of the head and neck. Am J Clin Oncol 1995;18:293296.
68
15. Dreyfuss A, et al. Taxotere for advanced, inoperable

squamous cell carcinoma of the head and neck (SCCHN).
Proc Am Soc Clin Oncol 1995;14:875a.
16. Forastiere AA. Current and future trials of Taxol (paclitaxel)
in head and neck cancer. Ann Oncol 1994;5 (Suppl 6):5154.
17. Hong WK, et al. Chemotherapy in head and neck cancer. N
Engl J Med 1983;308:75-79.
18. Degardin M, et al. An EORTC-ECSG phase II study of vinorelbine
in patients with recurrent and/or metastatic squamous cell
carcinomaof the head and neck. Ann Oncol 1998; 9:1103-1107.
19. Vermorken JB, et al. Platinum Based Chemotherapy plus
cetuximab in Head and neck cancer. N Engl J Med 2008; 359.1116.
20. van Herpen CM, et al. Phase II study on gemcitabine in
recurrent and/or metastatic adenoid cystic carcinoma of the
head and neck (EORTC 24982). Eur J Cancer. 2008 Nov;
44(17):2542-5.
21. Martinez-Trufero J, Isla D, Adansa JC et al. Phase II study of
capecitabine as palliative treatment for patients with
recurrent and metastatic squamous head and neck cancer
after previous platinum-based treatment. Br J Cancer. 2010
Jun 8;102(12):1687-91.
22. Martn M, Diaz-Rubio E et al. Ifosfamide in advanced
epidermoid head and neck cancer. Cancer Chemother
Pharmacol. 1993;31(4):340-2.
23. Boussen H, Cvitkovic E, Wendling JL et al. Chemotherapy of
metastatic and/or recurrent undifferentiated nasopharyngeal
carcinoma with cisplatin, bleomycin, and fluorouracil. J Clin
Oncol. 1991 Sep;9(9):1675-81
24. Hu W, Ding W, Yang H, Shao M. et al. Weekly paclitaxel with
concurrent radiotherapy followed by adjuvant chemotherapy
in locally advanced nasopharyngeal carcinoma. Radiother
Oncol. 2009 Dec; 93(3):488-91.
25. Airoldi M, Gabriele AM, Garzaro M et al. Induction
chemotherapy with cisplatin and epirubicin followed by
radiotherapy and concurrent cisplatin in locally advanced
69
nasopharyngeal carcinoma observed in a non-endemic

population.Radiother Oncol. 2009 Jul;92(1):105-10.
26. Li YH, Wang FH, Jiang WQ et al. Phase II study of
capecitabine and cisplatin combination as first-line chemotherapy
in Chinese patients with metastatic nasopharyngeal carcinoma.
Cancer Chemother Pharmacol. 2008 Aug; 62(3): 539-44.
27. Zhang L, Zhang Y et al. Phase II clinical study of gemcitabine
in the treatment of patients with advanced nasopharyngeal
carcinoma after the failure of platinum-based chemotherapy.
Cancer Chemother Pharmacol. 2008 Jan;61(1):33-8
28. Chua DT, Sham JS, Au GK.A phase II study of docetaxel and
cisplatin as first-line chemotherapy in patients with metastatic
nasopharyngeal carcinoma. Oral Oncol. 2005 Jul;41(6):589-95.
29. Ngan RK, Yiu HH, Lau WH et al. Combination gemcitabine
and cisplatin chemotherapy for metastatic or recurrent
nasopharyngeal carcinoma: report of a phase II study. Ann
Oncol. 2002 Aug;13(8):1252-8.
30. Chua DT, Kwong DL, Sham JS, Au GK, Choy D.A phase II
study of ifosfamide, 5-fluorouracil and leucovorin in patients
with recurrent nasopharyngeal carcinoma previously treated
with platinum chemotherapy. 2000 Apr;36(6):736-41.
31. No authors listed. Preliminary results of a randomized trial
comparing neoadjuvant chemotherapy (cisplatin, epirubicin,
bleomycin) plus radiotherapy vs. radiotherapy alone in
stage IV(> or = N2, M0) undifferentiated nasopharyngeal
carcinoma: a positive effect on progression-free survival.
International Nasopharynx Cancer Study Group. VUMCA I trial.
Int J Radiat Oncol Biol Phys. 1996 Jun 1;35(3):463-9.
32. Veterans Affairs Laryngeal Cancer Study Group. Induction
chemotherapy plus radiation compared with surgery plus
radiation in patients with advanced laryngeal cancer. N
Engl J Med 1991;324:1685-90.
33. Forastiere AA et al. Concurrent chemotherapy and
radiotherapy for organ preservation in advanced laryngeal
cancer. N Engl J Med 2003;349:2091-2098.
70
34. Hitt R, et al. Randomized phase I/II clinical trial of induction

chemotherapy with either cisplatin / 5-fluorouracil (PF) or
docetaxel /cisplatin / 5-fluorouracil (TPF) followed by
chemoradiotherapy (CRT) vs. CRT alone form in patients
with unresectable locally advanced head and neck cancer
(abst 5515). J Clin Oncol. 2006;24 Suppl 18: 283s.
35. Hitt R, et al. Phase III Study Comparing Cisplatin Plus
Fluorouracil to Paclitaxel, Cisplatin, and Fluorouracil Induction
Chemotherapy Followed by Chemoradiotherapy in Locally
Advanced Head and Neck Cancer. J Clin Oncol 2005;23:8636-45.
36. Yeo W. et al. Phase II study of the combination of carboplatin
and 5-fluorouracil in metastatic nasopharyngeal carcinoma.
Cancer Chemother Pharmacol 1996;38:466-70.
37. Yeo W.et al. A phase II study of combination paclitaxel and
carboplatin in advanced nasopharyngeal carcinoma. Eur J
Cancer 1998;34:2027-31.
38. Fandi A, et al. Long-Term Disease-Free Survivors in
Metastatic Undifferentiated Carcinoma of Nasopharyngeal
Type. J Clin Oncol 2000;18:1324-30.
39. Guardiola E, et al. Results of a randomized phase II study
comparing docetaxel with methotrexate in patients with
recurrent head and neck cancer. Eur J Cancer 2004;40:2071-6.
40. Fountzilas G, et al. Paclitaxel and gemcitabine vs. paclitaxel
and pegylated liposomal doxorubicin in advanced nonnasopharyngeal head and neck cancer. An efficacy and cost
analysis randomized study conducted by the Hellenic Cooperative
Oncology Group. Ann Oncol 2006;17:1560-7.
41. Fountzilas G, et al. Paclitaxel and gemcitabine vs. paclitaxel
and pegylated liposomal doxorubicin in advanced nonnasopharyngeal head and neck cancer. An efficacy and cost
analysis randomized study conducted by the Hellenic
Cooperative Oncology Group Ann Oncol 2006;17:1560-7.
71
Cncer de Tireide
Adriamicina + Cisplatina
a cada 21 dias
Ref. (1)
Sorafenibe
Sorafenibe: 400mg VO BID
Ref. (2)
Paclitaxel
Paclitaxel: 120 mg/m2 IV durante 96 horas a cada 21 dias
Ref. (3)
1. Shimaoka K, et al. A randomized trial of Adriamicina versus

Adriamicina plus cisplatin in patients with advanced thyroid
carcinoma. Cancer 1985;56:21552160.
2. Lam ET, Ringel MD, Kloos RT, Prior TW et al. Phase II clinical
trial of sorafenib in metastatic medullary thyroid cancer. J
Clin Oncol. 2010 May 10;28(14):2323-30.
3. Ain KB, Egorin MJ, DeSimone PA. Treatment of anaplastic
thyroid carcinoma with paclitaxel: phase 2 trial using
ninety-six-hour infusion. Thyroid. 2000;10:587-94.
72
Cncer de Glndula Salivar

Adriamicina: 50mg/m2 IV D1
Cisplatina: 20mg/m2/dia IV D1 a D5
a cada 3 semanas
Ref. (1)
a cada 21 dias
Ref. (2)
Ciclofosfamida
Ciclofosfamida: 1000mg/m2 IV D1
a cada 21 dias
Ref.(3)
CAP
Ciclofosfamida: 500mg/m2 IV D1
Doxorrubicina: 50mg/m2 IV D1
a cada 28 dias
Ref. (4)
PAF
Doxorrubicina: 30mg/m2 IV D1 e D8
5-Fluorouracil: 500mg/m2 IV D1 e D8
a cada 28 dias
Ref. (5)
Epirrubicina
a cada 21 dias
Ref. (6)
73
Cisplatina + Vinorelbina
Vinorelbina: 25mg/m2 IV D1 e D8
a cada 3 semanas
Ref. (7)
1. de Haan LD, De Mulder PH, Vermorken JB, Schornagel JH,

Vermey A, Verweij J. Cisplatin-based chemotherapy in
advanced adenoid cystic carcinoma of the head and neck.
Head Neck. 1992 Jul-Aug;14(4):273-7.
2. Airoldi M, Fornari G, Pedani F, Marchionatti S, Gabriele P,
Succo G, Bumma C. Paclitaxel and carboplatin for recurrent
salivary gland malignancies. Anticancer Res. 2000 SepOct;20(5C):3781-3.
3. Spiers A, Esseltine DLW, et al. Metastatic Adenoid Cystic
Carcinoma of Salivary Glands: Case Reports and Review of
the Literature. Cancer Control Journal. Vol 3, No. 4
July/August 1996.
4. Dreyfuss AI, Clark JR et al. Cyclophosphamide, doxorubicin,
and cisplatin combination chemotherapy for advanced
carcinomas of salivary gland origin. Cancer. 60:2869-2872,
1987.
5. Venook AP, Tseng A, et al. Cisplatin, Doxorubicin, and 5Fluorouracil Chemotherapy for Salivary Gland Malignancies:
A Pilot Study of the Northern California Oncology Group.
JCO June 1, 1987 vol. 5 no. 6 951-955
6. Vermorken JB, Verweij J et al. Epirubicin in patients with
advanced or recurrent adenoid cystic carcinoma of the head
and neck: A phase II study of the EORTC Head and Neck
Cancer Cooperative Group . Annals of Oncology Volume4,
Issue 9 Pp. 785-788.
7. Airoldi M,Pedani F, Succo G et al. Phase II Randomized Trial
Comparing Vinorelbine versus Vinorelbine plus cisplatin in
patients with recurrent salivary gland malignancies. Cancer
2001; 91: 541-7.
74
Cncer de Bexiga
Cisplatina: 75mg/m2
IV
Gencitabina: 1000mg/m2 IV
a cada 28 dias
D1
D1, D8, D15
Carboplatina + Gencitabina
Carboplatina: AUC 4
Gencitabina: 1000mg/m2
a cada 21 dias
IV
IV
Gemcitabina + Paclitaxel
Paclitaxel: 200mg/m2
a cada 21 dias
IV
IV
D1, D8, D15

D1
Ref. (3)
MVAC
Methotrexate: 30mg/m2
Vinblastina: 3mg/m2
Doxorrubicina: 30mg/m2
Cisplatina: 70mg/m2
a cada 28 dias
IV
IV
IV
IV
D1, D15, D22

D2, D15, D22
D2
D2
Ref. (4)
CISCA
Ciclofosfamida: 650mg/m2
Adriamicina: 50mg/m2
Cisplatina: 100mg/m2
a cada 21 dias
IV
IV
IV
D1
D1
D2
Ref. (1)
D1
D1, D8
Ref. (2)
Ref. (5)
75
CMV
Methotrexate: 30mg/m2
Vinblastina: 4mg/m2
Ref. (6)
Docetaxel: 75mg/m2
Cisplatina: 75mg/m2
IV D2
IV D1, D8
IV D1, D8
a cada 21 dias
IV
IV
D1
D1 a cada 21 dias
Carboplatina: AUC 6
Ref. (7)
IV
IV
D1
D1 a cada 21 dias
CAP
Cisplatina: 75mg/m2
Ref. (8)
IV
IV
IV
D1
D1
D1 a cada 21 dias
IV
D1, D8, D15
Gencitabina
a cada 28 dias
Ref. (9)
Paclitaxel
24 horas a cada 21 dias
IV
D1 em infuso de
Ref. (10)
Ou
Paclitaxel: 80mg/m2
a cada 28 dias
Ref. (11)
76
IV
D1, D8, D15
Carboplatina + Paclitaxel + Gencitabina

Paclitaxel: 80mg/m
IV D1 e D8
Carboplatina: AUC 5
IV D1
Gencitabina: 800mg/m IV D1 e D8
a cada 21 dias
Ref. (12)
Cisplatina: 100mg/m IV em 2 aplicaes, na 1 e 4 semana da
Radioterapia.
Radioterapia: dose total de 40 Gy em fraes de 180 cGy .
Ref. (13)
Gencitabina + Paclitaxel + Cisplatina
Gencitabina: 1000mg/m IV D1 e D8
Paclitaxel: 80mg/m IV D1 e D8
Cisplatina: 70 mg/m IV D1
a cada 21 dias
Ref. (14)
Pemetrexede
Pemetrexede: 500 mg/m IV D1 a cada 21 dias
Ref. (15)
Vinflunina
Vinflunina: para pacientes com ECOG PS (0) a dose
recomendada de 320mg/m durante 20 minutos no D1.
Para pacientes com ECOG PS (1) ou irradiao plvica prvia
iniciar com a dose de 280mg/m e escalonar at a dose ideal de
320mg/m.
Ref. (16)
77
1. Kaufman, D., et al. Phase II trial of gemcitabine plus cisplatin

in patients with metastatic urothelial cancer. J Clin Oncol,
2000. 18(9): p. 1921-7.
2. Linardou, H., et al. Gemcitabine and carboplatin combination
as first-line treatment in elderly patients and those unfit for
cisplatin-based chemotherapy with advanced bladder
carcinoma: Phase II study of the Hellenic Co-operative
Oncology Group. Urology, 2004. 64(3): p. 479-84.
3. Meluch, A.A., et al. Paclitaxel and gemcitabine chemotherapy
for advanced transitional-cell carcinoma of the urothelial
tract: a phase II trial of the Minnie pearl cancer research
network. J Clin Oncol, 2001. 19(12): p. 3018-24.
4. Sternberg, C.N., et al. Methotrexate, vinblastine, doxorubicin,
and cisplatin for advanced transitional cell carcinoma of the
urothelium. Efficacy and patterns of response and relapse.
Cancer, 1989. 64(12): p. 2448-58.
5. Logothetis CJ, Dexeus FH, Chong C, et, al. Cisplatin,
cyclophosphamide and doxorubicin chemotherapy for
unresectable urothelial tumors: The M.D. Anderson
Experience. J Urol. 1989; 141:33-37.
6. Harker, W.G., et al. Cisplatin, methotrexate, and vinblastine
(CMV): an effective chemotherapy regimen for metastatic
transitional cell carcinoma of the urinary tract. A Northern
California Oncology Group study. J Clin Oncol, 1985. 3(11): p.
1463-70.
7. Vaughn, D.J., et al. Phase II study of paclitaxel plus
carboplatin in patients with advanced carcinoma of the
urothelium and renal dysfunction (E2896): a trial of the
Eastern Cooperative Oncology Group. Cancer, 2002. 95(5): p.
1022-7.
8. Okajima E, Ozono S, Hirao Y, et. al. Neoadjuvant therapy for
locally invasive bladder cancer. Urol Int. 1989;44 (6):332-337.
9. Moore, M.J., et al. Gemcitabine: a promising new agent in the
treatment of advanced urothelial cancer. J Clin Oncol, 1997.
15(12): p. 3441-5.
78
10. Roth, B.J., et al. Significant activity of paclitaxel in advanced

transitional-cell carcinoma of the urothelium: a phase II trial
of the Eastern Cooperative Oncology Group. J Clin Oncol,
1994. 12(11): p. 2264-70.
11. Vaughn, D.J., et al. Phase II trial of weekly paclitaxel in
patients with previously treated advanced urothelial cancer.
J Clin Oncol, 2002. 20(4): p. 937-40.
12. White RWV,,Lara P, Goldman B, Tangen C, Smith DC, et al. A
Sequential Treatment Approach to Myoinvasive Urothelial
Cancer: A Phase II Southwest Oncology Group Trial (S0219).
The Journal of Urology: 2009; 181;2480-2481
13. Shipley WU, Winter KA, Kaufman DS, Lee WR, Heney NM,
Tester WR, Donnelly BJ, Venner PM, Perez CA, Murray KJ,
Doggett RS, True LD. Phase III trial of neoadjuvant chemotherapy
in patients with invasive bladder cancer treated with
selective bladder preservation by combined radiation therapy
and chemotherapy: initial results of Radiation Therapy
Oncology Group 89-03. J Clin Oncol. 1999;17(4):1327-8.
14. Bellmunt J, Von der Maase J, Mead GM, Heyer J, Houede N,
et al. Randomized phase III study comparing paclitaxel/ cisplatin/
gemcitabine (PCG) and gemcitabine/cisplatin (GC) in patients
with locally advanced (LA) or metastatic (M) urothelial cancer
without prior systemic therapy; EORTC30987/Intergroup Study.
Journal of Clinical Oncology, 2007 ASCO Annual Meeting
Proceedings Part I. Vol 25, No. 18S (June 20 Supplement),
2007: LBA5030.
15. Sweeney CJ, et al. Phase II Study of Pemetrexed for SecondLine Treatment of Transitional Cell Cancer of the Urothelium.
J Clin Oncol 2006;24:3451-57
16. Bellmunt J, Theodore C, DemKov T, Komyakov B, Sengelov L,
Daugaard G, Caty A, et al. Phase III Trial of Vinflunine Plus
Best Suportive Care Compared with Best Supportive Care
Alone After Platinum Containing Regimen in Patients With
Advanced Transitional Cell Carcinoma of the Urothelial Tract
(TCCU). J Clin Oncol 2009: 27: 4454-4461.
79
Cncer Renal
Bevacizumabe+ Interferon Alfa
Bevacizumabe: 10mg/kg
IV
Interferon-alfa: 9 milhes UI
SC
Por 1 ano
D1, D14
3X/semana
Ref. (1)
Interferon Alfa + Interleucina 2

Interferon alfa: 9 milhes U
SC D1 a D4
Interleucina 2: 12 milhes U
SC D1 a D4 em 4 semanas
a cada 6 semanas
Ref. (2)
80
Sunitinibe
Sunitinibe: 50mg
a cada 6 semanas
VO
Sorafenibe
Sorafenibe: 400mg
sem interrupo
VO (2X/dia)
Tensirolimo
Tensirolimo: 25mg
Ref. (5)
IV
D1 a D28
Ref. (3)
Contnuo
Ref. (4)
D1
Semanal
Interferon Alfa
Interferon alfa: 5-15milhes/UI
Ref. (6)
SC
3-5X/semana
Interleucina 2
Interleucina 2: 720000UI/KG
8-12 semanas
IV
12/12H D1-5, 15-19

Ref. (7)
Everolimo
Everolimo: 10mg
Ref. (8)
VO
dia
Contnuo
Pazopanibe
Pazopanibe: 800mg
Ref. (9)
VO
dia
Contnuo
1. Rini, B.I., Bevacizumab plus interferon-alpha versus

interferon-alpha monotherapy in patients with metastatic renal
cell carcinoma: Results of overall survival for CALGB 90206
journal of clinical oncology, 2009. 27(18S): p. abstract 5020.
2. Atzpodien, J., et al. European studies of interleukin-2 in
metastatic renal cell carcinoma. Semin Oncol, 1993. 20(6
Suppl 9): p. 22-6.
3. Motzer, R.J. and R.M. Bukowski, Targeted therapy for
metastatic renal cell carcinoma. J Clin Oncol, 2006. 24(35): p.
5601-8.
4. Ratain, M.J., et al. Phase II placebo-controlled randomized
discontinuation trial of sorafenib in patients with metastatic
renal cell carcinoma. J Clin Oncol, 2006. 24(16): p. 2505-12.
5. Hudes, G., et al. Temsirolimus, interferon alfa, or both for
advanced renal-cell carcinoma. N Engl J Med, 2007. 356(22):
p. 2271-81.
6. Minasian, L.M., et al. Interferon alfa-2a in advanced renal cell
carcinoma: treatment results and survival in 159 patients
with long-term follow-up. J Clin Oncol, 1993. 11(7): p. 1368-75.
7. Acquavella, N., et al. Toxicity and activity of a twice daily
high-dose bolus interleukin 2 regimen in patients with
metastatic melanoma and metastatic renal cell cancer. J
Immunother, 2008. 31(6): p. 569-76.
81
8. Motzer, R.J., et al. Efficacy of everolimus in advanced renal

cell carcinoma: a double-blind, randomised, placebocontrolled phase III trial. Lancet, 2008. 372(9637): p. 449-56.
9. Sternberg CN, et al. Pazopanib in locally advanced or
metastatic renal cell carcinoma: results of a randomized
phase III trial. J Clin Oncol 2010;28(6):1061-1068.
82
Cncer de Prstata
Flutamida + Leuprorrelina
Flutamida: 250mg VO TID
Leuprorrelina: 7,5mg IM a cada 28 dias ou 22,5 mg IM a cada 12
semanas
Ref. (01)
Flutamida + Gosserrelina
Flutamida: 250 mg VO TID
Gosserrelina: 10,8 mg SC a cada 12 semanas
Ref. (02)
Docetaxel + Prednisona
Docetaxel: 75 mg/m IV D1
Prednisona: 5 mg VO BID
a cada 21 dias no total de 10 ciclos
Ref. (03)
Docetaxel + Estramustina
Docetaxel: 35 mg/m IV D2 das semanas 1 e 2
Estramustina: 420 mg VO nas primeiras 4 doses e 280 mg VO
nas prximas 5 doses D1 ao D3 das semanas 1 e 2
a cada 21 dias
Ref. (04)
Mitoxantrona + Prednisona
Mitoxantrona: 12 mg/m IV D1
a cada 21 dias
Ref. (05)
Docetaxel
Docetaxel: 20-40 mg/m semanalmente por 3 semanas
a cada 4 semanas
Ref. (06)
Gosserrelina
Gosserrelina: 3,6 mg SC D1
a cada 28 dias
83
Ou
Gosserrelina: 10,8 mg SC D1
a cada 12 semanas
Ref. (07)
Leuprorrelina
Leuprorrelina: 7,5 mg IM D1
a cada 28 dias
Ou
Leuprorrelina: 22,5 mg IM D1
a cada 12 semanas
Ref. (08)
Bicalutamida
Bicalutamida: 50 mg VO diariamente
Ref. (09)
Flutamida
Flutamida: 250 mg VO TID
Ref. (10)
Nilutamida
Nilutamida: 300 mg VO do D1 ao D30, e ento 150 mg VO
diariamente
Ref. (11)
Prednisona
Ref. (12)
Cetoconazol
Cetoconazol: 1200 mg VO diariamente
Ref. (13)
Paclitaxel
Paclitaxel: 135-170 mg/m2 IV em 24 horas D1
a cada 21 dias
Ref. (14)
Ou
84
Paclitaxel: 150 mg/m2 IV D1 em infuso de 1 hora a cada 6

semanas.
a cada 8 semanas
Ref. (15)
DES
Dietilestilbestrol: 1 a 3 mg VO no dia
Ref. (16)
Cabazitaxel + Prednisona
Cabazitaxel: 25 mg/ m2 IV a cada 21 dias
Prednisona: 10 mg VO/dia
Ref. (17)
Vinorelbina + Hidrocortisona
Vinorelbina: 30 mg/ m2 Dias 1 e 8 a cada 21 dias.
+
Hidrocortisona: 40 mg VO dia, uso contnuo.
Ref. (18)
Abiraterona + Prednisona
Abiraterona: 1g VO dia
+
Prednisona: 5 mg VO 2 x dia, uso contnuo.
Ref. (19)
1. Eisenberger MA, et al. Prognostic factors in stage D2 prostate

cancer: important implications for future trials; results of a
cooperative intergroup study (INT.0036). The national
cancer institute intergroup study #0036. Semin oncol
1994;21:613-619.
2. Jurincic CD, et al. Combined treatment (goserelin plis
flutamide) versus monotherapy (goserelin alone) in
advanced prostate cancer: a randomized study. Semin oncol
1991;18 (Suppl 6):21-25.
3. Tannock IF, de Wit R, Berry WR, et al: Docetaxel plus
prednisone or mitoxantrone plus prednisone for advanced
prostate cancer. N Engl J Med 351:1502-1512, 2004.
4. Copur MS, et al. Weekly docetaxel and estramustine in patients
85
with hormone-refractory prostate cancer. Semin oncol

