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The chemotherapy protocol describes in detail the aim, the modalities, the complications and the expected results of the medical treatment which is going to be prescribed. It is used as a reference throughout the prescription.

Description of the prescription circumstances

The protocol precisely describes:

• the type of pathology for which it is prescribed (cancer location, histology),

• the cancer stage,

• its integration within a global multidisciplinary protocol,

• the clinical situations allowing or forbidding its use,

• other exceptional indications or contraindications,

• useful literature references.

Description of drugs

For each drug, the protocol precisely describes:

• the dosage (related to the weight, the body surface, the desired blood concentration, the desired Area under the Curve, and so on).

• the day, the hour, the order and the duration of drug administration,

• the route of administration,

• ,the adjuvant treatment (hydration, antiemetic drugs, antiallergic drugs, ...),

• the particular precautions that should be taken during the use of the drug and its follow-up,

Description of the chemotherapy cycles

The protocol then describes:

• the interval which separates the various cycles (or cures), thus defining the dose intensity

• the number of cycles, as programmed

• the main expected toxicities,

• the prerequisite conditions before beginning a new cycle (clinical recovery, biological recovery),

• the toxicities which necessitate complete stopping or delay in treatment,

• the preventive or curative measures that should be taken against these major toxicities,

• the treatment modifications according to the observed toxicity,

• the general rules of dosage adaptation.

Simplified diagram of a chemotherapy protocol

The clear, quality drafting and precise knowledge of the therapeutic protocol enable efficient treatment of 'borderline' patients:

low leukocyte count,,

low platelet count,

abnormal serum creatinine,

liver enzymes modification.

Generally speaking and for many protocols, in the case of abnormalities, the first step is to increase the interval between cycles (delay of one week before prescribing the next cycle in order to allow a return to a normal blood count). Sometimes, there are precise adaptation rules implying dose diminution of one drug. In general, if after two subsequent cycles, a delay was necessary, the dosage is lowered in order to maintain as satisfactory a rhythm as possible (at least as long as the therapeutic efficiency is certain). Sometimes, growth factors need to be prescribed in order to shorten a delay due solely to leucopoenia.