2001;28:16-21.
5. Tannock IF, et al. Chemotherapy with mitoxantrone plus
prednisone or prednisone alone for symptomatic hormoneresistant prostate cancer: a Canadian randomized trial with
palliative end points. J clin oncol 1996:14:1756-1764.
6. Dreicer R. Chemotherapy for advanced prostate cancer:
docetaxel and beyond. Hematol oncol clin north Am
2006;20:935-926.
7. Dijkman GA, et al. A randomized trial comparing the safety
and efficacy oh the zoladex 10.8mg de pot, administered
every twelve weeks, to that of the zoladex 3.6mg depot,
administered every four weeks, in patients with advanced
prostate cancer. The Dutch South East Cooperative
Urological Group. Eur Urol 1995;27:43-46.
8. The Leuprolide Study Group. Leuporlide versus
diethylstilbestrol for metastatic prostate cancer. N Engk J
Med 1984;311:1281-1286.
Sharifi R, et al. Leuprolide acetate 22.5 mg 12-week depot
formulation in the treatment of patients with advanced
prostate cancer. Clin Ther 1996;18:647-657.
9. Schellhammer PF, et al. Clinical benefits of bicalutamide
compared with flutamide in combined androgen clockade
for patients with advanced prostatic carcinoma: final report
of a double blind, randomized, multicenter trial. Urology
1997;50:330-336.
10. Mc Leod DG, et al. The use of flutamide in hormone
refractory metastatic prostate cancer. Cancer 1993;72:38703873.
11. Janknegt RA, et al. Orchiectomy and nilutamine or placebo
as treatment of metastatic prostatic cancer in a
multinational doubleblind randomized trial. J Urol
1993;149:77-82.
12. Tannock IF, et al. Chemotherapy with mitoxantrone plus
prednisone or prednisone alone for symptomatic hormone-
86
resistant prostate cancer: a Canadian randomized trial with

palliative end points. J Clin Oncol 1996:14:1756-1764.
13. Johnson DE, et al. Ketoconazole therapy for hormonally
refractive metastatic prostate cancer Erology 1988;31:132134.
14. Roth BJ. et al. Taxol in advanced, hormone-refractory
carcinoma of the rrw.ate. A phase II trial of the Eastern
Cooperative Oncoiogy Group cancer 1993;2:245-2260.
15. Ahmed S, et al. Feasibility of weekly one hour paclitaxel in
hormone refractory prostate cancer (HRPC): a preliminary
report of a phase II trial. Proc Am Soe Clin Oncol 1998;
17:325a.
16. Smith DC, Redman BG, Flaherty LE, Li L, et al. phase II trial of
oral diethylstilbesterol as a secondline hormonal agent in
advanced prostate cancer. Urology.1998;52:257-60.
17. Bono J. S. de, Oudard S, Ozguroglu M, et al. Cabazitaxel or
mitoxantrone with prednisone in patients with metastatic
castration-resistant prostate cancer (mCRPC) previously treated
with docetaxel: Final results of a multinational phase III trial
(TROPIC). J Clin Oncol. 2010. 28:15s (suppl; abstr 4508).
18. Abratt R. P , Brune D., Dimopoulos M. - A, et. Al. Randomised
phase III study of intravenous vinorelbine plus hormone
therapy versus hormone therapy alone in hormonerefractory prostate cancer. Ann Oncol. 2004;15(11): 16131621.
19. de Bono JS, Logothetis CJ, Molina A, et. al. Abiraterone and
increased survival in metastatic prostate cancer. N Engl J
Med. 2011; 26;364(21):1995-2005.
87
Cncer de Testculo
PEB
Bleomicina: 30 UI, IV D2, D9 e D16
Etoposide: 100 mg/m IV D1 ao D5
Cisplatina: 20 mg/m IV D1 ao D5
a cada 21 dias no total de 3 ou 4 ciclos
Ref. (1)
Carboplatina 1- 2 ciclos
Carboplatina: AUC de 7 IV em 30 minutos
a cada 3 semanas no total de 1 ou 2 ciclos
Ref. (2)
EP
Ref. (3)
VeIP (regime de resgate)
Vimblastina: 0,11 mg/kg IV D1 e D2
Ifosfamida: 1200 mg/m IV D1 ao D5
Mesna: 400 mg/m IV, administrado 15 minutos antes da
primeira dose de ifosfamida, e ento 1200 mg/m/dia IV infuso
contnua por 5 dias
a cada 21 dias
Ref. (4)
88
VIP (regime de resgate)

Ifosfamida: 1200 mg/m IV D1 ao D5
Mesna: 400 mg/m IV administrado 15 minutos antes na primeira
dose de Ifosfamida, e ento 1200 mg/m/dia IV infuso
contnua por 5 dias.
Filgrastima: 300mcg SC por 5 dias
a cada 21 dias
Ref. (5)
TIP (regime de resgate)
Paclitaxel: 250 mg/m IV infuso contnua D1
Ifosfamida: 1200 mg/m IV durante 1 hora D2 ao D6
Cisplatina: 20 mg/m IV durante 1 hora D2 ao D6
Mesna: 400 mg/m IV 30 min antes, 4 e 8 horas aps Ifosfamida
Filgrastima: 300 mcg/dia SC por 5 dias.
a cada 21 dias
Ref. (6)
BEP
Cisplatina 50 mg/m2 IV D1 e D2
Bleomicina 30 mg IV D2, D9 e D16
Etoposide 165 mg/m2/dia IV D1, D2 e D3
Ref. (7)
CBOP/BEP (regime de resgate)
Ciclo 1 e 2 (C-BOP)
Cisplatina 50 mg/m2 IV D1 e D2
Vincristina 2mg IV D1 e D8
Bleomicina 15 mg IV D1 e D8
Cisplatina 40 mg/m2 IV
Carboplatina AUC3 IV D8
Bleomicina 15 mg IV em infuso contnua D8 a D12
89
Ciclo 3 (BO)
Vincristina 2mg IV D1 e D8
Bleomicina 15 mg IV D1 e D8
Ciclo 4, 5 e 6 (BEP modificado)
Cisplatina 20 mg/m2/dia, D1 a D5
Etoposide 100mg/m2/dia, D1 a D5
Bleomicina 15 mg IV D1, D8 e D15
SEMANAS 1 a 4 2 ciclos de C-BOP
SEMANAS 5 e 7 2 ciclos de BO
SEMANAS 10, 13 e 17 3 ciclos de BEP modificado
Ref. (8)
1. Williams SD, et al. Treatment of disseminated germ-cell
tumors with cisplatin, bleomycin, and either vinblastine or
etoposide. N Engl J Med 1987;316:1465-1440.
2. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ,
Joffe JK, et al. Radiotherapy versus single-dose carboplatin
in adjuvant treatment of stage I seminoma: a randomised
trial. Lancet 2005;366:293300.
3. Bosl G, et al. A randomized trial of etoposide + cisplatin
versus vinblastine + bleomycin + cisplatin +
cyclophosphamide + dactinomycin in patients with goodprognosis germ cell tumors. J Clin Oncol 1988;6:1231-1238.
4. Loehrer PJ, et al. Salvage therapy in recurrent germ cell
cancer: ifosfamide and cisplatin plus either vinblastine or
etoposide. Ann Intern Med 1988;109:540-546.
5. Loehrer PJ, et al. Salvage therapy in recurrent germ cell
cancer: ifosfamide and cisplatin plus either vinblastine or
etoposide. Ann Intern Med 1988;109:540-546.
6. Motzer R, Sheinfeld J, Mazumdar M et al. Paclitaxel,
Ifosfamide, and Cisplatin Second-Line Therapy for Patients
With Relapsed Testicular Germ Cell Cancer J Clin Oncol
2000:2413-2418.
90
7. De Wit R, Roberts JT, Wilkinson PM et al. Equivalence of Three

or Four Cycles of Bleomycin, Etoposide, and Cisplatin
Chemotherapy and of a 3- or 5-Day Schedule in GoodPrognosis Germ Cell Cancer: A Randomized Study of the
European Organization for Research and Treatment of
Cancer Genitourinary Tract Cancer Cooperative Group and
the Medical Research Council. J Clin Oncol 2001;19:1629-40.
8. Christian JA, Huddart RA, Norman A et al. Intensive in duction chemotherapy with CBOP/BEP in patients with
poor prognosis germ cell tumors. J Clin Oncol 2003;21:
87177.
91
Cncer de Pnis
TIP
Paclitaxel: 175 mg/m2 IV D1
Cisplatina: 25 mg/ m2 IV D1-D3
Ifosfamida: 1200 mg/ m2 IV D1-D3
Mesna : 400 mg/ m2 IV hora 0,4 e 8 da Ifosfamida a cada 21 dias
Ref. (1)
Cisplatina + 5-Fluorouracil
IV
2
Ref. (2)
D1
D1-D4 a cada 21 dias
1. Pagliaro Lance C., Williams Dallas L., Daliani, Danai.

Neoadjuvant paclitaxel, ifosfamide, and cisplatin
chemotherapy for metastatic penile cancer:a phase II study.
J Clin Oncol. 2010; 28: 3851-3857.
2. Shammas FV, Ous S, Fossa SD. Cisplatin and 5-fluorouracil in
advanced cancer of the penis. J Urol 1992;147:630-2.
92
Cncer de Endomtrio
Carboplatina: AUC 5-7
a cada 21 dias
Ref. (1)
Adriamicina + Ciclofosfamida
a cada 21 dias
Ref. (2)
Cisplatina: 50mg/m2
a cada 21 dias
Ref.(3)
Adriamicina + Paclitaxel
a cada 21 dias
Ref. (4)
IV
IV
D1
D1
IV
IV
D1
D1
IV
IV
D1
D1
IV
IV
D1
D1
Cisplatina + Doxorrubicina + Paclitaxel

Cisplatina: 50mg/m2
IV
IV
2
Paclitaxel: 160mg/m
IV
Filgrastima: 5mcg/kg
SC
a cada 21 dias
Ref. (5)
D1
D1
D2
D3-D12
93
CAP
Ref. (6)
IV
IV
IV
D1
D1
D1 a cada 21 dias
Carboplatina + Doxorrubicina Lipossomal

Carboplatina: AUC 5
IV
D1
2
Doxo lipossomal: 40mg/m
IV
D1 a cada 28 dias
Ref. (7)
94
Doxorrubicina
Doxorrubicina: 60mg/m2 IV
Ref. (8)
D1 a cada 21 dias
Paclitaxel
IV
Se RXT prvia: 175mg/m2 IV
Ref. (9)
D1 a cada 21 dias
D1 a cada 21 dias
Topotecano
Topotecano: 1mg/m2/dia
Se RXT prvia
0,8mg/m2/dia
Ref. (10)
IV D1-D5 a cada 21 dias

IV D1-D5 a cada 21 dias
Acetato de Megestrol
Acetato de megestrol: 160mg
Ref.(11)
VO
Tamoxifeno
Tamoxifeno: 20mg
Ref.(12)
Contnuo
VO
Contnuo
Anastrozol
Anastrozol: 1 mg/dia VO contnuo
Ref. (13)
Letrozol
Letrozol: 2,5 mg VO dia contnuo
Ref. (14)
Ifosfamida
Ifosfamida: 1200mg/m2 IV
Mesna: 300 mg/m2
IV
D1 a D5
concomitante, 4 e 8hs aps ifosfamida
Ref. (15)
Doxorrubicina lipossomal
Doxorrubicina lipossomal: 40mg/m2
Ref. (16)
IV
a cada 28 dias
D1
28 dias
1. Hoskins, P.J., et al. Paclitaxel and carboplatin, alone or with

irradiation, in advanced or recurrent endometrial cancer: a
phase II study. J Clin Oncol, 2001. 19(20): p. 4048-53.
2. Thigpen, J.T., et al. A randomized comparison of doxorubicin
alone versus doxorubicin plus cyclophosphamide in the
management of advanced or recurrent endometrial
carcinoma: A Gynecologic Oncology Group study. J Clin
Oncol, 1994. 12(7): p. 1408-14.
3. Deppe, G., et al. Treatment of recurrent and metastatic
endometrial carcinoma with cisplatin and doxorubicin. Eur J
Gynaecol Oncol, 1994. 15(4): p. 263-6.
4. Fleming G. F., Filiaci V. L., Bentley R. C, et. al.Phase III
randomized trial of doxorubicin + cisplatin versus doxorubicin
+ 24-h paclitaxel + filgrastim in endometrial carcinoma: a
95
Gynecologic Oncology Group study. Ann Oncol. 2004; 15(8):

1173-1178.
5. Fleming, G.F., 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 Clin Oncol, 2004. 22(11): p. 2159-66.
6. Burke, T.W., et al. Postoperative adjuvant cisplatin,
doxorubicin, and cyclophosphamide (PAC) chemotherapy
in women with high-risk endometrial carcinoma. Gynecol
Oncol, 1994. 55(1): p. 47-50.
7. Pignata, S., et al. A multicentre phase II study of carboplatin
plus pegylated liposomal doxorubicin as first-line
chemotherapy for patients with advanced or recurrent
endometrial carcinoma: the END-1 study of the MITO
(Multicentre Italian Trials in Ovarian Cancer and Gynecologic
Malignancies) group. Br J Cancer, 2007. 96(11): p. 1639-43.
8. Muss, H.B., Chemotherapy of metastatic endometrial cancer.
Semin Oncol, 1994. 21(1): p. 107-13.
9. Ball, H.G., Do we know the best therapy for early endometrial
cancer? Gynecol Oncol, 1996. 60(2): p. 173-5.
10. Wadler, S., et al. Topotecan is an active agent in the first-line
treatment of metastatic or recurrent endometrial
carcinoma: Eastern Cooperative Oncology Group Study
E3E93. J Clin Oncol, 2003. 21(11): p. 2110-4.
11. Thigpen, J.T., et al. Oral medroxyprogesterone acetate in
the treatment of advanced or recurrent endometrial
carcinoma: a dose-response study by the Gynecologic
Oncology Group. J Clin Oncol, 1999. 17(6): p. 1736-44.
12. Thigpen, T., et al. Tamoxifen in the treatment of advanced or
recurrent endometrial carcinoma: a Gynecologic Oncology
Group study. J Clin Oncol, 2001. 19(2): p. 364-7.
13. Rose PG, Brunetto, VL, et al. A Phase II trial of Anastrozolein
advanced recurrent or persistent endometrial carcinoma: A
Gynecologic Oncology Group Study. Gynecologic
Oncology,2000; 78, 212-216.
96
14. Ma B B.Y, Oza A, et al. The activity of letrozole in patients

with advanced or recurrent endometrial cancer and
correlation with biological markers a study of the National
Cancer Institute of Canada Clinical Trials Group, Intern J
Gynecol Cancer 2004. 14(4):650 - 658.
15. Sutton GP, et al. A Phase II Gynecologic Oncology Group Trial
of Ifosfamide and Mesna in Advanced or Recurrent
Adenocarcinoma of the Endometrium. Gynecol Oncol.
Ginecol Oncol 1996;63:25-7.
16. Homesley, HD, et. al. Phase II trial of liposomal doxorubicin
at 40 mg/m2 every 4 weeks in endometrial carcinoma: A
Gynecologic Oncology Group Study Gynecol Oncol 2005;
98:294-8.
97
Cncer de Colo Uterino

Cisplatina: 40mg/m2
IV
trmino da radioterapia
Paclitaxel: 135mg/m2 IV
Cisplatina: 75mg/m2 IV
Ref. (9)
D1
at
Ref. (1)
D1 em infuso de 24 horas
D1
a cada 21 dias
Cisplatina + Topotecano
Cisplatina: 50mg/m2
Topotecano: 0,75mg/m2/dia
Ref. (2)
IV D1
IV D1 a D3 a cada 21 dias
Cisplatina: 75mg/m2
5-Fluorouracil: 1000mg/m2
Ref. (3)
IV D1
IV D1 a D5 a cada 21 dias
Cisplatina + Vinorelbina
Cisplatina: 80mg/m2
IV D1
2
Vinorelbina: 25mg/m
IV D1, D8
Ref. (4)
Cisplatina: 60mg/m2
IV
Irinotecano: 60mg/m2
IV
a cada 28 dias
Docetaxel
Docetaxel: 100mg/m2
98
Semanal
IV
a cada 21 dias
D1
D1, D8, D15
Ref. (5)
D1 a cada 21 dias
Paclitaxel
Ref. (6)
IV
D1 a cada 21 dias
Irinotecano
Irinotecano: 125mg/m2
folga de 14 dias
IV
D1, D8, D15, D22 com

Ref. (7)
Topotecano
Topotecano: 1,5mg/m2/dia IV
Ref. (8)
D1 a D5 a cada 21 dias
Vinorelbina
Vinorelbina: 30 mg/m2 IV semanalmente
Ref. (10)
Ifosfamida
Ifosfamida: 1.200 mg/m2 ( com Mesna) IV D1 a D5 a cada 21 dias
Ref. (11)
Gencitabina
Gencitabina: 800 mg/m2 IV D1, D8 e D15 a cada 28 dias
Ref. (12)
1. Rose, P.G., et al. Concurrent cisplatin-based radiotherapy and
chemotherapy for locally advanced cervical cancer. N Engl J
Med, 1999. 340(15): p. 1144-53.
2. Long, H.J., 3rd, et al. Randomized phase III trial of cisplatin
with or without topotecan in carcinoma of the uterine
cervix: a Gynecologic Oncology Group Study. J Clin Oncol,
2005. 23(21): p. 4626-33.
3. Whitney, C.W., et al. Randomized comparison of fluorouracil
plus cisplatin versus hydroxyurea as an adjunct to radiation therapy
in stage IIB-IVA carcinoma of the cervix with negative para-aortic
lymph nodes: a Gynecologic Oncology Group and Southwest
Oncology Group study. J Clin Oncol, 1999. 17(5): p. 1339-48.
99
4. Pignata, S., et al. Phase II study of cisplatin and vinorelbine as

first-line chemotherapy in patients with carcinoma of the
uterine cervix. J Clin Oncol, 1999. 17(3): p. 756-60.
5. Chitapanarux, I., et al. Phase II clinical study of irinotecan and
cisplatin as first-line chemotherapy in metastatic or recurrent
cervical cancer. Gynecol Oncol, 2003. 89(3): p. 402-7.
6. Thigpen, T., et al. The role of paclitaxel in the management of
patients with carcinoma of the cervix. Semin Oncol, 1997.
24(1 Suppl 2): p. S2-41-S2-46.
7. Verschraegen, C.F., et al. Phase II study of irinotecan in prior
chemotherapy-treated squamous cell carcinoma of the
cervix. J Clin Oncol, 1997. 15(2): p. 625-31.
8. Muderspach, L.I., et al. A Phase II study of topotecan in patients
with squamous cell carcinoma of the cervix: a gynecologic
oncology group study. Gynecol Oncol, 2001. 81(2): p. 213-5.
9. Piccart, M.J., et al. Randomized intergroup trial of cisplatinpaclitaxel versus cisplatin-cyclophosphamide in women
with advanced epithelial ovarian cancer: three-year results.
J Natl Cancer Inst, 2000. 92(9): p. 699-708.
10. Morris M, Brader KR, Levenback C, et al. Phase II study of
vinorelbine in advanced and recurrent squamous cell
carcinoma of the cervix. J Clin Oncol. 1998; 16:1094-1098.
11. Sutton GP, Blessing JA, McGuire WP, et al. Phase II trial of
ifosfamide and mesna in patients with advanced or
recurrent squamous carcinoma of the cervix who had never
received chemotherapy: a gynecologic oncology group
study. Am J Obstet Gynecol. 1993; 168:805-7.
12. Schilder RJ, Blessing JA, Morgan M, et al. Evaluation of
gemcitabine in patients with squamous cell carcinoma of
the cervix: A phase II study of the Gynecologic Oncology
Group. Gynecol Oncol 76:204207, 2000.
100
Cncer de Mama
AC-D
Adriamicina: 60 mg/m2
IV
Ciclofosfamida: 600 mg/m2 IV
Docetaxel: 100mg/m2
IV
a cada 21 dias X 4 ciclos
D1
D1 a cada 21 dias X 4 ciclos
D1 aps 4 ciclos de AC
Ref. (1-3)
Ou
Doxorrubicina: 60 mg/m2 IV
Docetaxel: 35mg/m2
IV
semanal X 12 semanas
D1
D1a cada 21 dias X 4 ciclos
Ref. (2, 3)
AC-T
IV
D1
Ref. (2)
Paclitaxel: 80mg/m2
IV
D1
Ref. (2, 3)
TAC
Doxorrubicina: 50 mg/m2
Ciclofosfamida: 500 mg/m2
Docetaxel: 75 mg/m2
Ciprofloxacina: 500mg
Filgrastima: 300mcg
Ref. (4, 5)
IV
IV
IV
VO BID
SC
D1
D1
D1
D5-D14
D2-D14
101
AC
Ref. (6-8)
D1
FAC
5-Fluorouracil: 500 mg/m2 IV
Ref. (9, 10)
D1
D1
CMF oral
Ciclofosfamida: 100 mg/m2 VO D1 a D 14
Methotrexate: 40 mg/m2 IV
D1
2
Ref. (11)
102
CMF
Ciclofosfamida: 600mg/m2 IV
Ref. (12)
D1
D1
CMF
ciclos
D1 e D8
D1 e D8
D1 e D8 a cada 28 dias X 6
TC
Docetaxel: 75mg/m2
IV
Ref.(13)
D1
FEC 100
Epirrubicina: 100 mg/m2 IV
Ref. (14-16)
D1
D1
FEC 100- Docetaxel

Epirrubicina: 100 mg/m2 IV
Docetaxel: 100mg/ m2
IV
D1
D1
D1
D1 aps FEC
Ref. (17)
TCH
Docetaxel: 75mg/m2
Carboplatina: AUC 6
Trastuzumabe: 8mg/kg
D1
D1
ATAQUE
D1 a cada 21 dias por 1 ano
IV
IV
IV
IV
AC-TH
Paclitaxel: 80mg/m2
IV
Trastuzumabe: 4mg/kg IV
IV
Ref.(18)
D1
D1
D1
ATAQUE
semanal por 1 ano
AC-TH
D1
2
Ciclofosfamida: 600mg/m IV
IV
Trastuzumabe: 4mg/kg IV D1 ATAQUE
IV D1 semanal por 1 ano Ref.(18)
103
AC-TH
Paclitaxel: 80mg/m2
IV
IV
DH-FEC
Docetaxel: 100mg/m2
IV
5-Fluourouracil: 600mg/m2IV
Epirrubicina: 60mg/m2
IV
2
Ref. (19)
VH-FEC
Vinorelbina: 25g/m2
IV
5-Fluourouracil: 600mg/m2IV
IV
2
AD
Docetaxel: 75mg/m2
IV
a cada 21 dias
Ref. (8)
104
D1
D1
D1
ATAQUE
semanal por 1 ano

D1
ATAQUE
D1 semanal por 9 semanas
D1
D1
D1 aps 4 ciclos de DH

D1
ATAQUE
D1 semanal por 9 semanas
D1 aps 4 ciclos de DH
Ref. (19)
D1
D1
AT
IV
Ref. (20)
D1
D1
a cada 21 dias
Docetaxel + Capecitabina
Docetaxel: 75 mg/m2
IV
D1 a cada 21 dias
a cada 21 dias
Ref. (21)
Vinorelbina + Capecitabina
Vinorelbina: 25 mg/m2
IV
Capecitabina: 1000 mg/m2 VO BID D1 a D 14 a cada 21 dias
Ref. (22, 23)
Gencitabina + Capecitabina
D1 a cada 21 dias
2
Capecitabina: 1250mg/m VO BID D1 a D 14 a cada 21 dias
Ref. (24)
Ou
Capecitabina 750mg/m2
Ref. (25)
IV
VO BID D1 a D14 a cada 21 dias
Vinorelbina + Gencitabina
Vinorelbina 25mg/m2
IV
Ref. (26)
D1
D1 a cada 14 dias
105
IV D1 e D8
2
Gencitabina: 750 mg/m IV D1 e D8 a cada 21 dias
Ref. (27)
Doxorrubicina
Doxorrubicina: 60 mg/m2 IV D1 a cada 21 dias
Ref. (28)
Epirrubicina
Ref. (29)
IV D1 a cada 21 dias
Paclitaxel
Ref. (28, 30)
Ou
Paclitaxel: 90mg/m2
Ref. (31)
Docetaxel
Docetaxel: 100mg/m2
Ref. (32)
IV D1 a cada 7 dias
Ou
Docetaxel: 40mg/m2
IV
D1, D8, D15, D22, D29, D36
Ref. (33)
com 14 dias de folga
Capecitabina
Capecitabina: 1250mg/m2 VO BID D1 a D14 a cada 21 dias
Ref. (34)
106
Vinorelbina
Vinorelbina: 30mg/m2
Ref. (35)
IV D1 e D8 a cada 21 dias
Doxorrubicina Lipossomal
Doxo lipossomal: 40mg/m2 IV D1 a cada 28 dias
Ref. (36)
Gencitabina
Ref. (37)
IV
D1, D8, D15 a cada 28 dias
Trastuzumabe
Ref. (38)
IV
IV
D1
D1
ATAQUE
a cada 21 dias
IV
IV
D1
D1
ATAQUE
a cada 7 dias
Paclitaxel + Trastuzumabe
IV
subsequente
D1
D1
D1
a cada 21 dias
ATAQUE
a cada 7 dias
Ref. (40)
D1
D1
D1
a cada 7 dias
ATAQUE
a cada 7 dias
Ou
Ref. (39)
Ou
Paclitaxel: 90mg/m2
subsequente
Ref. (41)
IV
IV
IV
107
Docetaxel + Trastuzumabe
Docetaxel: 100mg/m2
IV
IV
subsequente
Ref. (42)
D1 a cada 21 dias
D1
ATAQUE
D1
a cada 7 dias
Ou
Docetaxel: 35mg/m2
subsequente
Ref. (43)
IV
IV
IV
Vinorelbina + Trastuzumabe
IV
subsequente
Ref. (44)
Gencitabina + Trastuzumabe
a cada 21 dias
subsequente
Ref. (45)
D1 a cada 7 dias
D1
ATAQUE
D1
a cada 7 dias
D1 a cada 7 dias
D1
ATAQUE
D1
a cada 7 dias
D1 e D8
D1
D1
ATAQUE
a cada 7 dias
Vinorelbina Oral
Vinorelbina: 80mg/m2 D1 semanal aps 3 administraes com
dose de 60mg/m2 semanal para testar mielossensibilidade
Ref. (71)
108
Gencitabina + Paclitaxel
Ref. (46, 47)
Gencitabina + Docetaxel
Docetaxel: 75mg/m2
IV
Ref. (48)
D1 e D8
D1
a cada 21 dias
Gencitabina + Vinorelbina
Vinorelbina : 30mg/m2
IV
Ref. (49)
D1 e D8
Lapatinibe + Capecitabina
Lapatinibe: 1250mg
Capecitabina : 2000mg/m2
a cada 21 dias
Ref. (50)
VO/dia contnuo
VO
D1 a D14
Lapatinibe + Trastuzumabe
Lapatinibe: 1250mg
VO/dia contnuo
D1
ATAQUE
D1
a cada 7 dias
Tamoxifeno
Tamoxifeno: 20mg
anos/indefinido
Ref. (51, 52)
Anastrozol
Anastrozol: 1mg VO
Ref. (53-55)
VO
Diariamente
Diariamente
5 anos/indefinido
109
Letrozol
Letrozol: 2,5mg VO
Ref. (56, 57)
Diariamente
indefinido
Exemestano
Exemestano: 25mg VO Diariamente
Ref. (58, 59)
indefinido
Tamoxifeno + Letrozol
Tamoxifeno: 20mg
VO
Letrozol: 2,5mg
VO
aps trmino Tamoxifeno
Ref. (60)
Tamoxifeno + Exemestano
Tamoxifeno: 20mg
VO
Exemestano: 25mg
VO
completar 5 anos
Ref. (61)
5 anos
5 anos
Diariamente
Diariamente
2-3 anos
At
Fulvestranto
Fulvestranto: 250mg
Ref. (62)
IM
Megestrol
Megestrol: 160 mg VO
Ref. (63)
Diariamente
indefinido
Toremifeno
Toremifeno: 60mg VO
Ref. (64)
Diariamente
indefinido
Anlogo LHRH+ Tamoxifeno

LHRH: -------- IM ou SCD1
Tamoxifeno: 20mg
VO
110
Diariamente
Diariamente
D1
a cada 28 dias
a cada 28 dias
Contnuo
Ref. (65)
Analogo LHRH+ Anastrozol

LHRH: -------- IM ou SCD1
Anastrozol
1mg
VO
a cada 28 dias
Contnuo
Dose densa AC T
Doxorrubicina: 60 mg/m IV no D1
Ciclofosfamida: 600 mg/m IV no D1
Filgrastima: 300mcg SC do D2 ao D12
a cada 14 dias no total de 4 ciclos.
seguido por
Paclitaxel: 175 mg/m IV no D1 a cada 14 dias por 4 ciclos
Filgrastima: 300mcg SC do D2 ao D12
Ou
Paclitaxel: 80 mg/m IV semanalmente por 12 semanas
Ref. (66)
ATH TH CMFH (NOAH trial)
Doxorrubicina: 60 mg/m IV no D1
Paclitaxel: 175mg/m IV D1 a cada 3 semanas X 3 ciclos
Seguido de:
Paclitaxel: 175 mg/m IV D1 X 4 ciclos
Seguido de:
Ciclofosfamida: 600mg/m2 IV D1 e D8
Methotrexate: 40mg/m2 IV D1 e D8
5-Fluorouracil: 600mg/m2 D1 e D8
Repetir CMF a cada 28 dias por 3 ciclos.
Trastuzumabe concomitante com toda a Quimioterapia (dose
ataque 8mg/kg seguido de dose de manuteno de 6mg/kg a
cada 3 semanas at completar 1 ano de terapia).
Ref. (67)
111
Paclitaxel + Bevacizumabe (ECOG 2100)

Paclitaxel: 90 mg/m2 IV no D1, D8 e D15 a cada 4 semanas,
associado a
Bevacizumabe: 10mg/kg IV a cada 2 semanas.
Ref. (68)
Docetaxel + Bevacizumabe (AVADO)
Docetaxel: 100mg/m2 IV no D1 a cada 3 semanas.
Bevacizumabe: 15mg/kg IV no D1 a cada 3 semanas.
Ref. (69)
Capecitabina + Bevacizumabe (RIBBON 1)
Capecitabina: 1000mg/m2 VO BID por 14 dias a cada 21 dias.
Bevacizumabe: 15mg/kg IV no D1 a cada 3 semanas.
Ref. (70)
1. Bear, H.D., et al. The effect on tumor response of adding
sequential preoperative docetaxel to preoperative
doxorubicin and cyclophosphamide: preliminary results
from National Surgical Adjuvant Breast and Bowel Project
Protocol B-27. J Clin Oncol, 2003. 21(22): p. 4165-74.
2. Sparano, J.A., et al. Weekly paclitaxel in the adjuvant
treatment of breast cancer. N Engl J Med, 2008. 358(16): p.
1663-71.
3. De Laurentiis, M., et al. Taxane-based combinations as
adjuvant chemotherapy of early breast cancer: a meta-analysis
of randomized trials. J Clin Oncol, 2008. 26(1): p. 44-53.
4. Martin, M., et al. Adjuvant docetaxel for node-positive breast
cancer. N Engl J Med, 2005. 352(22): p. 2302-13.
5. Mackey, J., Proc.ASCO, 2002. 21(abstract137).
6. Fisher, B., et al. Two months of doxorubicin-cyclophosphamide
with and without interval reinduction therapy compared
with 6 months of cyclophosphamide, methotrexate, and
fluorouracil in positive-node breast cancer patients with
tamoxifen-nonresponsive tumors: results from the National
112
Surgical Adjuvant Breast and Bowel Project B-15. J Clin

Oncol, 1990. 8(9): p. 1483-96.
7. Fisher, B., et al. Effect of preoperative chemotherapy on the
outcome of women with operable breast cancer. J Clin
Oncol, 1998. 16(8): p. 2672-85.
8. Nabholtz, J.M., et al. Docetaxel and doxorubicin compared
with doxorubicin and cyclophosphamide as first-line
chemotherapy for metastatic breast cancer: results of a
randomized, multicenter, phase III trial. J Clin Oncol, 2003.
21(6): p. 968-75.
9. Martin, M., et al. Doxorubicin in combination with
fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1,
21) versus methotrexate in combination with fluorouracil
and cyclophosphamide (i.v. CMF regimen, day 1, 21) as
adjuvant chemotherapy for operable breast cancer: a study
by the GEICAM group. Ann Oncol, 2003. 14(6): p. 833-42.
10. Stewart, D.J., et al. Cyclophosphamide and fluorouracil
combined with mitoxantrone versus doxorubicin for breast
cancer: superiority of doxorubicin. J Clin Oncol, 1997. 15(5):
p. 1897-905.
11. Bonadonna, G., et al. Combination chemotherapy as an
adjuvant treatment in operable breast cancer. N Engl J Med,
1976. 294(8): p. 405-10.
12. Pritchard, K.I., et al. Randomized trial of cyclophosphamide,
methotrexate, and fluorouracil chemotherapy added to
tamoxifen as adjuvant therapy in postmenopausal women
with node-positive estrogen and/or progesterone receptorpositive breast cancer: a report of the National Cancer
Institute of Canada Clinical Trials Group. Breast Cancer Site
Group. J Clin Oncol, 1997. 15(6): p. 2302-11.
13. Jones, S.E., et al. Phase III trial comparing doxorubicin plus
cyclophosphamide with docetaxel plus cyclophosphamide
as adjuvant therapy for operable breast cancer. J Clin Oncol,
2006. 24(34): p. 5381-7.
14. Coombes, R.C., et al. Adjuvant cyclophosphamide,
113
methotrexate, and fluorouracil versus fluorouracil, epirubicin,

and cyclophosphamide chemotherapy in premenopausal
women with axillary node-positive operable breast cancer:
results of a randomized trial. The International Collaborative
Cancer Group. J Clin Oncol, 1996. 14(1): p. 35-45.
15. Benefit of a high-dose epirubicin regimen in adjuvant
chemotherapy for node-positive breast cancer patients with
poor prognostic factors: 5-year follow-up results of French
Adjuvant Study Group 05 randomized trial. J Clin Oncol,
2001. 19(3): p. 602-11.
16. Epirubicin-based chemotherapy in metastatic breast
cancer patients: role of dose-intensity and duration of
treatment. J Clin Oncol, 2000. 18(17): p. 3115-24.
17. Roche, H., et al. Sequential adjuvant epirubicin-based and
docetaxel chemotherapy for node-positive breast cancer
patients: the FNCLCC PACS 01 Trial. J Clin Oncol, 2006.
24(36): p. 5664-71.
18. Romond, E.H., et al. Trastuzumab plus adjuvant
chemotherapy for operable HER2-positive breast cancer. N
Engl J Med, 2005. 353(16): p. 1673-84.
19. Joensuu, H., et al. Adjuvant docetaxel or vinorelbine with or
without trastuzumab for breast cancer. N Engl J Med, 2006.
354(8): p. 809-20.
20. Biganzoli, L., et al. Doxorubicin and paclitaxel versus
doxorubicin and cyclophosphamide as first-line chemotherapy
in metastatic breast cancer: The European Organization for
Research and Treatment of Cancer 10961 Multicenter Phase
III Trial. J Clin Oncol, 2002. 20(14): p. 3114-21.
21. O'Shaughnessy, J., et al. Superior survival with capecitabine
plus docetaxel combination therapy in anthracyclinepretreated patients with advanced breast cancer: phase III
trial results. J Clin Oncol, 2002. 20(12): p. 2812-23.
22. Biganzoli, L., M. Martin, and C. Twelves, Moving forward
with capecitabine: a glimpse of the future. Oncologist, 2002.
7 Suppl 6: p. 29-35.
114
23. Welt, A., et al. Phase I/II study of capecitabine and

vinorelbine in pretreated patients with metastatic breast
cancer. Ann Oncol, 2005. 16(1): p. 64-9.
24. Andres, R., et al. Gemcitabine/capecitabine in patients with
metastatic breast cancer pretreated with anthracyclines and
taxanes. Clin Breast Cancer, 2005. 6(2): p. 158-62.
25. Abstracts of the 27th Annual San Antonio Breast Cancer
Symposium. December 8-11, 2004, San Antonio, Texas, USA.
Breast Cancer Res Treat, 2004. 88 Suppl 1: p. S1-265.
26. Stathopoulos, G.P., et al. Phase II trial of biweekly
administration of vinorelbine and gemcitabine in pretreated
advanced breast cancer. J Clin Oncol, 2002. 20(1): p. 37-41.
27. Nagourney, R.A., et al. Gemcitabine plus cisplatin repeating
doublet therapy in previously treated, relapsed breast
cancer patients. J Clin Oncol, 2000. 18(11): p. 2245-9.
28. Sledge, G.W., et al. Phase III trial of doxorubicin, paclitaxel,
and the combination of doxorubicin and paclitaxel as frontline chemotherapy for metastatic breast cancer: an
intergroup trial (E1193). J Clin Oncol, 2003. 21(4): p. 588-92.
29. A prospective randomized trial comparing epirubicin
monochemotherapy to two fluorouracil, cyclophosphamide,
and epirubicin regimens differing in epirubicin dose in
advanced breast cancer patients. The French Epirubicin
Study Group. J Clin Oncol, 1991. 9(2): p. 305-12.
30. Seidman, A.D., et al. Phase II trial of paclitaxel by 3-hour
infusion as initial and salvage chemotherapy for metastatic
breast cancer. J Clin Oncol, 1995. 13(10): p. 2575-81.
31. Seidman, A.D., et al. Dose-dense therapy with weekly 1hour paclitaxel infusions in the treatment of metastatic
32. Nabholtz, J.M., et al. Prospective randomized trial of
docetaxel versus mitomycin plus vinblastine in patients
with metastatic breast cancer progressing despite previous
anthracycline-containing chemotherapy. 304 Study Group.
J Clin Oncol, 1999. 17(5): p. 1413-24.
115
33. Burstein, H.J., et al. Docetaxel administered on a weekly

basis for metastatic breast cancer. J Clin Oncol, 2000. 18(6):
p. 1212-9.
34. Blum, J.L., et al. Multicenter phase II study of capecitabine
in paclitaxel-refractory metastatic breast cancer. J Clin
Oncol, 1999. 17(2): p. 485-93.
35. Weber, B.L., et al. Intravenous vinorelbine as first-line and
second-line therapy in advanced breast cancer. J Clin Oncol,
1995. 13(11): p. 2722-30.
36. Al-Batran, S.E., et al. Reduced incidence of severe palmarplantar erythrodysesthesia and mucositis in a prospective
multicenter phase II trial with pegylated liposomal
doxorubicin at 40 mg/m2 every 4 weeks in previously
treated patients with metastatic breast cancer. Oncology,
2006. 70(2): p. 141-6.
37. Carmichael, J., et al. Advanced breast cancer: a phase II trial
with gemcitabine. J Clin Oncol, 1995. 13(11): p. 2731-6.
38. Baselga, J., et al. Phase II study of efficacy, safety, and
pharmacokinetics of trastuzumab monotherapy administered
on a 3-weekly schedule. J Clin Oncol, 2005. 23(10): p. 2162-71.
39. Baselga, J., et al. Phase II study of weekly intravenous
trastuzumab (Herceptin) in patients with HER2/neuoverexpressing metastatic breast cancer. Semin Oncol,
1999. 26(4 Suppl 12): p. 78-83.
40. Slamon, D.J., et al. Use of chemotherapy plus a monoclonal
antibody against HER2 for metastatic breast cancer that
overexpresses HER2. N Engl J Med, 2001. 344(11): p. 783-92.
41. Seidman, A.D., et al. Weekly trastuzumab and paclitaxel
therapy for metastatic breast cancer with analysis of efficacy
by HER2 immunophenotype and gene amplification. J Clin
Oncol, 2001. 19(10): p. 2587-95.
42. Marty, M., et al. Randomized phase II trial of the efficacy
and safety of trastuzumab combined with docetaxel in
patients with human epidermal growth factor receptor 2positive metastatic breast cancer administered as first-line
116
treatment: the M77001 study group. J Clin Oncol, 2005.

23(19): p. 4265-74.
43. Esteva, F.J., et al. Phase II study of weekly docetaxel and
trastuzumab for patients with HER-2-overexpressing
metastatic breast cancer. J Clin Oncol, 2002. 20(7): p. 1800-8.
44. Burstein, H.J., et al. Clinical activity of trastuzumab and
vinorelbine in women with HER2-overexpressing metastatic
45. O'Shaughnessy, J.A., et al. Phase II study of trastuzumab
plus gemcitabine in chemotherapy-pretreated patients
with metastatic breast cancer. Clin Breast Cancer, 2004. 5(2):
p. 142-7.
46. O'Shaughnessy, J., Gemcitabine combination chemotherapy
in metastatic breast cancer: phase II experience. Oncology
(Williston Park), 2003. 17(12 Suppl 14): p. 15-21.
47. Albain, K.S., et al. Gemcitabine plus Paclitaxel versus
Paclitaxel monotherapy in patients with metastatic breast
cancer and prior anthracycline treatment. J Clin Oncol, 2008.
26(24): p. 3950-7.
48. Chan, S., et al. Phase III study of gemcitabine plus docetaxel
compared with capecitabine plus docetaxel for
anthracycline-pretreated patients with metastatic breast
cancer. J Clin Oncol, 2009. 27(11): p. 1753-60.
49. Martin, M., et al. Gemcitabine plus vinorelbine versus
vinorelbine monotherapy in patients with metastatic breast
cancer previously treated with anthracyclines and taxanes:
final results of the phase III Spanish Breast Cancer Research
Group (GEICAM) trial. Lancet Oncol, 2007. 8(3): p. 219-25.
50. Geyer, C.E., et al. Lapatinib plus capecitabine for HER2positive advanced breast cancer. N Engl J Med, 2006.
355(26): p. 2733-43.
51. Fisher, B., et al. Tamoxifen and chemotherapy for lymph
node-negative, estrogen receptor-positive breast cancer. J
Natl Cancer Inst, 1997. 89(22): p. 1673-82.
52. Jaiyesimi, I.A., et al. Use of tamoxifen for breast cancer:
117
twenty-eight years later. J Clin Oncol, 1995. 13(2): p. 513-29.

53. Howell, A., Adjuvant aromatase inhibitors for breast cancer.
Lancet, 2005. 366(9484): p. 431-3.
54. Buzdar, A.U., P.V. Plourde, and G.N. Hortobagyi, Aromatase
inhibitors in metastatic breast cancer. Semin Oncol, 1996.
23(4 Suppl 9): p. 28-32.
55. Nabholtz, J.M., et al. Anastrozole is superior to tamoxifen as
first-line therapy for advanced breast cancer in
postmenopausal women: results of a North American
multicenter randomized trial. Arimidex Study Group. J Clin
Oncol, 2000. 18(22): p. 3758-67.
56. Dombernowsky, P., et al. Letrozole, a new oral aromatase
inhibitor for advanced breast cancer: double-blind
randomized trial showing a dose effect and improved
efficacy and tolerability compared with megestrol acetate. J
Clin Oncol, 1998. 16(2): p. 453-61.
57. Mouridsen, H., et al. Superior efficacy of letrozole versus
tamoxifen as first-line therapy for postmenopausal women
with advanced breast cancer: results of a phase III study of
the International Letrozole Breast Cancer Group. J Clin
Oncol, 2001. 19(10): p. 2596-606.
58. Lonning, P.E., Exemestane in breast cancer: current status
and future directions. Clin Breast Cancer, 2000. 1 Suppl 1: p.
S28-33.
59. Paridaens, R.J., et al. Phase III study comparing exemestane
with tamoxifen as first-line hormonal treatment of
metastatic breast cancer in postmenopausal women: the
European Organisation for Research and Treatment of
Cancer Breast Cancer Cooperative Group. J Clin Oncol, 2008.
26(30): p. 4883-90.
60. Goss, P.E., et al. Randomized trial of letrozole following
tamoxifen as extended adjuvant therapy in receptorpositive breast cancer: updated findings from NCIC CTG
MA.17. J Natl Cancer Inst, 2005. 97(17): p. 1262-71.
61. Coombes, R.C., et al. A randomized trial of exemestane after
118
two to three years of tamoxifen therapy in postmenopausal

women with primary breast cancer. N Engl J Med, 2004.
350(11): p. 1081-92.
62. Howell, A., Future use of selective estrogen receptor
modulators and aromatase inhibitors. Clin Cancer Res, 2001.
7(12 Suppl): p. 4402s-4410s; discussion 4411s-4412s.
63. Kimmick, G.G. and H.B. Muss, Endocrine therapy in
metastatic breast cancer. Cancer Treat Res, 1998. 94: p. 231-54.
64. Hayes, D.F., et al. Randomized comparison of tamoxifen and
two separate doses of toremifene in postmenopausal
patients with metastatic breast cancer. J Clin Oncol, 1995.
13(10): p. 2556-66.
65. Klijn, J.G., et al. Combined tamoxifen and luteinizing
hormone-releasing hormone (LHRH) agonist versus LHRH
agonist alone in premenopausal advanced breast cancer: a
meta-analysis of four randomized trials. J Clin Oncol, 2001.
19(2): p. 343-53.
66. Citron ML 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(8):1481.
67. Gianni K, Ejermann W, Semiglazov V, et al. Neoadjuvant
chemotherapy with trastuzumab followed byadjuvant
trastuzumab versus neoadjuvant chemotherapy alone, in patients
with HER2-positive locally advanced breast cancer (the
NOAH trial): a randomised controlledsuperiority trial with a
parallel HER2-negative cohort. Lancet 2010: 375; 377-384.
68. Miller K, Wang M, Gralow J, et al. A randomized phase III trial
of paclitaxel versus paclitaxel plus bevacizumab as first-line
therapy for locally recurrent or metastatic breast cancer: a
trial coordinated by the Eastern Cooperative Oncology
Group (E2100). Breast Cancer Res Treat. 2005;94(suppl 1):S6.
Abstract 3.
119
69. Miles DW, Chan A, Romieu G, et al. Randomised, doubleblind, placebo controlled, phase III study of bevacizumab
(BV) with docetaxel (D) or D with placebo (PL) as 1st line
therapy for patients with locally recurrent or metastatic
breast cancer (mBC): AVADO. J Clin Oncol 2008: 26;18S.
70. Robert NJ, Dieras V, Glaspy J, et al. RIBBON-1: Randomized,
double-blind, placebo-controlled, phase III trial of
chemotherapy with or without bevacizumab (B) for first-line
treatment of HER2-negative locally recurrent or metastatic
breast cancer (MBC). J Clin Oncol 2009: 27;15s (suppl; abstr
1005).
71. Freyer, T. Phase II Study of Oral Vinorelbine in First-Line
Advanced Breast Cancer Chemotherapy. JCO Jan 1,
2003:35-40.
120
Metstases sseas
e/ou Hipercalcemia Maligna
Denosumabe: 120 mg SC D1 a cada 30 dias
Ref. (1)
Ou
Pamidronato: 90mg
Ref. (2)
IV
D1 a cada 28 dias
IV
D1 a cada 21 a 28 dias
Ou
cido zoledrnico: 4 mg
Ref. (3)
1. Stopeck Alison T., Lipton Allan, Body Jean-Jacques, et al.

Denosumab compared with zoledronic acid for the
treatment of bone metastases in patients with advanced
breast cancer: a randomized, double-blind study. J Clinc
Oncol. 2010; 28: 5132-5139.
2. Berenson JR, Hillner BE, Kyle RA, et al. American Society of
Clinical Oncology clinical practice guidelines: The role of
bisphosphonates in multiple myeloma. J Clin Oncol 2002
Sep 1;20(17): 3719-36.
3. Migliorati Cesar A, Siegel Michael A, Elting Linda S.
Bisphosphonate-associated osteonecrosis: a long-term
complication of bisphosphonate treatment. Lancet Oncol.
2006; 7: 508-514.
121
Cncer de Ovrio
(Epitelial)
Ciclofosfamida + Carboplatina
Carboplatina: 300mg/m2 IV
Ref. (1)
D1
Ciclofosfamida + Cisplatina
IV
Ref. (2)
D1
Cisplatina + Paclitaxel
Cisplatina: 75mg/m2
Ref. (3)
IV
IV
D1
D1 em 24 horas de infuso
IV
Ou
Carboplatina: AUC 5 a 7 IV
D1
Paclitaxel: 175mg/m2 IV D1 a cada 21 dias X 6 ciclos
Ref. (4)
Carboplatina + Docetaxel
Carboplatina: AUC 6
IV
D1
2
Docetaxel: 60mg/m IV D1 a cada 21 dias X 6 ciclos
Ref. (5)
122
Ref. (6)
Doxo Lipossomal: 40-50mg/m2 IV D1 a cada 28 dias
Ref. (7-9)
Gencitabina
21 dias
Ref. (9)
D1, D8, D15
Paclitaxel
Paclitaxel: 135-170mg/m2 IV
Ref. (10)
cada
D1 a cada 21 dias
Ou
Paclitaxel: 80mg/m2
IV
Topotecano
Topotecano: 1,5mg/m2
Ref. (11)
IV
Topotecano: 2,5 a 4mg/m2

Ref. (12)
Etoposide
Etoposide: 50mg/m2/dia VO
28 dias
Ref. (13)
IV
D1 a D21
cada
123
Carboplatina
Carboplatina: AUC 6
Ref. (14)
IV
D1
Vinorelbina
Ref. (15)
IV
Tamoxifeno
Tamoxifeno: 20mg
Ref. (16)
VO
Contnuo
a cada 21 dias
Quimioterapia intraperitonial (estgio III)

IV em 24h D1
2
Cisplatina: 100 mg/m
IP
D2
IP
Ref. (18)
Docetaxel
Docetaxel: 100mg/m2
Ref. (19)
IV
D1
21 dias
Oxaliplatina
Oxaliplatina: 100 mg/m2 IV
Ref. (20)
D1
21 dias
TIP
Paclitaxel: 250 mg/m2 em 24 horas IV
D1
2
Ifosfamida: 1.200 mg/m
IV
D2 D6
Mesna : 400 mg/m2 IV nas horas 0,4 e 8 da Ifosfamida D2-D6
IV D2-D6 a cada 21 dias.
Ref. (21)
124
VeIP
Vinblastina: 0,1 mg/kg
IV
D1-D2
2
Ifosfamida: 1,200 mg/m IV
D1 D5
Mesna : 400 mg/m2 IV nas horas 0,4 e 8 da Ifosfamida D1-D5
IV
D1-D5
Ref. (22)
Cncer de Ovrio
(Tumor de Clulas Germinativas)
BEP
Cisplatina: 20mg/m2
IV
D1-D5
2
Etoposide: 100mg/m
IV
D1-D5
Bleomicina: 30UI
IV
D2, D9,D16 a cada 21 dias
Ref. (17)
1. Swenerton, K., et al. Cisplatin-cyclophosphamide versus
carboplatin-cyclophosphamide in advanced ovarian cancer:
a randomized phase III study of the National Cancer
Institute of Canada Clinical Trials Group. J Clin Oncol, 1992.
10(5): p. 718-26.
2. Alberts, D.S., et al. Improved therapeutic index of carboplatin
plus cyclophosphamide versus cisplatin plus cyclophosphamide:
final report by the Southwest Oncology Group of a phase III
randomized trial in stages III and IV ovarian cancer. J Clin
Oncol, 1992. 10(5): p. 706-17.
3. McGuire, W.P., et al. Cyclophosphamide and cisplatin
compared with paclitaxel and cisplatin in patients with stage
III and stage IV ovarian cancer. N Engl J Med, 1996. 334(1): p. 1-6.
4. Ozols, R.F., Combination regimens of paclitaxel and the
platinum drugs as first-line regimens for ovarian cancer.
Semin Oncol, 1995. 22(6 Suppl 15): p. 1-6.
5. Markman, M., et al. Combination chemotherapy with
carboplatin and docetaxel in the treatment of cancers of the
ovary and fallopian tube and primary carcinoma of the
peritoneum. J Clin Oncol, 2001. 19(7): p. 1901-5.
125
6. Nagourney, R.A., et al. Phase II trial of gemcitabine plus

cisplatin repeating doublet therapy in previously treated, relapsed
ovarian cancer patients. Gynecol Oncol, 2003. 88(1): p. 35-9.
7. Gordon, A.N., et al. Recurrent epithelial ovarian carcinoma: a
randomized phase III study of pegylated liposomal doxorubicin
versus topotecan. J Clin Oncol, 2001. 19(14): p. 3312-22.
8. Rose, P.G., et al. Liposomal doxorubicin in ovarian, peritoneal,
and tubal carcinoma: a retrospective comparative study of
single-agent dosages. Gynecol Oncol, 2001. 82(2): p. 323-8.
9. Ferrandina, G., et al. Phase III trial of gemcitabine compared
with pegylated liposomal doxorubicin in progressive or
recurrent ovarian cancer. J Clin Oncol, 2008. 26(6): p. 890-6.
10. McGuire, W.P., et al. Taxol: a unique antineoplastic agent
with significant activity in advanced ovarian epithelial
neoplasms. Ann Intern Med, 1989. 111(4): p. 273-9.
11. Kudelka, A.P., et al. Phase II study of intravenous topotecan
as a 5-day infusion for refractory epithelial ovarian
carcinoma. J Clin Oncol, 1996. 14(5): p. 1552-7.
12. Bhoola, S.M., et al. Retrospective analysis of weekly
topotecan as salvage therapy in relapsed ovarian cancer.
Gynecol Oncol, 2004. 95(3): p. 564-9.
13. Ozols, R.F., Oral etoposide for the treatment of recurrent
ovarian cancer. Drugs, 1999. 58 Suppl 3: p. 43-9.
14. Paclitaxel plus carboplatin versus standard chemotherapy
with either single-agent carboplatin or cyclophosphamide,
doxorubicin, and cisplatin in women with ovarian cancer: the
ICON3 randomised trial. Lancet, 2002. 360(9332): p. 505-15.
15. Bajetta, E., et al. Phase II study of vinorelbine in patients
with pretreated advanced ovarian cancer: activity in
platinum-resistant disease. J Clin Oncol, 1996. 14(9): p.
2546-51.
16. Kristensen, g., Chemotherapy versus hormonal treatment in
patients with platinum and taxane resistant ovarian cancer:
A NSGO study journal of clinical oncology, 2008.
26(suplement): p. abst5508.
126
17. Dimopoulos, M.A., et al. Treatment of ovarian germ cell

tumors with a 3-day bleomycin, etoposide, and cisplatin
regimen: a prospective multicenter study. Gynecol Oncol,
2004. 95(3): p. 695-700.
18. Armstrong Dk, et. al. Intraperitoneal Cisplatin and Paclitaxel
in Ovarian Cancer. New Engl Med 2006;354:34-43.
19. Kaye SS, et. al. Is cisplatin-taxol (PT) the standard treatment
in advanced ovarian cancer. Eur J Cancer 1997:31-2167-70.
20. ChOllet P, et. al. Single agent activity of oxaliplatin in heavily
pretreated advanced epithelial ovarian cancer Ann Oncol
1996; 7: 1065-70.
21. Motzer RJ, Sheinfeld J, Mazumdar M, et al. Paclitaxel,
ifosfamide, and cisplatin second-line therapy for patients
with relapsed testicular germ cell cancer. J Clin Oncol.
2000;18:2413-2418.
22. McCaffrey JA, Mazumdar M, Bajorin DF, et al. Ifosfamideand cisplatin-containing chemotherapy as first-line salvage
therapy in germ cell tumors: Response and survival. J Clin
Oncol . 1997; 15:2559-2563.
127
Doena Trofoblstica
Gestacional
EP/EMA
Etoposide: 150 mg/m2
IV
D1
2
Cisplatina*: 75 mg/m
IV
D1
Etoposide:100 mg/m2
IV
D8
2
Methotrexate: 300 mg/m IV(12hs) D8
Actinomicina: 0,5 mg
IV
D8
Leucovorin: 15 mg
VO ou IV (4 doses; 12/1 2 hs)
D9 (24hs aps metotrexato)
a cada 14 dias
2
* Aplicar em 3 doses de 25/mg/m por 4 horas cada, diludo em
1000ml de soluo de Cloreto de Sdio a 0,9%.
Ref. (1)
Methotrexate
Methotrexate: 1 mg/kg
Leucovorin: 0,1 mg/kg
Ref. (2)
IM D1, D3, D5 e D7
IM D2, D4, D6 e D8
Actinomicina
Actinomicina: 1,25 mg/m2 IV
Ref. (3)
D1
a cada14 dias
a cada 14 dias
EMA-CO
IV
D1 e D2
Methotrexate: 300 mg/m2 IV (12hs)D1
Actinomicina: 0,5 mg
IV
D1 e D2
Leucovorin: 15 mg
VO ou IV (4 doses; 12/1 2 hs)
D2 (24 hs aps Methotrexate)
Vincristina: 0,8 mg/m2 (mx. 2mg) IV
D8
2
Ciclofosfamida: 600 mg/m
IV
D8 a cada 14 dias
Ref. (4)
128
1. Newlands ES, et al. Etoposide and Cisplatin/Etoposide,

Methotrexate, and Actinomycin D (EMA) Chemotherapy for
Patients With High-Risk Gestational Trophoblastic Tumors
Refractory to EMA/Cyclophosphamide and Vincristine
Chemotherapy and Patients Presenting With Metastatic
Placental Site Trophoblastic Tumors J Clin Oncol 200;18:854-9.
2. Berkowitz RS, et al. Ten years' experience with methotrexate
and folinic acid as primary therapy for gestational
trophoblastic disease. Gynecol Oncol 1986;23:111-8.
3. Chen LM, et al. Single-agent pulse dactinomycin has only
modest activity for methotrexate-resistant gestational
trophoblastic neoplasia. Gynecol Oncol 2004;94:204-7.
4. Bower M, et al. EMA/CO for high-risk gestational trophoblastic
tumors: results from a cohort of 272 patients [published
erratum appears in J Clin Oncol 1997 Sep;15(9):3168]. J
Clinc Oncol 1997;15:2636-43.
129
Cncer de Vulva
5-Fluorouracil: 1000 mg/m2 IV D1 D4 a cada 21 dias
Ref. (1)
Paclitaxel
Paclitaxel: 175 mg/m2 IV D1 D4 a cada 21 dias
Ref. (2)
1. Moore DH, Thomas GM, Montana GS, Saxer A, Gallup DG, Olt
G. Preoperative chemoradiation for advanced vulvar cancer:
a phase II study of the Gynecologic Oncology Group. Int J
Radiat Oncol Biol Phys 1998;42:79-85.
2. Witteveen P.O. Velden, I. J. Van Der Vergote, Oliveira C.F. de, et
al. Phase II study on paclitaxel in patients with recurrent,
metastatic or locally advanced vulvar cancer not amenable
to surgery or radiotherapy: A study of the EORTC-GCG
(European Organisation for Research and Treatment of
Cancer-Gynaecological Cancer Group). Ann of Oncol. 2009;
20: 1511- 1516.
130
Cncer de Pulmo
No Pequenas Clulas
IV
Carboplatina: AUC 6
IV
Ref. (1)
Vinorelbina + Cisplatina
IV
2
Cisplatina: 50mg/m
IV
ciclos
Carboplatina: AUC 6
IV
Paclitaxel: 200 a 225mg/m2IV D1
Ref. (3)
D1
D1 semanal X 16 semanas
D1 e D8 a cada 28 dias X 4
Ref. (2)
D1
a cada 21 dias
Ou
Carboplatina: AUC 6
Ref. (4)
IV
IV
D1
D1
SEMANAL
a cada 28 dias
Carboplatina + Paclitaxel+ Bevacizumabe

IV
D1
Carboplatina: AUC 6
IV
D1
Bevacizumabe: 15mg/kg IV
D1 a cada 21 dias
Ref. (3)
131
Cisplatina + Paclitaxel
Cisplatina: 80mg/m2
Ref. (5)
IV
IV
D1
D1 a cada 21 dias
Docetaxel + Carboplatina
Docetaxel: 75mg/m2
IV
Carboplatina: AUC 6
IV
Ref. (6)
D1
D1 a cada 21 dias
Docetaxel: 75mg/m2
IV
2
Cisplatina: 75mg/m
IV
Ref. (6, 7)
D1
D1 a cada 21 dias
Docetaxel + Gencitabina
Docetaxel: 100mg/m2
IV
2
Gencitabina: 1100mg/m IV
G-CSF: 300mcg
SC
Ref. (8)
D8
D1 e D8
D9 a D15
IV
28 dias
132
a cada 21 dias
D1
D1, D8 e D15
Ref. (9)
cada
cada
Carboplatina + Gencitabina
Carboplatina: AUC 5
IV
2
Gencitabina: 1000mg/m IV
28 dias Ref. (10)
D1
D1, D8 e D15
Gencitabina + Vinorelbina
IV
Ref. (11)
D1 e D8
Vinorelbina + Carboplatina
IV
Carboplatina: AUC 6
IV
Ref. (12)
D1 e D8
D1
a cada 28 dias
Pemetrexede + Cisplatina
Pemetrexede: 500mg/m2 IV
Cisplatina: 75mg/m2
IV
Ref. (13)
D1
D1 a cada 21 dias
Pemetrexede + Carboplatina
Carboplatina: AUC5
IV
D1
D1 a cada 21 dias Ref. (14)
EP
Etoposide: 120mg/m2
Cisplatina: 60mg/m2
Ref. (15)
IV
IV
D1-D3
D1 a cada 21 dias
Paclitaxel
Ref. (16)
IV
D1 a cada 21 dias
Ou
Paclitaxel: 80-100mg/m2 IV
Ref. (17)
D1-D8-D15 a cada 21 dias
Docetaxel
Docetaxel: 75mg/m2
Ref. (18)
IV
D1 a cada 21 dias
Ou
Docetaxel: 35mg/m2
Ref. (19)
IV
133
Pemetrexede
Ref. (20)
Gencitabina
28 dias
D1 a cada 21 dias
D1, D8, D15

Ref. (21)
Vinorelbina
Ref. (22)
IV
D1
Gefitinibe
Gefitinibe: 250mg/m2
Ref. (23)
VO
Contnuo
VO
Contnuo
Erlotinibe
Erlotinibe: 150mg/dia
cada
Semanal
Ref. (24)
Bevacizumabe+ Cisplatina+ Gencitabina

Bevacizumabe: 7,5mg/kg IV
D1
Cisplatina: 80mg/m2
IV
D1
D1 e D8
a cada 21 dias
Ref. (25)
Cetuximabe+ Cisplatina + Vinorelbina
Cetuximabe: 400mg/m2 IV
D1
ATAQUE
2
Cetuximabe: 250mg/m IV
Semanal
Cisplatina: 80mg/m2
IV
D1
2
Vinorelbina: 25mg/m
IV
Ref. (26)
134
Vinblastina + Cisplatina
Vinblastina: 4mg/m D1, D8, D15 e D28. Aps o D43, repetir o
ciclo a cada 2 semanas at a ltima administrao de cisplatina.
Cisplatina: 80mg/m IV D1
Repetir a cisplatina cada 21 dias por 4 ciclos (D1, D22, D43 e
D64).
Ref. (27)
Etoposide + Cisplatina
Etoposide: 100mg/m IV D1 ao D3 com cada administrao de
cisplatina.
Ref. (28)
MIP
Mitomicina: 6 mg/m2
Ifosfamida: 3000 mg/m2
Ref. (29)
IV
IV
IV
D1
D1
IV
IV
IV
D1
D1 a D3
D1 a D3 a cada 21 dias por
IV
2
Irinotecano: 60 mg/m
IV
Ref. (31)
D1
MIP(2)
Mitomicina: 6 mg/m2
Ifosfamida: 1500 mg/m2
2 ciclos
Ref. (30)
135
Carboplatina: AUC:6
IV
2
Paclitaxel: 90 mg/m
IV
Ref. (32)
D1
1. Strauss, G.M., et al. Adjuvant paclitaxel plus carboplatin

compared with observation in stage IB non-small-cell lung cancer:
CALGB 9633 with the Cancer and Leukemia Group B, Radiation
Therapy Oncology Group, and North Central Cancer Treatment
Group Study Groups. J Clin Oncol, 2008. 26(31): p. 5043-51.
2. Winton, T., et al. Vinorelbine plus cisplatin vs. observation in
resected non-small-cell lung cancer. N Engl J Med, 2005.
352(25): p. 2589-97.
3. Sandler, A., et al. Paclitaxel-carboplatin alone or with
bevacizumab for non-small-cell lung cancer. N Engl J Med,
2006. 355(24): p. 2542-50.
4. Belani, C.P., et al. Randomized, phase III study of weekly
paclitaxel in combination with carboplatin versus standard
every-3-weeks administration of carboplatin and paclitaxel
for patients with previously untreated advanced non-smallcell lung cancer. J Clin Oncol, 2008. 26(3): p. 468-73.
5. Giaccone, G., et al. Randomized study of paclitaxel-cisplatin
versus cisplatin-teniposide in patients with advanced nonsmall-cell lung cancer. The European Organization for
Research and Treatment of Cancer Lung Cancer Cooperative
Group. J Clin Oncol, 1998. 16(6): p. 2133-41.
6. Fossella, F., et al. Randomized, multinational, phase III study
of docetaxel plus platinum combinations versus vinorelbine
plus cisplatin for advanced non-small-cell lung cancer: the
TAX 326 study group. J Clin Oncol, 2003. 21(16): p. 3016-24.
7. Belani, C.P., et al. Docetaxel and cisplatin in patients with
advanced non small-cell lung cancer (NSCLC): a multicenter
phase II trial. Clin Lung Cancer, 1999. 1(2): p. 144-50.
8. Georgoulias, V., et al. Platinum-based and non-platinum-
136
based chemotherapy in advanced non-small-cell lung

cancer: a randomised multicentre trial. Lancet, 2001.
357(9267): p. 1478-84.
9. Abratt, R.P., et al. Weekly gemcitabine with monthly cisplatin:
effective chemotherapy for advanced non-small-cell lung
cancer. J Clin Oncol, 1997. 15(2): p. 744-9.
10. Langer, C.J., et al. Gemcitabine and carboplatin in
combination: an update of phase I and phase II studies in nonsmall cell lung cancer. Semin Oncol, 1999. 26(1 Suppl 4): p. 12-8.
11. Frasci, G., et al. Gemcitabine plus vinorelbine versus
vinorelbine alone in elderly patients with advanced nonsmall-cell lung cancer. J Clin Oncol, 2000. 18(13): p. 2529-36.
12. Cremonesi, M., et al. Vinorelbine and carboplatin in
inoperable non-small cell lung cancer: a monoinstitutional
phase II study. Oncology, 2003. 64(2): p. 97-101.
13. Scagliotti, G.V., et al. Phase III study comparing cisplatin
plus gemcitabine with cisplatin plus pemetrexed in
chemotherapy-naive patients with advanced-stage nonsmall-cell lung cancer. J Clin Oncol, 2008. 26(21): p. 3543-51.
14. Scagliotti, G.V., Pemetrexed plus carboplatin or oxaliplatin
in advanced non-small cell lung cancer. Semin Oncol, 2005.
32(2 Suppl 2): p. S5-8.
15. Longeval, E. and J. Klastersky, Combination chemotherapy
with cisplatin and etoposide in bronchogenic squamous cell
carcinoma and adenocarcinoma. A study by the EORTC lung
cancer working party (Belgium). Cancer, 1982. 50(12): p. 2751-6.
16. Lilenbaum, R.C., et al. Single-agent versus combination
chemotherapy in advanced non-small-cell lung cancer: the
cancer and leukemia group B (study 9730). J Clin Oncol,
2005. 23(1): p. 190-6.
17. Tester, W.J., et al. Phase II study of patients with metastatic
nonsmall cell carcinoma of the lung treated with paclitaxel
by 3-hour infusion. Cancer, 1997. 79(4): p. 724-9.
18. Miller, V.A. and M.G. Kris, Docetaxel (Taxotere) as a single
agent and in combination chemotherapy for the treatment
137
of patients with advanced non-small cell lung cancer. Semin

Oncol, 2000. 27(2 Suppl 3): p. 3-10.
19. Hainsworth, J.D., et al. Weekly docetaxel in the treatment of
elderly patients with advanced nonsmall cell lung
carcinoma. A Minnie Pearl Cancer Research Network Phase
II Trial. Cancer, 2000. 89(2): p. 328-33.
20. Hanna, N., et al. Randomized phase III trial of pemetrexed
versus docetaxel in patients with non-small-cell lung cancer
previously treated with chemotherapy. J Clin Oncol, 2004.
22(9): p. 1589-97.
21. Manegold, C., et al. Single-agent gemcitabine versus
cisplatin-etoposide: early results of a randomised phase II
study in locally advanced or metastatic non-small-cell lung
cancer. Ann Oncol, 1997. 8(6): p. 525-9.
22. Furuse, K., et al. Randomized study of vinorelbine (VRB)
versus vindesine (VDS) in previously untreated stage IIIB or
IV non-small-cell lung cancer (NSCLC). The Japan
Vinorelbine Lung Cancer Cooperative Study Group. Ann
Oncol, 1996. 7(8): p. 815-20.
23. Herbst, R.S., Dose-comparative monotherapy trials of
ZD1839 in previously treated non-small cell lung cancer
patients. Semin Oncol, 2003. 30(1 Suppl 1): p. 30-8.
24. Rosell, R., et al. Screening for epidermal growth factor
receptor mutations in lung cancer. N Engl J Med, 2009.
361(10): p. 958-67.
25. Reck, M., et al. Phase III trial of cisplatin plus gemcitabine
with either placebo or bevacizumab as first-line therapy for
nonsquamous non-small-cell lung cancer: AVAil. J Clin
Oncol, 2009. 27(8): p. 1227-34.
26. Pirker, R., et al. Cetuximab plus chemotherapy in patients
with advanced non-small-cell lung cancer (FLEX): an openlabel randomised phase III trial. Lancet, 2009. 373(9674): p.
1525-31.
27. Arriagada R, Bergman B, Dunant A, et al. The International
Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-
138
based adjuvant chemotherapy in patients with completely

resected non-small cell lung cancer. N Engl J Med
2004;350:351-60.
28. Arriagada R, Bergman B, Dunant A, et al. The International
Adjuvant Lung Cancer Trial Collaborative Group. Cisplatinbased adjuvant chemotherapy in patients with completely
resected non-small cell lung cancer. N Engl J Med
2004;350:351-60.
29. Rosell R,et al. A Randomized Trial Comparing Preoperative
Chemotherapy Plus Surgery With Surgery Alone In Patients
With Non-Small-Cell Lung Cancer. N Engl Med
1994:330:153-8.
30. Depierre A., et al. Preoperative Chemotherapy Followed by
Surgery Compared With Primary Surgery in Resectable
Stage I (Except T1N0), II, and IIIa NonSmall-Cell Lung
Cancer. J Clin Oncol 2002;20:247-251.
31. DeVore RF, et al. Phase II Study of Irinotecan Plus Cisplatin in
Patients With Advanced NonSmall-Cell Lung Cancer. J CIin
Oncoll 1999:17:2710-20.
32. Quoix E. A., Oster J., Westeel V., et al.
Weekly paclitaxel combined with monthly carboplatin versus
single-agent therapy in patients age 70 to 89: IFCT-0501
randomized phase III study in advanced non-small cell lung
cancer (NSCLC). J Clin Oncol 28:18s, 2010 (suppl; abstr 2).
139
Cncer de Pulmo de
Pequenas Clulas
EP + Radioterapia
Etoposide: 100mg/m IV D1 ao D3
a cada 28 dias no total de 4 ciclos, concomitante a radioterapia
Ref. (1)
CAV seguido de EP + Radioterapia
Ciclofosfamida: 1000 mg/m IV D1
Doxorrubicina: 50 mg/m IV D1
Vincristina: 1mg/m IV D1 (mximo 2mg)
3 semanas aps CAV, administrar EP.
Alternar CAV e EP a cada 3 semanas.
Iniciar radioterapia torcica 20 a 30 Gy concomitante ao EP
Ref. (2)
EP
Etoposide: 120 mg/m IV D1 ao D3 ou etoposide 120mg/m IV
D1 e 240mg/m VO D2 e D3
a cada 21 dias
Ref. (3)
EC
Carboplatina: AUC de 6 IV D1
a cada 28 dias
Ref. (4)
140
Irinotecano: 60 mg/m IV D1, D8 e D15
a cada 28 dias
Ref. (5)
Carboplatina + Irinotecano
Carboplatina: AUC de 4 IV D1
Irinotecano: 175mg/m IV D1
a cada 21 dias
Ref. (6)
Paclitaxel: 200mg/m IV D1
a cada 21 dias
Ref. (7)
Carboplatina + Paclitaxel + Etoposide
Paclitaxel: 200 mg/m IV durante 1 hora D1
Etoposide: 50 mg alternando com 100 mg VO D1 ao D10
a cada 21 dias
Ref. (8)
CAE
Ciclofosfamida: 1000mg/m IV D1
Doxorrubicina: 50mg/m IV D1
Etoposide: 120mg/m IV D1 e 240mg/m VO D2 e D3
a cada 21 dias
Ref. (9)
Paclitaxel
Paclitaxel: 80-100 mg/m IV semanalmente por 3 semanas
a cada 28 dias
Ref. (10)
141
Topotecano
Topotecano: 4mg/m IV semanalmente em 30 minutos
Ou
Topotecano: 2,3mg/m VO D1 ao D5
a cada 21 dias
Ref. (11)
1. Takada M. et al. Phase III Study of Concurrent Versus

Sequential Thoracic Radiotherapy in Combination With
Cisplatin and Etoposide for Limited-Stage Small-Cell Lung
Cancer: Results of the Japan Clinical Oncology Group Study
9104. J Clin Oncol 20:3054, 2002.
2. Murray N. et al. Abbreviated treatment for elderly, infirm or
noncompliant patients with limited-stage small-cell lung
cancer. J Clin Oncol 16: 3323, 1998.
3. Ihde DC, et al. Prospective randomized comparison of highdose and standard-dose etoposide and cisplatin
chemotherapy in patients with extensive stage small cell
lung cancer. J Clin Oncol 1994;12:2022-2034.
Baka S. et al. Phase III randomised trial of doxorubicin-based
chemotherapy compared with platinum-based chemotherapy
in small-cell lung cncer. Br J Cancer99: 442, 2008
4. Viren M, et al. Carboplatin and etoposide in extensive small
cell lung cancer. Acta Oncol 1994;33:921-924.
5. Noda K, et al. Irinotecan plus cisplatin compared with
etoposide plus cisplatin for extensive small cell lung cancer.
N Engl J Med 2002;346:85-91.
6. Hermes A. et al. Irinotecan Plus Carboplatin Versus Oral
Etoposide Plus Carboplatin in Extensive Small-Cell Lung Cancer:
A Randomized Phase III Trial. J Clin Oncol 26: 4261, 2008.
7. Baka S. et al. Randomized phase III study of carboplatin and
paclitaxel versus vincristine, doxorubicin and cyclophosphamide
142
chemotherapy in intermediate and poor prognosis small

cell lung cancer: Preliminary results. J Clin Oncol 24: abstr
7059, 2006.
8. Hainsworth JD, et al. Paclitaxel, carboplatin and extendedschedule etoposide in the treatment of small cell lung
cancer comparison of sequential phase II trials using
different dose-intensities. J Clin Oncol 1997;15:3464-3470.
9. Baka S. et al. Phase III randomised trial of doxorubicin-based
chemotherapy compared with platinum-based chemotherapy
in small-cell lung cncer. Br J Cancer99: 442, 2008.
10. Hainsworth JD, et al. The current role and future prospects
of paclitaxelin in the treatment of small cell lung cancer.
Semin Oncol 1999;26 (Suppl 2):60-66.
11. Shipley D. L. et al. Topotecan: Weekly intravenous (IV)
schedule similar to standard 5-day IV schedule as secondline therapy for relapsed small cell lung cancer (SCLC)A
Minnie Pearl Cancer Research Network phase II trial . J Clin
Oncol 24: abstr 7083, 2006.
Mary E.R.et al. Phase III Trial Comparing Supportive Care
Alone With Supportive Care With Oral Topotecan in Patients
With Relapsed Small-Cell Lung Cncer. J Clin Oncol 24: 5441,
2006.
143
Mesotelioma
Cisplatina + Doxorrubicina
Cisplatina: 60mg/m2
Ref. (1)
IV
IV
D1
D1 a cada 21 dias
CAP
Cisplatina: 80mg/m2
Ref. (2)
IV
IV
IV
D1
D1
D1 a cada 21 dias
IV
Ref. (3)
D1, D8, D15

D1
a cada 28 dias
Gencitabina+ Carboplatina
Carboplatina: AUC 5
IV
Ref. (4)
D1, D8, D15

D1
a cada 28 dias
Pemetrexede + Cisplatina
Cisplatina: 75mg/m2
IV
Ref. (5)
D8
D1, D8
Pemetrexede
Pemetrexede: 500mg/m2 IV em 10 min D1
a cada 21 dias
Ref. (6)
144
a cada 21 dias
Vinorelbina
Vinorelbina: 30mg/m2 IV D1 semanalmente durante 6 ou 12
semanas (com intervalo de 2 semanas entre a 6a e 7a dose).
Ref. (7)
Pemetrexede + Carboplatina
Carboplatina: AUC de 5 IV
a cada 21 dias
Ref. (8)
D1
D1
Cisplatina e Raltitrexede
Cisplatina : 80 mg/m2
IV
Raltitrexede: 3 mg/m2
IV
Ref. (9)
D1
D1
a cada 21 dias
Raltitrexede
Raltitrexede: 3 mg/m2
Ref. (10)
D1
a cada 21 dias
IV
1. Ardizzoni, A., et al. Activity of doxorubicin and cisplatin

combination chemotherapy in patients with diffuse
malignant pleural mesothelioma. An Italian Lung Cancer
Task Force (FONICAP) Phase II study. Cancer, 1991. 67(12): p.
2984-7.
2. Shin, D.M., et al. Prospective study of combination
chemotherapy with cyclophosphamide, doxorubicin, and
cisplatin for unresectable or metastatic malignant pleural
mesothelioma. Cancer, 1995. 76(11): p. 2230-6.
3. Nowak, A.K., et al. A multicentre phase II study of cisplatin
and gemcitabine for malignant mesothelioma. Br J Cancer,
2002. 87(5): p. 491-6.
4. Favaretto, A.G., et al. Gemcitabine combined with carboplatin
in patients with malignant pleural mesothelioma: a
multicentric phase II study. Cancer, 2003. 97(11): p. 2791-7.
145
5. Vogelzang, N.J., et al. Phase III study of pemetrexed in

combination with cisplatin versus cisplatin alone in patients
with malignant pleural mesothelioma. J Clin Oncol, 2003.
21(14): p. 2636-44.
6. Taylor, P et al. Single-Agent Pemetrexed for Chemonaive and
Pretreated Patients with Malignant Pleural Mesothelioma:
Results of an International Expanded Access Program.
Journal of Thoracic Oncology, 2008;3:764-771.
7. Stebbing J, et al. The efficacy and safety of weekly vinorelbine
in relapsed malignant pleural mesothelioma. Lung Cancer
2009; 63:94-7.
8. Ceresoli GL, et al. Phase II study of pemetrexed plus
carboplatin in malignant pleural mesothelioma. J Clin Oncol
2006; 24:1443-1448.
9. van Meerbeeck JP, et al. Randomized Phase III Study of Cisplatin
With or Without Raltitrexed in Patients With Malignant
Pleural Mesothelioma: An Intergroup Study of the European
Organisation for Research and Treatment of Cancer Lung
Cancer Group and the National Cancer Institute of Canada. J
Clin Oncol 2005;23:6881-9.
10. Baas P, et al. The activity of raltitrexed (Tomudex) in malignant
pleural mesothelioma: an EORTC phase II study (08992). Eur
J Cancer 2003;39:353-7.
146
Timoma
CAP
Doxorubicina: 50 mg/m IV D1
a cada 21 dias
Ref. (1)
Cisplatina + Etoposide
a cada 21 dias
Ref. (2)
CAPP
Doxorrubicina: 20 mg/m/dia IV D1 ao D3 (total de 60 mg/m)
Prednisona: 100 mg VO/dia D1 ao D5
a cada 21 dias
Ref. (3)
PEE
Epirrubicina: 100 mg/m IV D1
Etoposide: 120 mg/m IV D1, D3 e D5
a cada 21 dias
Ref. (4)
147
ADOC
Doxorubicina: 40 mg/m IV D1
Vincristina: 0,6 mg/m IV D3
a cada 28 dias
Ref. (5)
1. Loehrer PJ, et al. Cisplatin plus doxorubicin plus

cyclophosphamide in metastatic or recurrent thymoma:
final results of an intergroup trial. J Clin Oncol 1994;12:11641168.
2. Giaccone G, et al. Cisplatin and etoposide combination
chemotherapy for locally advanced or metastatic thymoma.
A phse II study of the European Organization for Research
and Treatment of cancer Lung Cancer Cooperative Group. J
Clin Oncol 1996;14:814-820.
3. Kim ES, et al. Phase II study of a multidisciplinary approach
with induction chemotherapy, followed by surgical
resection, radiation therapy, and consolidation chemotherapy
for unresectable malignant thymomas: final report. Lung
Cncer 44:369-379,2004.
4. Venuta F, et al. Multimodality Treatment of Thymoma: A
Prospective Study. Ann Thorac Surg 1997;64:1585-1591.
5. Fornastero A, et al. Chemotherapy for invasive thymoma.
Cancer 1991;68:30-33.
148
Melanoma Maligno
Alfainterferon 2b em altas doses
Induo: 20 MUI/m/dia IV durante 20 min, 5 vezes por semana,
durante 4 semanas
Consolidao/Manuteno: 10 MUI/m/dia SC, 3 vezes por
semana durante 48 semanas.
Ref. (1)
Dacarbazina (DTIC)*
Dacarbazina: 250 mg/m/dia IV durante 30-60 minutos D1 ao D5
a cada 21 ou 28 dias
Ou
Dacarbazina: 1000 mg/m/dia IV durante 30 minutos D1
a cada 21 dias
Ref. (2)
Alfainterferon 2b
Alfainterferon 2b: 20 MUI/m/dia IM, 3 vezes por semana
durante 12 semanas.
Ref. (3)
Interleucina-2 (IL-2) em altas doses
Interleucina-2: 720.000 UI/kg IV durante 15 minutos a cada 8h mximo 12 a 15 doses por ciclo (do D1 ao D4 ou do D1 ao D5).
A primeira dose do segundo curso de IL-2 deve ser administrada
14 dias aps a primeira dose do primeiro curso.
Ref. (4)
149
Temozolomida
Temozolomida: 200 mg/m/dia VO D1-5.
a cada 28 dias
Ref. (5)
Fotemustina
Induo: 100mg/m2 IV durante 60 min D1, D8 e D15, com
intervalo de 05 semanas.
Manuteno: 100mg/m2 IV durante 60 min D1 a cada 03
semanas.
Ref. (6)
Dacarbazina (DTIC) + Carmustina (BCNu) + Cisplatina
Dacarbazina: 220 mg/m/dia IV em 30-60 min D1 ao D3 a cada
21 dias
Cisplatina: 25 mg/m/dia IV em 30-45 min D1 ao D3 a cada 21
dias
Carmustina: 150 mg/m IV durante 2 a 3 horas D1 a cada 42
dias.
Ref. (7)
Paclitaxel: 100 mg/m2 IV durante 1 hora
Carboplatina: AUC 2 IV em 30 min D1, D8 e D15 a cada 28 dias.
Ou
Paclitaxel: 175-200 mg/m2 IV durante 3 horas
Carboplatina: AUC 5 IV em 60min D1 a cada 21 dias.
Ref. (8)
Bioquimioterapia
Cisplatina + Vinblastina + Dacarbazina + IL-2 + IFN 2b
Cisplatina: 20mg/m2/dia IV em 30 min D1 ao D4
Vinblastina: 1,2mg/m2/dia IV pulso D1 ao D4
Dacarbazina: 800 mg/m2/dia IV em 1 hora D1 (administrar 1
hora aps Vinblastina)
150
IL-2: 9 MUI/m2 IV em 24h infuso contnua D1-4 (total de 96h)

Alfainterferon 2b: 5 MUI/m2 SC D1 ao D5, D8, D10 e D12
Filgrastima: 5mcg/Kg/d SC D7 ao D16
a cada 21 dias, com o mximo de 4 ciclos. Ref. (9)
Paclitaxel
Paclitaxel: 90 mg/m2 IV(80min) D1, D5 e D9
Ref. (10)
CVD
Cisplatina: 20mg/m2/dia IV
Vinblastina: 1,6mg/m2/dia IV
Dacarbazina: 800 mg/m2 IV
Ref. (11)
a cada 21 dias
D2 a D5
D1 a D5
D1 a cada 21 dias
Regime Dartmouth*
Carmustina: 150 mg/m2 IV
D1
IV
D1 a D3
2
Dacarbazina: 220 mg/m IV
*Alm dos quimioterpicos, o regime inclui tambm tamoxifeno,
10 mg, 2 vezes ao dia, com incio 1 semana antes da quimioterapia
e tomado de forma contnua.
Ref. (12)
1. Kirkwood JM, et al. Interferon alfa-2b adjuvant therapy of
high risk resected cutaneous melanoma: the Eastern Cooperative
Oncology Trial EST 1684. J Clin Oncol 1996;14:7-17.
Kirkwood JM, et al. High-dose Interferon alfa-2b significantly
prolongs relapse-free and overall survival compared with
the GM2-KLH/QS-21 vaccine in patients with resected stage
IIB-III melanoma: results of Intergroup Trial E1694/S9512/
C509801. J Clin Oncol 2001;19:2370-80.
Kirkwood JM, et al. A pooled Analysis of Eastern Cooperative
Oncology Group and Intergroup Trials of Adjuvant High Dose
Interferon for Melanoma. Clin Cancer Res 2004; 10:1670-1677.
151
2. Middleton MR, et al. Randomized phase III study of

temozolomide versus dacarbazine in the treatment of
patients with advanced metastatic malignant melanoma. J
Clin Oncol 2000; 18: 15866.
Avril, MF et al. Fotemustine compared with dacarbazine in
patients with disseminated malignant melanoma: a phase
III study. J Clin Oncol 2004; 22:1118-25.
Chapman PB, et al. Phase III multicentric randomized trial of
the Dartmouth regimen versus dacarbazine in patients with
metastatic melanoma. J Clin Oncol 1999; 17:2745-51.
Eigentler, TK et al. Palliative therapy of disseminated
malignant melanoma: a systematic review of 41 randomised
clinical trials. Lancet Oncol 2003;4:748-59.
3. Kirkwood JM, et al. Advances in the diagnosis and treatment
of malignant melanoma. Semin Oncol 1997;24 (suppl 4): 1-48.
4. Smith, FO et al. Treatment of metastatic melanoma using
Interleukin-2 alone or in conjunction with vaccines. Clin
Cancer Res 2008;14:5610-18.
Atkins, MB et al. High-Dose recombinant Interleukin 2
therapy for patients with metastatic melanoma: analysis of
270 patients treated between 1985 and 1993. J Clin Oncol
1999; 17: 2105-16.
Schwartzentruber, DJ. Guidelines for the safe administration
of high-dose interleukin-2. J Immunother 2001; 24:287-93.
5. Middleton MR, et al. Randomized phase III study of
temozolomide versus dacarbazine in the treatment of
patients with advanced metastatic malignant melanoma. J
Clin Oncol 2000;18:158-166.
6. Avril, MF et al. Fotemustine compared with dacarbazine in
patients with disseminated malignant melanoma: a phase
III study. J Clin Oncol 2004; 22:1118-1125.
7. Chapman PB, et al. Phase III multicentric randomized trial of
the Dartmouth regimen versus dacarbazine in patients with
metastatic melanoma. J Clin Oncol 1999; 17:2745-51.
Creagen ET, et al. Phase III clinical trial of the combination of
152
cisplatin, dacarbazine, and carmustine with or without

tamoxifen in patients with advanced malignant melanoma.
J Clin Oncol 1999;17:1884-1890.
8. Rao, RD et al. Combination of paclitaxel and carboplatin as
second-Line therapy for patients with metastatic
melanoma. Cancer 2006;106:375-82.
9. Atkins,MB et al. Phase III trial comparing concurrent
biochemotherapy with cisplatin, vinblastine, dacarbazine,
interleukin-2, and interferon alfa-2b with cisplatin,
vinblastine, and dacarbazine alone in patients with
metastatic malignant melanoma (E3695): a trial coordinated
by the Eastern Cooperative Oncology Group. J Clin Oncol
2008; 26:5748-5754.
10. Bedikian AY, et al. Phase II evaluation of paclitaxel by short
intravenous infusion in metastatic melanoma Melanoma
Res 2004;14:63-6.
11. Legha SS, et al. A prospective evaluation of a triple-drug
regimen containing cisplatin, vinblastine, and dacarbazine
(CVD) for metastatic melanomaCancer 1989;64:2024-9.
12. Chapman PS, et al. Phase III Multicenter Randomized Trial of
the Dartmouth Regimen Versus Dacarbazine in Patients
With Metastatic Melanoma. J Clin Oncol 1999; 17:2745-51.
153
Linfoma de Hodgkin
BEACOPP escalonado
Bleomicina: 10 mg/m IV D8
Vincristina: 1,4 mg/m IV D8 (dose mxima 2 mg)
Procarbazina: 100 mg/m VO D1 ao D7
Prednisona: 40 mg/m VO D1 ao D14
Filgrastima: 5 g/kg/dia SC, iniciando no D8 at a recuperao
dos neutrfilos.
a cada 21 dias
Ref. (01)
DHAP
Dexametasona: 40mg VO D1 ao D4
Cisplatina: 100mg/m IV em infuso contnua por 24h D1
Citarabina: 2000 mg/m IV em 2 horas 12/12h D2
Filgrastima: 300mcg SC D4 ao D13
Devem ser realizados 2-4 ciclos e no caso de resposta, coleta de
clulas progenitoras e posterior TMO
Profilaxia de conjuntivite por citarabina com colrio de
dexametasona.
Ref. (02)
ICE
Ifosfamida: 5mg/m IV D2
A Ifosfamida deve ser associada a Mesna na dose de 5000 mg/m.
a cada 14 dias
Filgrastima: 5 g/kg D5 ao D12.
Ref. (03)
154
Gencitabina
Gencitabina: 1250 mg/m IV D1, D8 e D15
a cada 28 dias
Ref. (04)
Gencitabina + Vinorelbina + Doxorrubicina Lipossomal
Peguilada
Vinorelbina: 20mg/m IV D1 e D8 em 10 min, sendo a 1 droga
Gencitabina: 1000 mg/m IV D1 e D8 em 30 min, sendo a 2 droga
Doxorrubicina Lipossomal Peguilada: 15mg/m IV D1 e D8 em
30-60 min
a cada 21 dias
Ref. (05)
ABVD
Doxorrubicina: 25mg/m
Bleomicina: 10UI/m
Vinblastina: 6mg/m
Dacarzabina: 375mg/m
a cada 28 dias
Ref. (06)
IV
IV
IV
IV
MOPP
Mustarda Nitrogenada: 6mg/m
Vincristina: 1,4mg/m
Procarbazina: 100mg/m
Prednisona: 40mg/m
a cada 28 dias
Ref. (07)
D1 e 15
D1 e 15
D1 e 15
D1 e 15
IV
IV
VO
VO
D1 e 8
D1 e 8
D1 a 14
D1 a 14
MOPP/ABVD HBRIDO
IV D1 e 8
IV D1 ( Dose mxima de 2mg)
Procarbazina: 100mg/m VO D1 a 14
Prednisona: 40mg/m
IV D1 a 14
155
Bleomicina: 10UI/m
Hidrocortisona: 100mg
Vinblastina: 6mg/m
a cada 28 dias
Ref. (08)
IV D8
IV D8
IV dada antes da Bleomicina
IV D8
EVA
Vincristina: 2mg/m2 IV D1
Doxorrubicina: 50 mg/m2 IV D2
a cada 28 dias
Ref. (09)
EVAP
Etoposide: 120 mg/m2 IV D1, 8 e 15
Vinblastina: 4 mg/m2 IV D1, 8 e 15
Citarabina: 30 mg/m2 IV D1, 8 e 15
Cisplatina: 40 mg/m2 IV D1, 8 e 15
a cada 28 dias
Ref. (10)
Mini- BEAM
BCNU: 60 mg/m2 IV D1
Ara-C: 100 mg/m2 IV a cada 12 horas D2-5
Melfalano: 30 mg/m2 IV D6
Ref. (11)
BEACOPP
Bleomicina: 10 mg/m2 IV D 8
Ciclofosfamida: 650 mg/m2 IV D1
156
Vincristina: 1.4 mg/m2 IV D (mximo 2 mg)

Procarbazina: 100 mg/m2 VO D1-7
Prednisona: 40 mg/m2 VO D1-14
a cada 21 dias
Ref. (12)
Stanford V
Doxorrubicina: 25 mg/m2 IV semanas 1, 3, 5, 7, 9 e 11
Vinblastina: 6 mg/m2 IV semanas 1, 3, 5, 7, 9 e 11
(dose reduzida para 4 mg/m2 nas semanas 9 e 11 em paciente
50 anos).
Mustarda Nitrogenada: 6 mg/m2 IV nas semanas 1, 5 e 9.
Etoposide: 60mg/m2 IV por 2 dias nas semanas 3, 7 e 11.
Vincristina: 1,4 mg/m2 IV nas semanas 2, 4, 6, 8,10 e 12.
(A dose reduzida para 1 mg/m2 nas semanas 10 e 12 em
paciente 50 anos).
Bleomicina: 5 UI/m2 IV nas semanas 2,4,6,8,10 e 12.
Prednisona: 40 mg/ m2 VO em dias alternados por 10 semanas
com desmame a cada 2 dias da semana 10 a 12.
Ref .(13)
1. Diehl V; Franklin J; Pfreundschuh M; Lathan B; Paulus U;

Hasenclever D; Tesch H; Herrmann R; Dorken B; MullerHermelink HK; Duhmke E; Loeffler M. Standard and
increased-dose BEACOPP chemotherapy compared with
COPP-ABVD for advanced Hodgkin's disease.N Engl J Med
2003 Jun 12;348(24):2386-95.
2. Josting A. et al. Time-intensified dexamethasone/cisplatin/
cytarabine: an effective salvage therapy with low toxicity in
patients with relapsed and refractory Hodgkins disease.
Ann Oncol 13:1628, 2002.
157
3. Abali H. et al. Comparison of ICE (Ifosfamide-CarboplatinEtoposide) Versus DHAP (Cytosine Arabinoside-CisplatinDexamethasone) as Salvage Chemotherapy in Patients with
Relapsed or Refractory Lymphoma.Cancer investigation
2008, Vol. 26, No. 4, Pages 401-406.
4. Santoro A, et al. Gemcitabine in the treatment of refractory
Hodgkins disease: results of a multicenter phase II study. J
Clin Oncol 2000;18;2645-2619.
5. Barlet N. L. et al. Gemcitabine, vinorelbine, and pegylated
liposomal doxorubicin (GVD), a salvage regimen in relapsed
Hodgkins lymphoma: CALGB 59804. Annals of Oncology 18:
10711079, 2007.
6. Bonadonna G. et al. Combination Chemotherapy of Hodgkins
disease With Adriamycin, bleomycin, Vinblastine, and
Imidazole Carboxamide Versus Mopp. Cancer 1975; 36: 252259.
7. De Vita VT, Jr et al. Combination Chemotherapy in Tratamento
of Advanced Hodgkins desease. Ann Intern Med 1970; 73;
881-895.
8. Klimo P. et al. Mopp/ABV hybrid program: Combination
Chemotherapy baseol on Early introduction of seven
effective drogs for advanced hodgkins disease. J Clin Oncol
1985; 3: 1174-1182.
9. Radford J, et al. Results of a randomized trial comparing
MVPP chemotherapy with a hybrid regimen, CHLVPP/EVA,
in the initiai treatment of Hodginkin's disease J. Clin Oncol
1995;13:2379-2385.
10. Longo Dl, The use of chemotherapy in the treatment of
Hodgkin's disease. Semin Oncol 1990;17:716-735.
11. Colwill R, et al. Mini-Beam as salvage therapy for relapsed
or refractory Hodgkin's disease before intensive therapy
and autologous bon marrow transplantation. J Clin Oncol
1995;13:396-402.
12. Diehl V. et al. BEACOPP, a new dose-escalated and
accelerated regimen is at least as effective as COPP/ABVD in
158
patients with advanced-stage hodgkin's lymphoma. J Clin

Oncol 1998:16:3810-3821.
13. Hoskin PJ, Lowry L, Horwich A, Jack A, et al. Randomized
comparison of the Stanford V Regimen and ABVD in the
treatment of advanced Hodgkin's Lymphoma: United
Kingdom National Cancer Research Institute Lymphoma
Group Study ISRCTN 64141244. J Clin Oncol. 2009; 27:53905396.
159
Linfoma No-Hodgkin
Rituximabe (LNH Folicular)
Rituximabe: 375mg/m2 semanalmente por 4 semanas.
Ref. (01)
R CVP (linfomas CD20 positivo)
Rituximabe: 375mg/m IV D1
Ref. (02)
R CHOP
Rituximabe: 375mg/m2 D1
a cada 21 dias.
Ref. (03)
FND
Fludarabina: 25 mg/m IV D1 ao D3
Dexametasona: 20 mg VO D1 ao D5
a cada 21 dias
Cuidados de Suporte
Sulfametoxazol 800mg + Trimetoprima 160mg VO 1x/dia 3 dias
por semana, at 3 meses aps trmino do tratamento
Ref. (04)
160
R-FND
Dexametasona: 20 mg VO D1 ao D5
a cada 21 dias
Ref. (05)
FC
a cada 21-28 dias
Ref. (06)
Fludarabina
a cada 28 dias
Ref. (07)
CVP
Ciclofosfamida: 400 mg/m2 VO D1 -5 (ou 800 mg/m2 IV D1)
Vincristina: 1.4 mg/m2 IV D1 (mximo 2 mg)
a cada 21 dias
Ref. (08)
CHOP
a cada 21 dias
Ref. (09)
161
CNOP
Mitoxantrona: 10 mg/m2 IV D1
a cada 21 dias
Ref. (10)
CHOP + Rituximabe (Nebraska regimen)
Doxorrubicina: 5O mg/m2 IV D3
Vincristina: 1.4 mg/m2 IV D3 (mximo de 2 mg)
Prednisona: 100 mg VO D3-7
Rituximabe: 375 mg/m2 IV no D1
a cada 21 dias
Ref. (11)
CNOP
Ciclofosfamida: 750 mg/m2 D1
Prednisona: 100 mg VO D1-5
a cada 21 dias
Ref. (12)
EPOCH
Etoposide: 50 mg/m2/dia IV em infuso contnua D1-4
Vincristina: 0.4 mg/m2/dia IV em infuso contnua D1-4
Ciclofosfamida: 750 mg/m2 IV D5, iniciar aps infuso contnua
Doxorrubicina: 10 mg/m2/dia IV em infuso contnua D1-4
a cada 21 dias
Ref. (13)
162
EPOCH + Rituximabe
Etoposide: 50 mg/m2/dia IV em infuso contnua D1-4
Prednisona: 60 mg/m2 VO BID D1-5
Vincristina: 0.4 mg/m2/dia em infuso contnua D1-4
Ciclofosfamida: 750 mg/m2 IV D5, iniciar aps infuso contnua
Rituximabe: 375 mg/m2 IV no dia 1
a cada 21 dias
Ref. (14)
MACOP-B
Methotrexate: 400mg/m2 IV nas semanas 2,6 e 10
Leucovorin: 15mg/m2 VO a cada 6 horas por 6 doses, iniciando
24 horas aps o methotrexate
Doxorrubicina: 50 mg/m2 IV nas semanas 1, 3, 5, 7, 9 e 11
Ciclofosfamida: 350 mg/m2 IV nas semanas 1, 3, 5, 7, 9 e 11
Vincristina: 1.4 mg/m2 IV nas semanas 2, 4, 6, 8, 10 e 12
Prednisona: 75mg/dia VO por 12 semanas com retirada nas 2
ltimas semanas
Bleomicina: 10 U/m2 IV nas semanas 4, 8 e12
Bactrim F: 1 comp. VO BID
Cetoconazol: 200 mg/dia VO
Administrar um ciclo.
Ref. (15)
m-BACOD
Methotrexate: 200 mg/m2 IV D8 e 15
Leucovorin: 10 mg/m2 VO a cada 6 horas por 8 doses, iniciando
24 aps o methotrexate
Bleomicina: 4 U/m2 IV D1
Doxorubicina: 45 mg/m2 IV D1
Vincristina: 1 mg/m2 IV D1 (mximo de 2 mg)
Dexametasona: 6 mg/m2 VO D1-5
a cada 21 dias
Ref. (16)
163
ProMACE/CytaBoM
Prednisona: 60mg/m2 VO D1-14
Etoposide: 120mg/m2 IV D1
Citarabina: 300mg/m2 IV D8
Bleomicina: 5 U/m2 IV D8
Vincristina: 1.4 mg/m2 IV D8
Methotrexate: 120 mg/m2 IV D8
Leucovorin resgate com: 25mg/m2 VO cada 6 horas por 6 doses,
iniciando 24 horas aps o methotrexate
Bactrim F: 1 comp. VO BID D1-21
a cada 21 dias
Ref. (17)
ESHAP (Regime de salvamento)
Metilprednisolona: 500 mg IV D1-4
Cisplatina: 25 mg/m2/dia IV infuso contnua D1-4
Citarabina: 2,000 mg/m2 IV D5 depois de completar a cisplatina
e etoposide
a cada 21 dias
Ref. (18)
DHAP (Regime de salvamento)
Cisplatina: 100 mg/m2 IV infuso contnua de 24 horas D1
Citarabina: 2,000 mg/m2 IV em infuso de 3 horas a cada 12
horas por 2 doses D2 aps trmino de infuso de cisplatina
Dexametasona: 40 mg VO ou IV D1-4
a cada 3-4 semanas
Ref. (19)
164
ICE (Regime de salvamento)

Ifosfamida: 5,000 mg/m2 IV infuso contnua de 24 horas D2
Mesna: 5,000 mg/m2 IV em combinao com a dose de
Ifosfamida
a cada 14 dias
G-CSF administrado na dose de 5 mg/kg D5-12.
Ref. (20)
MINE (Regime de salvamento)

Mesna: 1,330 mg/m2 IV administrar ao mesmo tempo de
Ifosfamida D1 a 3, seguido por 500mg IV 4 horas depois da
Ifosfamida D1 a 3
Ifosfamida: 1,330 mg/m2 IV D1-3
a cada 21 dias
Ref. (21)
Alto Grau
Protocolo de Magrath (Linfoma de Burkitt)
Ciclofosfamida: 1,200 mg/m2 IV D1
Prednisona: 40 mg/m2 VO D1 -5
Methotrexate: 300 mg/m2 IV D10, em 1 hora, seguido por 60
mg/m2 IV D10 e 11, em 41 horas
Resgate com Leucovorin: 15 mg/m2 IV cada 6 horas por 8 doses,
iniciando 24 horas aps o methotrexate D12
Ara-C Intratecal: 30 mg/m2 IT D7, somente no ciclo 1 45 mg/m2
IT D7, em todos os ciclos subsequentes
165
Methotrexate Intratecal em todos os ciclos: 12.5 mg IT D10

a cada 28 dias
Ref. (22)
Ou
Regime A (CODOX-M)
Ciclofosfamida: 800 mg/m2 IV D1 e 200 mg/m2 IV D2-5
Vincristina: 1.5 mg/m2 IV D1 e 8 no ciclo 1 e D1, 8 e 15 no ciclo 3
Methotrexate: 1,200 mg/m2 IV durante 1 hora, seguido por
240 mg/m2/hora nas 23 horas seguintes D10
Leucovorin: 192mg/m2 IV iniciando na hora 36 aps o incio da
infuso e 12 mg/m2 IV a cada 6 horas at os nveis de
Methotrexate reduzirem abaixo de < 50 nMol/L
Profilaxia do SNC
Citarabina: 70 mg IT D1 e 3
Methotrexate: 12 mg IT D15
Regime B (IVAC)
Ifosfamida: 1,500 mg/m2 D1-5 (com Mesna)
Etoposide: 60mg/m2 IV D1-5
Citarabina: 2 g/m2 IV a cada 12 horas D1 e 2 no total de 4 doses
Sequncia A/B/A/B - 4 ciclos
Ref. (28)
Regime de Stanford (Linfoma de Burkitt e pequenas
clulas no-clivadas)
Methotrexate: 3 g/m2 IV em infuso de 6 horas D10
166
Resgate com Leucovorin: 25 mg/m2 IV ou VO a cada 6 horas por

12 doses, iniciando 24 horas aps o Methotrexate
Methotrexate Intratecal: 12 mg D1 e 10
a cada 21 dias
Ref. (23)
Stanford V
Vinblastina: 6mg/m
Bleomicina: 5UI/m
Etoposide: 60mg/m
Prednisona: 40mg
a cada 28 dias
IV
D1
IV
D1 e 15
IV
D1 e 15
IV
D8 e 22
IV
D8 e 22
IV
D15 e 16
VO por dia
Em pacientes acima de 50 anos, a dose da Vinblastina deve ser

reduzida para 4mg/m e a dose da Vincristina para 1mg/m nas
semanas 9 e 12. Iniciar reduo da dose da prednisona na
semana 10. Usar Bactrin Profiltico VO BID e Aciclovir 200mg
VO TID.
Ref. (24)
Regime de Monoterapia
Rituximabe
Rituximabe: 375 mg/m2 IV D1, 8, 15 e 22
Repetir um ciclo adicional.
Ref. (25)
Fludarabina
Fludarabina: 25 mg/m2 IV D1-5
a cada 28 dias
Ref. (26)
167
Cladribina
Cladribina: 0.5-0.7 mg/kg SC D1-5 or 0.1 mg/kg
IV D1-7
a cada 28 dias
Ref. (27)
1. Colombat P et al. Rituximab (anti-CD20 monoclonal antibody)
as single first-line therapy for patients with follicular
lymphoma with a low tumor burden: clinical and molecular
evaluation. Blood 2001 Jan 1;97(1):101-6.
2. Marcus R. et al. CVP chemotherapy plus rituximab compared
with CVP as first-line treatment for advanced follicular
lymphoma. BLOOD 105: 1417, 2005.
3. Hiddemann W; et al. Frontline therapy with rituximab added
to the combination of cyclophosphamide, doxorubicin,
vincristine, and prednisone (CHOP) significantly improves
the outcome for patients with advanced-stage follicular
lymphoma compared with therapy with CHOP alone: results
of a prospective randomized study of the German LowGrade Lymphoma Study Group.Blood. 2005 Dec 1;106(12):
3725-32. Epub 2005 Aug 25.
4. MacLaughlin P, et al. Fludarabine, mitoxantrone and
dexamethasone: an effective new regimen for indolent
lymphoma. J Clin Oncol 1996;14:1262-1268.
5. McLaughlin P; et al. Safety of fludarabine, mitoxantrone, and
dexamethasone combined with rituximab in the treatment
of stage IV indolent lymphoma.Semin Oncol. 2000 Dec;27(6
Suppl 12):37-41.
6. Hochster H, et al. Eficacy of cyclophosphamide (CYC) and
fludarabine (FAMP) as first-line therapy of low-grade nonHodgkins lymphoma (NHL). Clood 1994;84(Suppl 1):383a.
7. Falkson CI. A phase II trial in patients with previously trated
low-grade lymphoma. Am J Clin Oncol 1996;19:268-270.
8. Bagley CM. Jr et al. Advanced lymphosarcoma: intensive
cyclical Combination chemotherapy with cyclophosphamide,
168
vincristine, and prednisone. Ann Intern Med 1972:76:227-234.

9. McKelvey EM, et al. Hydroxydaunomycin (Adriamycin)
Combination chemotherapy in malignant lymphoma.
Cancer 1976;38:1484-1493.
10. Sonnevald P. et al. Companson of doxorubicin and
mitoxantrone in the treatment of elderly patients with
advanced diffuse non-Hodgkin's lymphoma using CHOP
versus CNOP chemotherapy J Clin Oncol 1995;13;25302539.
11. Vose JM, et al. Phase II study of rituximab in combination
with CHOP chemotherapy in patients with previously
untreated, aggressive non- Hodgkin's lymphoma. J clin
Oncol 2001;19:389-397.
12. Vose JM, et al. CNOP for diffuse aggressive non-Hodgkin's
lymphoma: the Nebraska lymphoma study group experience.
Leuk Lymphoma 2002;43:799-804.
13. Wilson WH, et al. EPOCH chemotherapy: toxicity and
efficacy in relapsed and refractory non-Hodgkin's
lymphoma. J clin Oncol 1993;11:1573-1582.
14. Wilson WH. Chemotherapy sensitization by rituximab:
experimental and clinicai Evidence. Semin Oncol 2000;27
(Suppl 12):30-36.
15. 262. Klimo P, et al. MACOP-B Chemotherapy for the
treatment of diffuse large-cell lymphoma. Ann Intern Med
1985;102:596-602.
16. Shipp MA, et al. Identification of major prognostic subgroups
of patients with large-cell lymphoma treated with mBACOD or M- BACOD. Ann Intern Med 1986; 104:757-765.
17. Longo DL, et al. Superiority of proMACE- CytaBom over ProMACE-MOPP in the treatment of advanced diffuse
aggressive lymphoma: results of a prospective randomized
trial. J clin Oncol 1991;9:25-38.
18. Velasquez WS, et al. ESHAP-an effective chemotherapy
regimen in refractory and relapsing lymphoma: a 4-year
tbllow-up study. J Clin Oncol 1994;12:1169-1176.
169
19. Velasquez WS, et al. Effective salvage therapy for lymphoma

with cisplatin in combination with high-dose ara-C and
dexamethasone. Blood 1988:71:117-122.
20. Moskowitz C, et al. Ifosfamide, carboplatin, and etoposide: a
highly effective cytoreduction and peripheral blood
progenitor cell mobilization regimen for transplant-eligible
patients with non-Hodgkin's lymphoma. J Clin Oncol
1999;17:3776-3785.
21. Rodriguez MA, et al. a phase II trial of mesna/ifosfamide,
mitoxantrone, and etoposide for refractory lymphoma. Ann
Oncol 1995;6:609-611.
22. Magrath I, et al. An effective therapy for both undifferentiated
lymphomas and lyrnphohlastic lymphomas in children and
young adults. Blood 1984; 63:1102-1111.
23. Berstein JT. et al. Combined modality therapy for adults with
small non-cleaved cell lymphoma(Burkitt's and nonBurkitt's types). J Clin Oncol 1986:4:847-858.
24. Bartlett NL, et. al. Brief Chemotherapy, Stanford V And
Adjuvant Radiotherapy for Bulky 02 Advanced - Stage
Hodgkins disease: A Preliminary Report. J Clin Oncol 1995;
13:1080-1088.
25. McLaughlin P, et al. Rituximab chimeric anti-CD20 monoclonal
antibody therapy br relapsed indolent lymphoma: half of
patients respond to a four-dose treatment program. J clin
Oncol 1998;16:2825-2833.
26. Falkson Cl. A phase U trial in patients with previously trated
low-grade lymphoma. Am J Clin Oncol 1996;19:268-270.
27. Betticher DC, et al. Fewer infections but maintained antitumor
activity with lower-dose versus standard-dose cladribine in
pretreated low-grade non-Hodgkin's lymphoma. J Clin
Oncol 1998:16:850-858.
28. Magrath I, Adde M, Shad A, et al. Adults and children with
small non-cleaved-cell lymphoma have a similar excellent
outcome when treated with the same chemotherapy
regimen. J Clin Oncol. 1996; 14:925-34.
170
Linfoma de Grandes Clulas B

CHOP + Rituximabe
Prednisona: 100 mg VO D1 ao D5
Rituximabe: 375 mg/m IV D1
a cada 21 dias
Ref. (01)
R-ICE (regime de resgate)
Ifosfamida: 5000 mg/m IV contnua por 24 horas D4
Mesna: 5000 mg/m IV na mesma bolsa de infuso de Ifosfamida.
a cada 14 dias
Filgrastima: 5 g/kg D7 ao D14.
Ref. (02)
1. Coiffer B, et al. Rituximab plus CHOP in combination with

CHOP chemotherapy in patients with diffuse large B-cell
lymphoma; an update of the GELA study. N Engl J Med 2002;
346:235-242.
2. Kewalramani T et al.Rituximab and ICE as second-line therapy
before autologous stem cell transplantation for relapsed or
primary refractory diffuse large B-cell lymphoma. BLOOD
2004; 103-10.
171
Linfoma de Clulas
do Manto
Rituximabe + Hyper CVAD
Ciclos 1, 3, 5 e 7
Ciclofosfaminda: 300mg/m IV por 3h D1 ao D4 de 12/12h (
total de 6 doses)
Mesna: 600mg/m IV em infuso contnua. Iniciar 1h pr
ciclofosfamida at 12h aps a ltima dose de ciclofosfamida.
Doxorrubicina: 16,6mg/m/dia IV em 24h contnuo D5 ao D7
(iniciar 12h aps ltima dose de ciclofosfamida)
Vincristina: 1,4mg/m (mximo de 2mg) IV D5 e D12
Dexametasona: 40mg IV ou VO D2 ao D5 e D12 ao D15
Filgrastima: 5 mcg/kg/dia SC iniciar 24hs aps trmino da
quimioterapia
Ciclos 2, 4, 6 e 8
Methotrexate: 200mg/m IV D2 por 2h, seguido por 800mg/m
IV por 22h
Citarabina: 3000 mg/m2 IV por 2h a cada 12h D3 e D4 (total 4
doses)
Resgate do MTX com Leucovorin:
Iniciar 12hs aps o trmino da infuso: Leucovorin 50mg,
seguido de 15mg VO a cada 6h por 8 doses. Nvel srico de
Methotrexate deve ser checado 24 e 48h aps o fim da infuso
e doses de Leucovorin devem ser aumentadas para 100mg IV a
cada 3h se o nvel srico do MTX superar o valor de 1mol/L ou
0,1mol/L em 24 e 48h respectivamente.
Ref. (01)
172
CHOP + Rituximabe
Rituximabe: 375 mg/m IV D1
Ref. (02)
FCM + Rituximabe
Fludarabina: 25 mg/m IV por 30 min D2 ao D4
Ciclofosfamida: 200 mg/m IV por 4h D2 ao D4
Mitoxantrona: 8mg/m IV por 30 min D2
a cada 28 dias para um total de 4 ciclos
Ref. (03)
Rituximabe + Hyper CVAD
Ciclos 1,3, 5 e 7
Ciclofosfamida: 300mg/m IV por 3h de 12/12h D2 ao D4
Doxorrubicina: 12,7mg/m IV em 24h contnuo D5 ao D7,
iniciada 12h aps ltima dose de Ciclofosfamida
Vincristina: 1,4mg/m (mximo de 2mg) IV 12h aps a ltima
dose de Ciclofosfamida e repetida D12 do ciclo
Dexametasona: 40mg IV ou VO D2 ao D5 e D12 ao D15
Observao: 1h antes da admnistrao de Ciclofosfamida deve
ser iniciado mesna 600mg/m IV por 24h D2 ao D4 e
completada 12h aps a ltima dose de Ciclofosfamida.
Ciclos 2, 4, 6 e 8
Methotrexate: 200mg/m IV D2 por 2h, seguido por 800mg/m
IV por 22h
173
Citarabina: 3000 mg/m2 IV por 2h a cada 12h D3 e D4

Terapia de Resgate: Leucovorin 50mg VO administrado como
resgate do Methotrexate 12h aps a infuso deste, seguido de
15mg VO a cada 6h por 8 doses.
Ref. (04)
Bortezomibe
Bortezomibe: 1.3 mg/m2 IV D1, 4, 8 e 11
a cada 21 dias
Ref. (5)
1. Romaguera J E et al. High Rate of Durable Remissions After

Treatment of Newly Diagnosed Aggressive Mantle-Cell
Lymphoma With Rituximab Plus Hyper-CVAD Alternating
With Rituximab Plus High-Dose Methotrexate and
Cytarabine. J Clin Oncol 23:7013, 2005.
2. Lenz G. et al. Immunochemotherapy With Rituximab and
Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone
Significantly Improves Response and Time to Treatment Failure,
But Not Long-Term Outcome in Patients With Previously
Untreated Mantle CellLymphoma: Results of a Prospective
Randomized Trial of the German Low Grade Lymphoma
Study Group (GLSG). J Clin Oncol 23:1984, 2005.
3. Forstpointner R et al.The addition of rituximab to a
combination of fludarabine, cyclophosphamide, mitoxantrone
(FCM) significantly increases the response rate and prolongs
survival as compared with FCM alone in patients with relapsed
and refractory follicular and mantle cell lymphomas: results
of a prospective randomized study of the German LowGrade Lymphoma Study Group. Blood 2004 ; 104 : 3064 71.
4. Romaguera J E et al. Update of the M. D. Anderson Cancer
Center experience with hyper-CVAD and rituximab for the
treatment of mantle cell and Burkitt-type lymphomas. Clin
Lymphoma Myeloma 8:S57, 2007.
174
5. Goy AH, et al. Report of a phase II study of proteosome

inhibitor bortezomib in patients with relapsed or refractory
indolent and aggressive B-cell lytnphomas. Proc Am Soc
Clin Oncol 2003;22:570 (abstract 2291).
175
Linfoma Primrio do Sistema

Nervoso Central
Protocolo de quimioterapia isolada para linfoma primrio
de SNC
Methotrexate: 1000 mg/m2 IV D1, D10 e D20
Procarbazina: 60 mg/m2 VO D1 ao D7
Metilprednisolona: VO ou IV, 120 mg/m2 em dias alternados D1
ao D20 e 60 mg/m2 D21 ao D45
Methotrexate 15 mg e Citarabina 40 mg IT D1, D5, D10 e D15
Observao:
Iniciar Methotrexate aps alcalinizao de urina e pH urinria >7,5.
Resgate com leucovorin 25 mg iniciar 24 hs aps o trmino da
administrao do Methotrexate IV a cada 6 horas por 3 dias e 10
mg a cada 6 horas por 2 dias aps o Methotrexate IT ou
conforme nvel srico de Methotrexate.
Dia 45 reavaliao
Se doena estvel ou progressiva, suspender protocolo
Se resposta parcial ou completa, realizar mais 5 ciclos a cada 6
semanas
Methotrexate: 1000 mg/m2 IV D1
Procarbazina 60mg/m2 VO D1 ao D7
Methotrexate IT 15 mg e citarabina 40 mg D1
Resgate com Leucovorin: iniciar 24 horas aps o trmino da
infuso do Methotrexate IV, Leucovorin 25 mg VO a cada 6
horas por 3 dias. Aps o Methotrexate IT iniciar Leucovorin 10
mg a cada 6 horas por 2 dias.
Ref. (01)
176
Linfoma Primrio do SNC

Methotrexate: 3.5 gm/m2 IV durante 2 horas semanalmente por
5 doses
Methotrexate Intratecal: 12 mg IT semanalmente depois do
Methotrexate IV
Leucovorin: 10 mg IV a cada 6 horas por 12 doses, iniciando 24
horas depois do MTX IV e 10mg
IV a cada 12 horas por 8 doses, iniciando 24 horas depois do MTX IT
Vincristina: 1.4 mg/m2 IV semanalmente durante o Methotrexate IV
Procarbazina: 100 mg/m2/dia VO por 7 dias ciclos 1, 3 e 5 do
Methotrexate IV
Quando a quimioterapia completada, a radioterapia
holocraniana realizada com dose total de 45 cGy.
Ref. (02)
Tratamento de pacientes imunocompetentes

Semanas 1, 5 e 9:
Procarbazina: 100 mg/m2/dia VO, por 7 dias
Vincristina: 1,4 mg/m2/dia IV (no exceder 2,8 mg)
Methotrexate: 2,5 g/m2 IV, durante 2 h
Leucovorin: 10 mg VO, de 6/6 h, por 12 doses;
iniciar 24 h aps o incio do Methotrexate.
Semanas 2, 4, 6, 8 e 10:
Methotrexate intra-Ommaya: 12 mg/dose
iniciar 24 horas aps o Methotrexate.
Semanas 3 e 7:
Vincristina: 1,4 mg/m2 IV (no exceder 2,8 mg)
Methotrexate: 2,5 g/m2 IV, durante 2 h
177
iniciar 24 h aps o incio do Methotrexate.

Semana 11:
- realizar RNM de crebro. Se < 50 anos, prosseguir com RT: RT
de crebro total (45 Gy em 25 fraes de 180 cGy/dia); 30 a 40
Gy em globo ocular acometido pelo linfoma. Para pacientes
com RC, a RT de crebro total constituda de 36 Gy divididos
em 2 fraes dirias de 1,2 Gy (total de 15 dias). Se > 60 anos,
administrar doses de Ara-C com as doses descritas para as
semanas 16 e 19.
Semana 16:
realizar RNM de crebro e administrar
Ara-C: 2g/m2/dia IV, durante 3 horas, por 2 dias.
Semana 19:
Ara-C: 3 g/m2/dia IV, em 3 horas, por 2 dias.
Ref. (03)
1. Hoang-Xuan et al. Chemotherapy alone as inicial treatment

for primary CNS lymphoma in patients older than 60 years:
a multicenter phase II study of the european organization
for research and treatmnet of cncer brain tumor group.
JCO, 2003;21:2726-2731.
2. Abrey L, et al. Treatment for primary CNS lymphoma; the
next step. J Clin Oncol 2002;18:3144-3150.
3. De Angelis LM, Tong WP, Lin S, Fleisher M, et al. Combination
chemotherapy and radiotherapy for primary central
nervous system lymphoma: Radiation Therapy Oncology
Group Study 93-10. J Clin Oncol 2002; 20: 4643-8.
178
Mieloma Mltiplo
Bortezomibe + Dexametasona (Vel/Dex)
Bortezomibe: 1,3 mg/m2 IV pulso D1, D4, D8 e D11
Dexametasona: 40 mg/dia VO D1 ao D4 nos ciclos 1,2,3 e 4
Dexametasona 40 mg/dia VO D1-4 e D9-12 nos ciclos 1 e 2
Ref. (01)
Bortezomibe + Doxorrubicina + Dexametasona (PAD)
Bortezomibe: 1,3 mg/m IV pulso D1, D4, D8 e D11
Doxorrubicina: 9 mg/m IV em 1h D1 ao D4
Dexametasona: 40 mg VO D1 ao D4 para todos os ciclos; D8 ao
D11 e D15 ao D18 somente para o ciclo 1.
Ref. (02)
VMP
Bortezomibe: 1,3 mg/m2 IV D1, D4, D8, D11, D22, D25, D29 e
D32 (ciclos 1-4) e D1, D8, D22 e D29 (ciclos 5-9)
Melfalano: 9 mg/m2 e prednisona 60 mg/m2 VO D1 ao D4
a cada 6 semanas no total de 9 ciclos
Total : 9 x ciclos de 6 semanas (54 sem)
Ref. (03)
CVD
Bortezomibe: 1,3 mg/m2 IV em pulso D1, D4, D8 e D11
Dexametasona: 40mg/dia VO D1 e D2, D4 e D5, D8 e D9, D11 e
D12
Ciclofosfamida: 500mg/dia VO D1, D8 e D15
a cada 21 dias no total mximo de 9 ciclos
Ref. (04)
179
Cybord
1 cohort
Dexametasona: 40mg VO D1 ao D4, do D9 ao D12 e D17 ao D20
Ciclofosfamida: 300mg/m2/dia VO D1, D8, D15 e D22
a cada 28 dias
2 cohort
Dexametasona: 40mg/dia VO D1 ao D4, D9 ao D12 e D17 ao D20
para os ciclos 1 e 2 e semanalmente nos ciclos 3 e 4.
Ciclofosfamida: 300mg/m2/dia VO D1, D8, D15 e D22
a cada 28 dias
Ref. (05)
Regimes Combinados
MP
Melfalano: 8-10 mg/m2 VO D1-4
Prednisona: 60 mg/m2 D1-4
a cada 42 dias
Ref. (06)
MPR
Melfalano: 0.18 mg/kg por 4 dias
Prednisona: 2 mg/kg/dia por 4 dias
Revlimide: 10 mg/dia por 21 dias a cada 4-6 semanas
Ref. (07)
MPT
Melfalano: 0.25 mg/kg D1 a 4
Prednisona: 1.5 mg/kg D1 a 4 a cada 4 a 6 semanas
Talidomida: 50-100 mg/dia continuamente.
Ref. (08)
180
VAD
Vincristina: 0.4 mg/dia IV em infuso contnua D1-4
Dexametasona: 40 mg VO D1-4, 9-12 e 17-20
a cada 28 dias
Ref. (09)
Talidomida + Dexametasona
Talidomida: 200 mg/dia VO
Dexametasona: 40 mg/dia VO D1-4, 9-12 e 17-20
a cada 28 dias (Celgene Talidomida PI.)
Ref. (10)
Bortezomibe + Doxorrubicina Lipossonal
Peguilada
Bortezomibe: 1.3 mg/m2 IV pulso D1, 4, 8 e 11
Doxorrubicina: 30 mg/m2 IV D4, depois do Bortezomibe
a cada 21 dias
Ref. (11)
Lenalidomida + Dexametasona
Lenalidomida: 25 mg/dia VO D1-21
Dexametasona: 40 mg/dia VO D1-4, 9-12
e 17-20 (nos primeiros 4 ciclos) seguido por 40 mg/dia VO D1-4
ou 40 mg/dia VO D1, 8, 15 e 22.
a cada 28 dias (Celgene Revlimid PI)
Ref. (12)
Regimes de Monoterapia
Dexametasona
Dexametasona: 40 mg IV ou VO D1-4, 9-12 e 17-20
a cada 21 dias
Ref. (13)
181
Lenalidomida
Lenalidomida: 30 mg VO D1 a 21 a cada 28 dias
Ref. (14)
Melfalano
Melfalano: 90-140 mg/m2 IV D1 a cada 28-42 dias
Ref. (15)
Talidomida
Talidomida: 200-800 mg VO dia
Continuar tratamento at progresso da doena ou toxicidade
proibitiva.
Ref. (16)
Bortezomibe
Bortezomibe: 1.3 mg/m2 IV D1, 4, 8 e 11
a cada 21 dias
Ref. (17)
Se ocorrer doena progressiva aps 2 ciclos ou doena estvel

aps 4 ciclos pode se acrescentar Dexametasona 20mg VO
diariamente nos dias de descanso aps o Bortezomibe.
Interferon -2b
Interferon -2b: 2 milhes IU SC ou IM. 3 vezes semanalmente
Usar como terapia de manuteno em pacientes com resposta
significativa com a quimioterapia de induo.
Ref. (18)
1. Jean-Luc Harousseau et al. Bortezomib Plus Dexamethasone
Is Superior to Vincristine Plus Doxorubicin Plus Dexamethasone
As Induction Treatment Prior to Autologous Stem-Cell
Transplantation in Newly Diagnosed Multiple Myeloma:
Results of the IFM 2005-01 Phase III Trial. JCO 2010. JCO
October 20, 2010 vol. (28) : 4621-4629
2. Oakervee HR et al. BR J Haematol.2005;129:755-62
3. San Miguel, JF et al. Bortezomib plus Melphalan and
182
Prednisone for Initial Treatment of Multiple Myeloma. N

Engl J Med 2008; 359:906-917.
4. Davies, FE et al. The combination of cyclophosphamide,
velcade and dexamethasone (CVD) induces high response rates
with comparable toxicity to velcade alone (V) and velcade
plus dexamethasone (VD). Haematologica 2007;92:1149-1150.
5. Reeder et al. Cyclophosphamide, bortezomib and dexamethasone
induction for newly diagnosed multiple myeloma: high response
rates in a phase II clinical trial. Leukemia (2009) 23, 13371341.
Craig B. Reeder, et al. Once- versus twice-weekly bortezomib
induction therapy with CyBorD in newly diagnosed multiple
myeloma. Blood, Apr 2010; 115: 3416 3417.
6. Southwest Oncology Group study. Remission maintenance
therapy for multiple myeloma. Arch Intern Med 1975:135:147-152.
7. Palumbo A, Falco P, Falcone A, Corradini P, Di Raimondo F, Giuliani
N, Rossi G, Morabito F, Canepa L, Gozzetti A, Ambrosini MT, Zeldis
J, Knight R, Foa R, Boccadoro M, Petrucci MT. Oral Revlimid plus
melphalan and prednisone (R-MP) for newly diagnosed multiple
myeloma: Results of a multicenter phase I/II study(asbstract).
Blood: ASH Annual Meeting Proceedings 2006: 108(11 Part l of2):
240a, abstract #0800.
8. Palumbo A. Bringhen S, Caravita T. Merla E, Capparella V, Callea V,
Cangialosi C Grasso M, Rossini F, Galli M, Catalno L, Zamagni E,
Petrucci MT, De Stefano V, Ceccarelli M, Ambrosini MT, Avonto I,
Falco P, Ciccone G, Liberati AM, Musto P, Boccadoro M, Italian
Multiple Myeloma Network GIMEMA. Oral melphalan and prednisone
chemotherapy plus thalidomide compared with melphalan and
prednisone alone in elderly patients with multiple myeloma:
Randomised controlled trial. Lancet 2006: 367(9513):825-31.
9. Barlogie B, et al. Effective treatment of advanced multiple
mueloma refractory to alkylating agents. N Engl J Med
1984;310:1353-1356.
10. Rajkumar SV, et al. Combination therapy with thalidomide plus
dexamethasone for newly diagnosed myeloma. J Clin Oncol
2002;20:4319-4323.
183
11. Orlowaki RX Peterson BI, Caligiuri MA, et al. Bortezomib and

pegylated liposomal doxorubicin as initial therapy for adult
patients with symptomatic multiple myeloma: CALGB study
10301 Pster presented at the 10th intemational myeloma
Workshop, 2005, april 10-14, Sydney, Austrlia.
12. Rajkumar SV, Jacobus S, Callander N, Fonseca R, Vesole D,
Williams M. Abonour R, siegel D, Greipp P. Phase III trial of
lenalidomide plus high-dose dexamethasone versus
lenalidomide plus low-dose dexamethasone in newly diagnosed
multiple myeloma (E4A03): A trial coordinated by the Eastern
Cooperative Oncology Group (Abstract). Proceedings of the
43rd Annual Meeting of the American Society of clinicai
oncology 2007b: june 1-5: Chicago. IL: Abstract #LBA8025.
13. Alexanian R, et al. High-dose glucocorticoid treatment of
resistant myeloma. Ann Intern Med 1986:105:8-11.
14. Richardson PG, blood E, MTsiades CS, Jagannath S,
Zeldenrust S, Alsina M. Schlossman RL, Rajkumar SV,
Desikan KR, Hideshima T Munshi N, Kelly colson k, doss D,
McKenney M, Gorelik S, Warren D, Freeman A, Rich R, Wu A
Olesnyckj M, Wride K, Dalton W, Zeldis J, Knight R, Weller E.
Anderson KC. A randomized phase 2 study of lenalidomide
therapy for patients with relapsed or relapsed and refractory
multiple myeloma. Blood :006;108(10):3458-64.
15. Cunningham D. et al. High-dose melphalan for multiple
myeloma: long-tenn follow-up data. J Clin Oncol
1994;12:7&l-768.
16. Singhal S, et al. Antitumor activity of thalidomide in
refractory multiple myeloma. N Engl J Med 1999;34P1565-1571.
17. Richardson P. et al. A phase II study of botezomib in
relapsed. refractory myeloma. N Engl J Med 2003;348:2609-2617.
18. Browman GP. et al. Randomized trial of interferon
maintenance in multiple myeloma: a study of the National
Cancer Institute of Canada Clinicai Trials Group. J Clin Oncol
1995;13:2354-2360. 312.
184
Sndrome Mielodisplsica
Azacitidina
Azacitidina: 75 mg/m2 SC diariamente por 7 dias
a cada 6 semanas. Pacientes devem ser tratados por pelo menos
4 ciclos.
Ref. (1)
Decitabina
Decitabina: 15 mg/m2 IV infuso contnua de 3 horas a cada 8
horas por 3 dias
a cada 4 semanas. Pacientes devem ser tratados por pelo menos
4 ciclos.
Ref. (2)
Decitabina: 20 mg/m2 IV infuso contnua por 1h por 5 dias
a cada 4 a 6 semanas. Pacientes devem ser tratados por pelo
menos 4 ciclos.
Ref. (3)
Lenalidomida
Lenalidomida: 10 mg VO dia
A dose continuada ou modificada baseada em achados
clnicos e laboratoriais.
Ref. (4)
1. Silverman LR, et al. Further analysis of trials with azacitidine

in patients with myelodysplastic syndrome. studies 8421,
8921, and 9221 by the Cancer and Leukemia Group B. J Clin
Oncol 2006:324: 3895-3903.
2. Kantarjian H, et al. Decitabine improves patient outcomes in
myelodysplastic syndromes. Cancer 2006; 106:1794-1780.
185
3. Kantarjian H, et al. Decitabine dosng schedules. sem in

Hematolqly 2005;32 (suppl):sl7-522.
4. Galili N., et al. Immunomodulatory drugs in myelodysplastic
syndromes Expert Opin Investig Drugs 2006;15:805-813.
186
Macroglobulinemia
de Waldestrn
Bortezomibe e Rituximabe
Bortezomibe: 1,6 mg/m2 IV semanalmente D1, D8, D15.
Rituximabe: 375 mg/m2 IV semanalmente no ciclo 1 e 4.
Ref. (01)
Bendamustina e Rituximabe
Rituximabe: 375 mg/m2/dia IV D1
Bendamustina: 90 mg/m2/dia IV durante 30 minutos D1 e D2
Ref. (02)
1. Irene M. Ghobrial et al. Phase II trial of weekly bortezomib in

combination with rituximab in untreated patients with
Waldenstrm Macroglobulinemia. American Journal of
Hematology. 2010, 85: 670674.
2. Mathias J. Rummel, Salah E. Al-Batran, Soo-Z. Kim, et al.
Bendamustine Plus Rituximab Is Effective and Has a
Favorable Toxicity Profile in the Treatment of Mantle Cell
and Low-Grade Non-Hodgkin's Lymphoma Journal of
Clinical Oncology, Vol 23, No 15, 2005: pp. 3383-3389.
187
Leucemia de Clulas
Cabeludas (Tricoleucemia)
Tratamento padro:
Cladribina: 0,1 mg/kg/dia IV infuso contnua por 7 dias (ciclo nico).
Opes do uso de cladribina:
a. 0,14 mg/Kg/dia IV, infundir durante 2h por 5 dias
b. 0,14 mg/Kg IV, infundir durante 2h uma vez por semana
c. 0,14 mg/Kg SC, uma vez por semana
Avaliar associao de rituximabe 375 mg/m2, IV na HCL variante
Ref. (01)
1. Saven A, et al. Blood 1998;92:1918-26.

Lauria F, Bocchia M, Marotta G, Raspadori D, Zinzani PL,
Rondelli D. Weekly administration of 2-chlorodeoxyadenosine
in patients with hairy-cell leukemia is effective and reduces
infectious complications. Haematologica. 1999;84(1):2225.
Golomb HM. Hairy cell leukemia: treatment successes in the
past 25 years. J Clin Oncol. 2008;26(16):26072609.
Robak T, Jamroziak K, Gora-Tybor J, et al. Cladribine in a
weekly versus daily schedule for untreated active hairy cell
leukemia: final report from the Polish Adult Leukemia Group
(PALG) of a prospective, randomized, multicenter trial.
Blood. 2007;109(9):36723675.
Juliusson G, Liliemark J. Purine analogues: rationale for development,
mechanisms of action, and pharmacokinetics in hairy cell leukemia.
Hematol Oncol Clin North Am. 2006;20(5):10871097.
Zinzani PL, Tani M, Marchi E, et al. Long-term follow-up of frontline treatment of hairy cell leukemia with 2chlorodeoxyadenosine. Haematologica. 2004;89(3):309313.
188
Zenhausern R, Schmitz SF, Solenthaler M, et al. Randomized trial

of daily versus weekly administration of 2-chlorodeoxyadenosine
in patients with hairy cell leukemia: a multicenter phase III
trial (SAKK 32/98). Leuk Lymphoma. 2009:111.
189
Leucemias Agudas
Quimioterapia de Induo
Regime de Linker
Daunorrubicina: 50 mg/m2 IV a cada 24 horas D1-3
Vincristina: 2 mg IV D1,8, 15 e 22
Prednisona: 60 mg/m2 VO dividido em 3 doses D1-28
L-Asparaginase: 6,000 U/m2 IM D17-28
Se a medula ssea foi positiva para leucemia residual,
Daunorrubicina: 50 mg/m2 IV D15
Se a medula ssea no dia 28 for positiva para leucemia residual,
Daunorrubicina: 50 mg/m2 IV D29 e 30
Vincristina: 2 mg IV D29 e 36
L-Asparaginase: 6,000 U/m2 IM D29-35
Ref. (1,2)
Terapia de Consolidao
Regime de Linker
Tratamento A (ciclo 1, 3, 5 e 7)
Daunorubicina: 50 mg/m2 IV D1 e 2
Vincristina: 2mg IV D1 e 8
L-Asparaginase:12,000 U/m2 D2, 4, 7, 9, 11 e 14
Tratamento B (ciclo 2, 4, 6 e 8)
Teniposide: 165 mg/m2 IV D1,4, 8 e 11
Citarrabina: 300 mg/m2 IV D1, 4, 8 e 11
Tratamento C (ciclo 9)
Methotrexate: 690 mg/m2 IV durante 42 horas
Leucovorin: 15 mg/m2 IV a cada 6 horas 12 doses iniciando na
hora 42
Ref. (1,2)
190
Terapia de Manuteno
Regime de Linker
Methotrexate: 20 mg/m2 VO semanalmente
6-Mercaptopurina: 75 mg/m2 VO contnuo por um total de 30
meses aps a resposta completa.
Profilaxia SNC
Radioterapia craniana: 1,800 cGy em 10 redues durante 12 a
14 dias
Methotrexate: 12 mg IT semanalmente por 6 semanas
Iniciar dentro de uma semana aps resposta completa
Em pacientes com envolvimento do SNC no diagnstico a
quimioterapia intratecal deve ser iniciada durante a quimioterapia
de induo
Methotrexate: 12 mg IT semanalmente por 10 doses
Radioterapia craniana: 2,800 cGy
Ref. (1,2)
Terapia de Induo
Regime de Larson
Induo (semana 1-4)
Daunorrubicina: 45 mg/m2 IV D1-3
Vincristina: 2 mg IV D1, 8, 15 e 22
Prednisona: 60 mg/m2/dia VO D1-21
L-Asparaginase: 6,000 IU/m2 SC D5, 8, 11, 15, 18, 22
Intensificao precoce (semana 5-12)
6-Mercaptopurina: 60 mg/m2/dia VO D1-14
Citarabina: 75 mg/m2 IV D1-4 e D8-11
L-Asparaginase: 6,000 IU/m2 SC D15, 18, 22 e 25
191
Profilaxia do SNC e manuteno interina (semana 13-25)

Radioterapia craniana: 2,400 cGy D1-12
Methotrexate: 15 mg IT D1, 8, 15, 22 e29
Methotrexate: 20 mg/m2 VO D36, 43, 50, 57 e 64
Intensificao Tardia (semana 26-33)
Doxorrubicina: 30 mg/m2 IV D1, 8 e 15
Vincristina: 2 mg IV D1, 8 e15
Dexametasona: 10 mg/m2/dia VO D1-14
Ciclofosfamida: 1 ,000 mg/m2 IV D29
6-Tioguanina: 60 mg/m2/dia VO D29 - 42
Citarrabina: 75 mg/m2 D29, 32, 36-39
Manuteno Prolongada (continuar at 24 meses aps o diagnstico)
Vincristina: 2mg IV D1
Prednisona: 60 mg/m2/dia VO D1-5
Methotrexate: 20 mg/m2 VO D1, 8, 15 e 22
Repetir ciclo de manuteno a cada 28 dias.
Ref. (3)
Regime Hyper-CVAD
Ciclofosfamida: 300 mg/m2 IV durante 3 horas a cada 12 horas
por 6 doses D1-3
Mesna: 600 mg/m2 IV durante 24 horas D1-3, terminando 6
horas apos a ltima dose de Ciclofosfamida
Dexametasona: 40 mg VO ou IV D1-4 e 11-14
Alternando ciclos a cada 21 dias com:
Methotrexate: 200 mg/m2 IV durante 2 horas,
seguido por 800 mg/m2 IV durante 24 horas no D1
Leucovorin: 15 mg IV a cada 6 horas por 8 doses, iniciando 24
192
horas aps o trmino de infuso do Methotrexate

Citarabina: 3,000 mg/m2 IV durante 2 horas a cada 12 horas por
4 doses D2-3
Metilprednisolona: 50 mg IV BID D1-3
Alternar 4 ciclos de hiper-CVAD com 4 ciclos de Methotrexate
em dose alta
Ref. (4).
Profilaxia SNC
Methotrexate: 12mg IT
D2
Citarabina: 100 mg IT D8
Repetir a cada ciclo de quimioterapia, dependendo do risco de
doena no SNC.
1. Linker CA, et al. Improved results of treatment of adult acute

lymphoblastic leukemia. Blood 1987:69:1242-1248.
2. Linker CA, et al. treatmentof adult acute lymphoblastic
leukemia with intensive cyclical chemotherapy: a follow-up
report. Blood 1991;75:2814-2822.
3. Larson R, et al. A five-drug regimen remission induction
regimen with intensive consolidation for adults with acute
lymphoblastic leukemia: Cancer an Leukemia Group B study
8811, Blood 1995;85:2025-2037.
4. Kantarjian H, et al. Results of treatment with hyper- CVAD, a
dose-intensive regimen in adult acute lymphoblastic
leukemia. J Clin Oncol 2000;18:547-561.
193
Leucemia Mielide Crnica

Imatinibe
Imatinibe: 400 mg/dia VO
Ref. (1)
Dasatinibe
Dasatinibe: 70mg VO BID
Dasatinibe: 100mg VO MID
Ref. (2)
Nilotinibe
Nilotinibe: 400mg VO BID
Ref. (3)
Hidroxiuria
Hidroxiuria: 40 mg/kg/dia VO
Ref. (4)
1. Kantarjian H, et al. Hematologic and Cytogenetic Responses
to Imatinib Mesylate in Chronic Myelogenous Leukemia.
NEJM.2002;346:645-52.
2. Shah NP; Kantarjian HM; Kim DW; et al. Intermittent target
inhibition with dasatinib 100 mg once daily preserves
efficacy and improves tolerability in imatinib-resistant and intolerant chronic-phase chronic myeloid leukemia.J Clin
Oncol. 2008 Jul 1;26(19):3204-12.
3. Av a i l a b l e f r o m t h e U S F D A w e b s i t e a t :
<www.fda.gov/cder/foi/label/2007/022068lbl.pdf
4. Hehlmann R, et al. Randomized comparison of interferonalpha with busulfan and hydroxyurea in chronic
myelogenous leukemia. The German CML Study Group.
Blood 1994;84:4064-4077.
194
Leucemia Linftica Crnica

CVP
Ciclofosfamida: 400 mg/m VO D1 ao D5 (ou 800 mg/m IV D1)
a cada 21 dias
Ref. (1)
FC
a cada 21 ou 28 dias
Ref. (2)
Clorambucil
Clorambucil: 6 a 14 mg/dia VO como terapia de induo e ento
0,7 mg/kg VO por 2 a 4 dias
a cada 21 dias
Ref. (3)
Fludarabina
Fludarabina: 20 a 30 mg/m IV D1 ao D5
a cada 28 dias
Ref. (4)
FP
Prednisona: 30 mg/m IV D1 ao D5
a cada 28 dias
Ref. (5)
CP
Clorambucil: 30 mg/m VO D1
a cada 28 dias
Ref. (6)
195
FR
Rituximabe: 375 mg/m IV D1, D3 e D5
a cada 28 dias
Ref. (7)
FCR
Ciclo 1:
Fludarabina: 25 mg/m IV D2-D4
Ciclofosfamida: 250 mg/m IV D2-D4
Rituximabe: 375 mg/m2 D1
Ciclo 2-6:
Fludarabina: 25 mg/m IV D1-D3
Ciclofosfamida: 250 mg/m IV D1-D3
Rituximabe: 500 mg/m2 D1
a cada 28 dias
Ref. (8)
FCR-Lite
Ciclo 1:
Rituximabe: 375 mg/m2 IV D1
Fludarabina: 20 mg/m2 IV D2 ao D4
Ciclofosfamida: 150 mg/m2 IV D2 ao D4
Ciclos 2-6:
Rituximabe: 500 mg/m2 IV D1 e no D14
Fludarabina: 20 mg/m2 IV em 30 minutos D1 ao D3
Ciclofosfamida: 150 mg/m2 IV em 60 minutos D1 ao D3
Manuteno:
Rituximabe 500 mg/m2 IV a cada 3 meses at recidiva
Ref. (9)
Alentuzumabe
Alentuzumabe: 3,10 e 30 mg IV em 2 horas D1, D2 e D3
respectivamente.
196
Alentuzumabe: 30 mg IV trs vezes por semana at o total de 12

semanas (incluindo a semana com escalonamento) Ref. (10)
Rituximabe e Alentuzumabe
Ciclo 1:
Rituximabe: 375 mg/m2 IV no D1 e 500 mg/m2 IV D8, D15 e D22
Alentuzumabe: 30 mg/dia IV em infuso contnua D2 ao D7
Alentuzumabe: 30 mg/dia SC D10, D12, D17, D19, D24 e D26
Ciclo 2-3 (opcional):
Rituximabe: 500 mg/m2 IV D1, D8, D15 e D22
Alentuzumabe: 30 mg/dia SC D3, D5, D10, D12, D17, D19, D24
e D26
Ref. (11)
Bendamustina e Rituximabe
Ciclo 1:
Bendamustina: 70 mg/m2 IV D1 e D2
Ciclos2-6:
Bendamustina: 70 mg/m2 IV D1 e D2
Ref. (12)
Rituximabe e Corticide em Dose Alta

Ciclos 1-3:
Solumedrol: 1000 mg/m2 IV em 90 minutos uma vez ao dia D1
ao D5
Rituximabe: 375 mg/m2 IV semanalmente por 4 semanas
Ref. (13)
OFAR
Ciclos 1-6:
Oxaliplatina: 25 mg/m2 IV D1 ao D4
Fludarabina: 30 mg/m2 IV D2 e D3
Citarabina: 1000 mg/m2 IV D2 e D3
197
Rituximabe: 375 mg/m2 IV D3 (Ciclo 1) e D1 (Ciclos 2-6)

Ref. (14)
CFAR
Ciclo 1:
Ciclofosfamida: 250 mg/m2 IV D3 ao D5
Fludarabina: 25 mg/m2 IV D3 ao D5
Alentuzumabe: 30 mg IV D1, D3 e D5
Rituximabe: 375 mg/m2 IV D2 (ciclo 1) e 500mg/m2 IV D2
(ciclo 2-6)
Ref. (15)
1. Raphael B, et al. Comparison of chlorambucil and prednisone
versus cyclophosphamide, vincristine, and prednisone as
initial treatment for chronic lymphocytic leukemia: longterm follow-up of an Eastern Cooperative Oncology Group
randomized clinical trial. J clin Oncol 1991:9:770-776.
2. Keating MJ, et al. Long-term follow-up of patients with
chronic lymphocytic leukemia (CLL) receiving fludarabine
regimens as initial therapy. Blood 1998;92:1165-1171.
3. Dighiero G, et al. Chlorambucil in indolent chronic lymphocytic
leukemia French cooperative Group on chronic Lymphocytic
leukemia. N Engl J Med 1998;338:1506-1514.
4. Keating MJ, et al. Long-term follow-up of patients with
chronic lymphocytic leukemia (CLL) receiving fludarabine
regimend as initial therapy. Blood 1988;92:1165-1171.
5. OBrien S, et al. Results of fludarabine and prednisone
therapy in 264 patients with chronic lymphocytic leukemia
with multivariate analysisderived prognostic model for
response to treatment. Blood 1993;82:1695-1700.
6. Raphael B, et al. Comparison of chlorambucil and prednisone
versus cyclophosphamide, vincristine, and prednisone as
initial treatment for chronic lymphocytic leukemia: longterm follow- up of an Eastern Cooperative Oncology Group
randomized clinical trial. J clin Oncol 1991:9:770-776.
7. Byrd JC, et al. Randomized phase 2 study of fludarabine with
198
concurrent versus sequential treatment with rituximab in

symptomatic untreated patients with B-cell chronic
lymphocytic leukemia: results from Cancer and Leukemia
Group B9712. Blood 2003;101:6-14.
8. Keating M, et al. Early results of a chemoimmunotherapy
regimen of fludarabine, cyclophosphamide, and rituximab
as initial therapy for CLL. J Clin Oncol 2005;22:4079-4088.
9. Fonn KA, et al. Chemoimmunotherapy with low dose
fludarabine and cyclophosphamide and high dose
rituximab in previously untreated patients with chronic
lymphocytic leukemia. J Clin Oncol 2009; 27:498-503.
10. Hillmen P, et al. Alemtuzumab compared with chlorambucil
as first line therapy for chronic lymphocytic leukemia. J Clin
Oncol 2007;25:5616-5623.
11. Faderl S, et al. Alemtuzumab by continuous intravenous
infusion followed by subcutaneous injection plus rituximab
in the treatment of patients with chronic lymphocytic
leukemia recurrence. Cancer 2010; 116:2360-2365.
12. Firsten K, et al. Bendamustine in combination with
rituximab for patients with relapsed chronic lynphocytic
leukemia: a multicenter phase II Trial of the German CLL
Study Group. Blood 2008; 112:Abstract 330.
13. Castro JE, et al. Rituximab in combination with high-dose
methylprednisolone for the treatment of fludarabine
refractory high-risk chronic lymphocytic leukemia.
Leukemia 2008; 22:2048-53.
14. Tsimberidou AM, et al. Phase I-II study of oxaliplatin,
fludarabine, cytarabine, and rituximab combination therapy
in patients with Richter's syndrome or fludarabinerefractory chronic lymphocytic leukemia. J Clin Oncol 2008;
26:196-203.
15. Badoux XC, et al. Chemoimmunotherapy with Cyclophosphomide,
Fludarabine, Alemtuzumab and Rituximab (CFAR) Is
Effective in Relapsed Patients with Chronic Lymphocytic
Leukemia (CLL). Blood 2009; 114:Abstract 3431.
199
Sarcomas de Partes Moles

AIM- Doxorrubicina, Ifosfamida e Mesna
Doxorrubicina: 75 mg/m2/ciclo IV em pulso divididos entre D1 a D3
Ifosfamida: IV 69g/m2/ciclo, divididos entre D1 a D3
Mesna
Ref. (1)
AIM- Doxorrubicina, Ifosfamida e Mesna
Doxorrubicina: 30 mg/m2/dia IV pulso D1 e D2
Ifosfamida: 3,75g/m2/dia IV D1 e D2
Mesna: 750 mg/m2 IV imediatamente antes, 4 horas e 8 horas
aps administrao da Ifosfamida
Ref. (2)
MAID- Mesna, Doxorrubicina, Ifosfamida e Dacarbazina
Doxorrubicina: 60 mg/m2 IV contnua D1 ao D4
Dacarbazina: 1g/m2 IV contnua D1 ao D4
Ifosfamida: 6 g/m2 IV D1 ao D3 associada a Mesna
Mesna: 10.000 mg/m2 D1 ao D4
Ref. (3)
Gencitabina e Docetaxel
Gencitabina: 900 mg/m2 IV D1 e D8
Ref. (4)
200
Ifosfamida e Epirrubicina
Ifosfamida: 1,8g/m2/dia IV D1 ao D5 (dose total por ciclo de 9g/m2)
Mesna: IV pulso na dose equivalente a 20% da dose de
Ifosfamida, a ser administrada antes, 4 horas e 8 horas aps
infuso de Ifosfamida
Epirrubicina: 60mg/m2/dia IV pulso D1 e D2 (dose mxima por
ciclo de 120 mg/m2)
Ref. (5)
AD- Doxorrubicina e Dacarbazina
Doxorrubicina: 60 mg/m2 IV contnua D1 ao D4
Dacarbazina: 1g/m2 IV contnua D1 ao D4
Ref. (6)
CYVADIC- Ciclofosfamida, Vincristina, Doxorrubicina e
Dacarbazina
Doxorrubicina: IV 120 mg/m2 D1
Dacarbazina: 250 mg/m2/dia D1 ao D5
Vincristina: 5mg/m2 IV D1
Ref. (7)
VAC/IE Vincristina, Doxorrubicina e Ciclofosfamida
alternados com Ifosfamida e Etoposide
Ciclo A:
Vincristina: 2 mg/m2 IV D1 (dose mxima de 2mg)
Doxorrubicina: IV 75 mg/m2 em infuso rpida D1
Ciclofosfamida: 1200 mg/m2 D1, seguida de Mesna (dose no
especificada).
A dose cumulativa mxima de doxorrubicina de 375 mg/m2.
Uma vez atingida, deve-se substituir a Doxorrubicina por
Dactinomicina 1,25 mg/m2 IV D1 iniciada no ciclo 11.
201
Ciclo B:
Ifosfamida: 1,8 g/m2/dia IV D1 ao D5 (concomitante mesna)
Etoposide: 100 mg/m2/dia IV D1 ao D5.
Alternar os ciclos A e B a cada 3 semanas, por um total de 17
ciclos. Durao estimada da QT: 49 semanas
Ref. (8)
IE- Ifosfamida e Etoposide
Etoposide: 100mg/m2/dia IV D1 ao D5 durante 2 horas, seguido
imediatamente pela Ifosfamida
Ifosfamida: 1,8g/m2/dia IV D1 ao D5 durante 2 horas (administrada
concomitante Mesna)
Mesna: 60% da dose da Ifosfamida.
Ref. (9)
VAC- Vincristina, Dactinomicina e Ciclofosfamida
Regime de Induo (semanas 1 a 17):
Vincristina: 1,5 mg/m2 (mximo de 2 mg) IV pulso D1 das semanas
1 a 13 e, posteriormente, uma dose na semana 17
Dactinomicina: 0,015 mg/Kg/dia (mximo de 0,5mg) IV pulso
D1 ao D5 das semanas 1, 4, 7 e 17
Ciclofosfamida: 2,2 g/m2 IV D1 das semanas 1, 4, 7, 10, 13 e 17
Regime de manuteno (semanas 21 a 44):
Vincristina: 1,5 mg/m2 (mximo de 2 mg) IV pulso D1 das
semanas 21 a 26, 30 a 35 e 39 a 44
Dactinomicina: 0,015 mg/Kg/dia (mximo de 0,5mg) IV pulso
D1 ao D5 das semanas 21, 24, 30, 33, 39 e 42
Ciclofosfamida: 2,2 g/m2 IV D1 das semanas 21, 24, 30, 33, 39 e 42
Ref. (10)
202
Doxorrubicina lipossomal: 50 mg/m2 IV em 1 hora a cada 4
semanas
Ref. (11)
Imatinibe
Imatinibe: 400mg VO 1 vez ao dia, podendo-se aumentar a
dose para 2 x ao dia, contnuo
Ref. (12)
Sunitinibe
Sunitinibe: 50 mg por dia VO durante 4 semanas a cada 6
semanas
Ref. (13)
Temozolomida
Temozolomida: 200 mg/m2 (1a dose) VO
D1
28 dias
Temozolomida: 90 mg/m2 (2a dose em diante) VO 12/1 2 horas
D1 a D5 28 dias
Ref. (14)
Gencitabina
D1
semanal*
* No perodo de induo, a quimioterapia aplicada por 7
semanas, seguidas por uma de descanso. Na fase seguinte, de
manuteno, a quimioterapia aplicada por 3 semanas,
seguidas por uma de descanso.
Ref. (15)
Paclitaxel
Ref. (16)
IV
D1
21 dias
203
1. S. R. Grobmyer, R. G. Maki, G. D. Demetri, M. Mazumdar4, E.

Riedel, M. F. Brennan1 & S. SingerDepartments of Surgery,
Medicine and Biostatistics, Memorial Sloan Kettering Cancer
Center, New York, NY; 4Department of Medicine, Dana
Farber Cancer Institute, Boston, MA, USA. Annals of
Oncology 15: 16671672, 2004.
2. Karen Antman, John Crowley, Stanley P. Balcerzak, et al. An
Intergroup Phase III Randomized Study of Doxorubicin and
Dacarbazine With or Without Ifosfamide and Mesnain
Advanced Soft Tissue and Bone Sarcomas Journal of Clinical
Oncology, Vol 11, No 7 (July), 1993: pp 1276-1285.
4. Robert G. Maki, J. Kyle Wathen, Shreyaskumar R. Patel, et al.
Phase II Study of Gemcitabine and Docetaxel Compared
With Gemcitabine Alone in Patients With Metastatic Soft
Tissue Sarcomas: Results of Sarcoma Alliance for Research
Through Collaboration Study 002 Journal of Clinical
Oncology, Vol 25, No 19 (July 1), 2007: pp. 2755-2763.
5. Sergio Frustaci, Franco Gherlinzoni, Antonino De Paoli, et al.
Adjuvant Chemotherapy for Adult Soft Tissue Sarcomas of
the Extremities and Girdles: Results of the Italian
Randomized Cooperative Trial. Journal of Clinical Oncology,
Vol 19, No 5 (March 1), 2001: pp 1238-1247.
7. H. M. Pinedo,; V. H. C. BramvvelL, H. T. Mouridsen, et al.
Cyvadic in Advanced Soft Tissue Sarcoma: A Randomized
Study Comparing Two Schedules A Study of the EORTC Soft
204
Tissue and Bone Sarcoma Group. Cancer 53:1825-1832, 1984.

8. Holcombe E. Grier, Mark D. Krailo, Nancy J. Tarbell et al.
Addition of Ifosfamide and Etoposide to Standard
Chemotherapy for Ewings Sarcoma and Primitive
Neuroectodermal Tumor of Bone. N Engl J Med 348;694, 2003.
9. A. Kawai, H. Chuman, A. Makimoto, Y. Ito, et al. Ifosfamide etoposide chemotherapy in patients with advanced adult
soft tissue sarcomas. Journal of Clinical Oncology, 2004
ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 9062
10. K. Scott Baker, James R. Anderson, Michael P. Link,
Holcombe E. Grier, Stephen J. Qualman, Harold M. Maurer,
John C. Breneman, Eugene S. Wiener, and William M. Crist.
Benefit of Intensified Therapy for Patients With Local or Regional
Embryonal Rhabdomyosarcoma: Results From the Intergroup
Rhabdomyosarcoma Study IV. J Clin Oncol 18:2427-2434,2000.
11. I.Judson et al. Randomised Phase II Trial of pegylated
liposomal doxorubicin versus doxorubicin in the treatment
of advanced or metastatic soft tissuea sarcoma. European
Journal of Cancer 2001; 37:870-877.
12. Jaap Verweij, Paolo G Casali, John Zalcberg et al. Progressionfree survival in gastrointestinal stromal tumours with highdose imatinib: randomised trial. Lancet 2004; 364: 1127134.
13. George D Demetri, Allan T van Oosterom, Christopher R
Garrett, et al. Efficacy and safety of sunitinib in patients with
advanced gastrointestinal stromal tumour after failure of imatinib:
a randomised controlled trial. Lancet 2006; 368: 1329-38.
14. Talbot SM, et al. A phase II trial of temozolomide in patients
with unresectable or metastatic soft tissue sarcoma. Cancer
2003;98:1942-6.
15. Merimsky O, et al. Gemcitabine in soft tissue or bone sarcoma
resistant to standard chemotherapy: a phase II study Cancer
Chemother Pharmacol 2000;45:177-81
16. Fata F, et al. Paclitaxel in the treatment of patients with
angiosarcoma of the scalp or face. Cancer 1999;86:2034-7.
205
Sarcoma de Kaposi
Daunorrubicina lipossomal
Daunorrubicina lipossomal: 40 mg/m IV D1
a cada 14 dias
Ref. (1)
Doxorrubicina lipossomal peguilada
Doxorrubicina lipossomal peguilada: 20 mg/m IV D1
a cada 21 dias
Ref. (2)
Paclitaxel
Paclitaxel: 135 mg/m IV durante 3 horas D1
a cada 21 dias
Ref. (3)
Ou
Paclitaxel: 100 mg/m IV durante 3 horas D1
a cada 14 dias
ABV
Doxorrubicina: 20 mg/m IV
Bleomicina: 10 mg/m
IV
Vincristina: 1 mg
IV
Ref. (4)
D1
D1
D1
a cada 14 dias
1. Gill PS, et al. Randomizes phase III trial of liposomal

daunorubicin versus doxorubicin, bleomycin, and
vincristine in AIDS- related Kaposis sarcoma. J Clin Oncol
1996;14:2353-2364.
206
2. Northfelt DW, et al. Efficacy of pegylated-liposomal doxorubicin

in the treatment of AIDS relates Kaposis sarcoma after failure
of standard chemotherapy. J Clin Oncol 1997;15:653-659.
3. Gill PS, et al. Paclitaxel is safe and effective in the treatment
of advanced AIDS-related Kaposis sarcoma. J Clin Oncol
1999;17:1876-1880.
Gill PS, et al. Multicenter trial of low-dose paclitaxel in
patients with advanced AIDS-related Kaposis sarcoma.
Cancer 2002;95:147-154.
4. Northfelt DW, et al. J Clin Oncol 1998;16:2445-51.
207
Sarcomas sseos
Tratamento Neo-adjuvante
Doxorrubicina, Cisplatina e Methotrexate em altas doses
(Pacientes com at 30 anos de idade)
Fase pr-operatria
IV
D1 e D2
Semanas 0 e 5
2
Doxorrubicina: 25 mg/m IV contnuo D1 a D3 Semanas 0 e 5
Methotrexate*: 12 g/m2 (mximo 20 g) IV D1 Semanas 3, 4, 8 e 9
Leucovorin**: 10 mg (24 horas aps o Methotrexate)
IV 6/6 horas D2
Semanas 3, 4,8 e 9
* Requer hidratao do paciente e alcalinizao da urina com
infuso de bicarbonato de sdio;
** O cido foinico mantido at o nvel srico de Methotrexate
atingir concentrao menor que 100 nmol/L.
Fase ps-operatria
IV
D1 e D2 Semanas 12 e 17
Doxorrubicina: 25 mg/m2 IV contnuo D1 a 03 Semanas 12,17,
22 e 27
Methotrexate*:12 g/m2 (mximo 20 g) IV D1
Semanas 15, 16, 20, 21, 25, 26, 30 e 31
Leucovorin: 10 mg (24 horas aps o Methotrexate) IV 6/6 horas
D2
Semanas 15, 16, 20, 21, 25, 26, 30 e 31
* Se o paciente necessitar de um perodo de recuperao maior
que 1 semana entre as doses das semanas 20 e 21 e das
semanas 25 e 26, a segunda dose de Methotrexate poder ser
suprimida, para no prejudicar a intensidade de dose da
Doxorrubicina.
Ref. (1)
208
Doxorrubicina e Cisplatina
IV 24 horas D1
2
Doxorrubicina: 25 mg/m IV
Ref. (2)
Etoposide e Ifosfamida de induo, com regime
complementar ps-operatrio
Fase pr-operatria*
IV
D1 a D5
Ifosfamida: 3500 mg/m2 IV 4 horas D1a D5
Mesna: 700 mg/m2
IV 4 horas D1 a D5
(combinada com a ifosfamida)
Mesna: 700 mg/m2
IV 3 horas (aps a ifosfamida)
D1 a D5
2
Mesna: 700 mg/m
IV pulso
Nas horas 3, 6 e 9 aps a Ifosfamida D1a D5 a cada 21 dias por
2 ciclos
*A quimioterapia acima aplicada por dois ciclos (durao de 6
semanas), antes da cirurgia.
Fase ps-operatria*
Methotrexate*: 12 g/m2 (mximo 20 g)
IV
D1
Semanas 1, 2, 6, 7,11, 12, 16, 17, 30 e 31
Acido Folnico: 15 mg (24 horas aps o metotrexato) IV 6/6
horas (total 10 doses)
D2
Semanas 1, 2, 6, 7,11,12,16,
17, 30 e 31
IV
D1 e D2 Semanas 12 e17
Doxorrubicina: 37,5 mg/m2
IV
D1e D2 Semanas
3, 13, 21, 27e32
IV D1 a D5 Semanas 8, 18 e 24
2
Ifosfamida: 2400 mg/m
IV 4 horas D1 a D5 Semanas 8, 18 e 24
Mesna: 480 mg/m2
IV 4 horas
D1 a D5 (combinada
com a ifosfamida)
Semanas 8, 18 e 24
Mesna: 480 mg/m2
IV 3 horas (aps a ifosfamida)
D1 a D5
Semanas 8, 18 e 24
209
Mesna 480 mg/m2

IV pulso Nas horas 3, 6 e 9 aps a
ifosfamida
D1 a D5
Semanas 8, 18 e 24
*A quimioterapia de manuteno tem incio 1 ou 2 semanas
aps a cirurgia.
Ref. (3)
Sarcoma de Ewing
ICE
Carboplatina: 400 mg/m2 IV
D1 a D2
IV
D1 a D5
2
Ifosfamida*: 1800 mg/m IV
*Acompanhada de mesna para uroproteo.
Ref. (4)
Protocolo INT-0091 do Instituto Nacional de Cncer (NCI)
Ciclo 1
Vincristina: 2 mg/m2 (mximo 2 mg)IV
D1
Doxorrubicina: 75 mg/m2
IV
D1
Ciclofosfamida**: 1200 mg/m2
IV
D1
Dactinomicina***: 1,25 mg/m2
IV
D1 a cada 42 dias
Ciclo 2
EV
D1 a D5
Ifosfamida**: 1800 mg/m2 EV
*A quimioterapia aplicada a cada 21 dias, alternando o ciclo 1
com o ciclo 2, num total de 17 ciclos, equivalentes a 49 semanas;
** Acompanhada de mesna para uroproteo;
***A dactinomicina substitui a doxorrubicina quando a dose
acumulada dessa droga atinge 375 mg/m2.
Ref. (5)
210
1. Meyers PA, et al. Osteosarcoma: A Randomized, Prospective

Trial of the Addition of Ifosfamide and/or Muramyl Tripeptide
to Cisplatin, Doxorubicin, and High-Dose Methotrexate. J
Clin Oncol 2005;23:2004-11.
2. Bramwell VH, et al. A comparison of two short intensive adjuvant
chemotherapy regimens in operable osteosarcoma of limbs
in children and young adults: the first study of the European
Osteosarcoma Intergroup. J Clin Oncol 1992;10:1579-91.
3. Goorin Am, et al. Phase II/III Trial of Etoposide and High-Dose
Ifosfamide in Newly Diagnosed Metastatic Osteosarcoma: A
Pediatric Oncology Group Trial. J Clin Oncol 2002;20:426-33.
4. Van Winkle P, et al. Ifosfamide, carboplatin, and etoposide (ICE)
reinduction chemotherapy in a large cohort of children and
adolescents with recurrent/refractory sarcoma: The Children's
Cancer Group (CCG) experience. Pediatr Blood Cancer
2005;44:338-47.
5. Grier HE, et al. Addition of Ifosfamide and Etoposide to Standard
Chemotherapy for Ewing's Sarcoma and Primitive
Neuroectodermal Tumor of Bone. N Engl J Med
2003;348:694-701.
211
Feocromocitoma
CVD
Vincristina: 1,4 mg/m2
IV
Dacarbazina: 600 mg/m2 IV
Ref. (1)
D1
D1
D1-D2 a cada 21 dias
1. Huang Hui, Abraham Jame, Hung Elizabeth. Treatment of

malignant pheochromocytoma/paraganglioma with
cyclophosphamide, vincristine, and dacarbazine. Cancer.
2008; 113: 2020-2028.
212
Escala de
Performance
213
214
ECOG 0 a 4
GRAu
NVEL DE ATIVIDADE
Completamente ativo, capaz de realizar todas as

atividades tal como antes da doena, sem
restries (Karnofsky 90-100%).
Restrio de atividades fisicamente estenuantes,

mas deambulando e capaz de resolver tarefas
leves ou sedentrias, por exemplo, trabalhos
domsticos leves, servios de escritrio
(Karnofsky 70-80%).
Deambulando e capaz de cuidar de si prprio

mas incapaz de realizar qualquer trabalho; de p
e ativo mais de 50% das horas em que passa
acordado (Karnofsky 50-60%).
Limitao da capacidade de se autocuidar,

confinado ao leito ou a uma poltrona durante
mais de 50% do perodo em que permanece
acordado (Karnofsky 30-40%).
Completamente incapacitado; no consegue

executar qualquer autocuidado; totalmente
confinado ao leito ou poltrona (Karnofsky 1020%).
Oken, MM, Creech, RH, Tormey, DC, Horton, J. Davis, TE,
McFadden, ET, Carbone, PP: Am J Clin Oncol 5:649-655, 1982.
215
Notas
216
Frmulas teis
em Oncologia
217
218
Determinao do
Clearance de Creatinina
Frmula de Cockcroft-Gault
(Cockcroft, DW, Gault, MH. Nephron 1976; 16: 3134):
Clearance de creatinina (ml/min) = Peso (Kg) x (140 idade)
72 x creatinina srica (mg/dl)
Para mulheres multiplicar o resultado por 0,85.
Determinao da rea sobre

a curva (AUC)
Calvert, H, et al. J Clin Oncol 1989;7:17481756
Dose de Carboplatina (mg) = (25 + Clearance ml/min) x AUC
AUC mais usadas: 5 a 7
219
Clculo da Superfcie
Corporal
Calculada por mg/m2
Pode ser calculada por nomogramas ou atravs de calculadoras
prprias para este fim. A frmula usada :
Superficie Corporal = Peso (kg) x altura (cm)
3600
Ou ENTO:
SC (m2) = 0,007184 X ( Altura (cm))0,725 X ( Peso kg))0,425
ou seja:
Superficie corporal = 0,007184 que multiplica a altura em cm
elevado a 0,725 --> multiplica esse resultado pelo peso em kg
elevado a 0,425
1. DuBois D, DuBois E.F. A formula to estimate the approximate

surface area if height and weight be known. Arch. Intern.
Med. 17:862, 1916.
2. Mosteller, R. D. Simplified calculation of body surface area.
N Engl J Med. 1987; 317:1098.
220
Correo de Dose
para Pacientes em
Hemodilise(1)
221
222
DROGA
NECESSIDADE DE AjuSTE EM
HEMODILISE
5-Fluorouracil
No
Capecitabina
Sem informao
Carboplatina
Sim
Cisplatina
Sim
Ciclofosfamida
Sim
Docetaxel
Sem informao
Doxorrubicina
No
Epirrubicina
No
Etoposide
Sim
Gencitabina
No
Irinotecano
Sem informao
Methotrexate
Sem informao
Oxaliplatina
Sem informao
Paclitaxel
No
Vinorelbina
Sim
Adaptado de Janus N. et al (1)
223
DROGA
5FU
Capecitabina
VIA ELIMINAO
ADMINISTRAR
Respiratria Aps HD
Urinria Aps HD
Carboplatina
Urinria
Aps HD
Cisplatina
Urinria
Aps HD
Ciclofosfamida
Urinria
Aps HD
Docetaxel
Fezes
Doxorrubicina
Epirrubicina
Etoposide
Fezes
Fezes
Fezes
Gencitabina
Urinria
Irinotecano
Fezes
Antes ou
Aps HD
Aps HD
Aps HD
Antes ou
Aps HD
6 a 12h
antes da HD
Aps HD
Methotrexate
Urinria
Aps HD
Oxaliplatina
Urinria
Aps HD
Paclitaxel
Fezes
Vinorelbina
Fezes
Antes ou
Aps HD
Aps HD
DOSE
GRAu
RECOMEN- DE
DADA
RECOMENDAO
Usual
C
Sem
informao
Dose=AUC
B
x (25+0)
Reduo de
B
50 a 75%
Reduo
B
de 25%
C
65mg/m2
Usual
Usual
Reduo
de 50%
Usual
C
C
B
Sem
informao
Reduo
de 75%
Reduo
de 30%
Usual
Reduo de
20 a 30%
C
C
B
C
HD: hemodilise. Adaptado de Janus N. et al (1)
224
PROTOCOLO
DROGAS AjuSTE
DE DOSE
IFL (Saltz)
Irinotecano,
Leucovorin,
5FU
Sim
FOLFOX4
Oxaliplatina,
5FU
Sim
Irinotecano,
5FU
Ciclofosfamida,
FEC100
Epirrubicina,
5FU
Carboplatina+ Carboplatina,
Docetaxel
Docetaxel
Sim
FOLFIRI
Sim
Sim
Cisplatina+
Gencitabina
Cisplatina,
Gencitabina
Cisplatina+
Docetaxel
Cisplatina,
Docetaxel
Sim
Cisplatina+
Gencitabina
Cisplatina,
Gencitabina
Sim
Sim
DOSES
RECOMENDADAS
Irinotecano 50mg/m2
semanal, Leucovorin
10mg/m2,semanal,5FU
400mg/m2 semanal
Oxaliplatina
32mg/m2,5FU
240mg/m2 pulso e
400mg/m2 infusional
Irinotecano 120mg/m2
Ciclofosfamida
375mg/m2, Epirrubicina
100mg/m2,5FU
500mg/m2
Carboplatina AUC
x(25+0), Docetaxel
65mg/m2
Cisplatina 25mg/m2,
Gencitabina
1000mg/m2
Cisplatina 25mg/m2,
Docetaxel 65mg/m2
Cisplatina 25mg/m2,
Paclitaxel 135mg/m2
em 24 horas ou
175mg/m2 em 3 horas
Adaptado de Janus Net al (1)
1. Janus N, Thariat J et al. Proposal for dosage adjustment and timing of

chemotherapy in hemodialyzed patients. Ann Oncol. 2010, 21, 1395-1403.
225
Notas
226
Classificao
Internacional de
Doenas CID
Oncologia
227
228
C00
C01
C02
C03
C04
C05
C06
C07
C08
C09
C10
C11
C12
C13
C14
C15
C16
C17
C18
C19
C20
C21
C22
C23
C24
C25
C26
C30
C31
C32
C33
C34
C37
C38
C39
Neopl. malig. do lbio

Neopl. malig. da base da lngua
Neopl. malig. outr partes e NE da lngua
Neopl. malig. da gengiva
Neopl. malig. do assoalho da boca
Neopl. malig. do palato
Neopl. malig. outr. partes e partes NE da boca
Neopl. malig. da gland. partida
Neopl. malig. outr. gland. saliv. maiores e NE
Neopl. malig. da amgdala
Neopl. malig. da orofaringe
Neopl. malig. da nasofaringe
Neopl. malig. do seio piriforme
Neopl. malig. da hipofaringe
Neopl. malig. out. loc. mal def. labio cav. oral far.
Neopl. malig. do esfago
Neopl. malig. do estmago
Neopl. malig. do intestino delgado
Neopl. malig. do clon
Neopl. malig. da juno retossigmide
Neopl. malig. do reto
Neopl. malig. do nus e do canal anal
Neopl. malig. fgado vias biliares intra-hepat
Neopl. malig. da vescula biliar
Neopl. malig. outras partes e NE vias biliares
Neopl malig do pncreas
Neopl. malig .outr. mal def. aparelho digestivo
Neopl. malig. cavidade nasal e do ouvido mdio
Neopl. malig. dos seios da face
Neopl. malig. da laringe
Neopl. malig. da traquia
Neopl. malig. dos bronquos e dos pulmes
Neopl. malig. do timo
Neopl .malig. do corao mediastino e pleura
Neop. malig. out. loc. mal def. ap. resp. org. intrat.
229
C40
C41
C43
C44
C45
C46
C47
C48
C49
C50
C51
C52
C53
C54
C55
C56
C57
C58
C60
C61
C62
C63
C64
C65
C66
C67
C68
C69
C70
C71
C72
C73
C74
C75
C76
230
Neopl. malig. ossos/cartilag. artic. membros

Neopl. malig. ossos/cartil. artic. outr. loc. e NE
Melanoma malig. da pele
Outr. neopl. malig. da pele
Mesotelioma
Sarcoma de Kaposi
Neopl. malig. nervos perif. e sist. nerv. autnom.
Neopl. malig. tec. moles retro- e peritonio
Neopl. malig. tec. conjuntivo e outr. tec. moles
Neopl. malig. da mama
Neopl. malig. da vulva
Neopl. malig. da vagina
Neopl. malig. do colo do tero
Neopl. malig. do corpo do tero
Neopl. malig. do tero poro NE
Neopl. malig. do ovrio
Neopl. malig. outr. org. genitais femin. e NE
Neopl. malig. da placenta
Neopl. malig. do pnis
Neopl. malig. da prstata
Neopl. malig. dos testculos
Neopl. malig. outr. org. genit. masc. e NE
Neopl. malig. do rim exceto pelve renal
Neopl. malig. da pelve renal
Neopl. malig. dos ureteres
Neopl. malig. da bexiga
Neopl. malig. de outr. orgos urinrios e NE
Neopl. malig. do olho e anexos
Neopl. malig. das meninges
Neopl. malig. do encfalo
Neopl. mal. med. esp. nerv. cran. out. sist. nerv. cen.
Neopl. malig. da gland. tireide
Neopl. malig. da gland. supra-renal
Neopl. malig. outr. gland. endcrinas estr. relac.
Neopl. malig. outr. localiz. e mal definidas
C77
C78
C79
C80
C81
C82
C83
C84
C85
C88
C90
C91
C92
C93
C94
C95
C96
C97
Neopl. malig. secund. e NE gangl. linfticos

Neopl. malig. secund. org. respirat. e digestivos
Neopl. malig. secund. de outr. localiz.
Neopl. malig. s/especificao de localiz.
Doenc. de Hodgkin
Linfoma no-Hodgkin folicular
Linfoma no-Hodgkin difuso
Linfomas de clulas T cutneas e perifricas
Linfoma no-Hodgkin de outr. tipos e tipo NE
Doenc. imunoproliferativas malignas
Mieloma mlt. e neopl. malig. de plasmcitos
Leucemia linfide
Leucemia mielide
Leucemia monoctica
Outr. leucemias de clulas de tipo espec.
Leucemia de tipo celular NE
Outr. neopl. mal. e NE tec. linf. hematop. e corr.
Neopl. malig. de localiz. mult. independentes
231
Notas
232
Sites teis em
Oncologia
233
234
www.sboc.org.br
www.sbcancer.org.br
www.inca.gov.br
www.asco.org
www.nccn.org
www.cancer.gov
www.esmo.org
www.pubmed.com
www.bvs.org.br
235
Notas
236
Notas
237
Notas
238
Notas
239
Notas
Projeto Grfico e Diagramao

Communicatio Design
www.communicatio.com.br
240

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