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Dose reductions of oxaliplatin were instituted for grade ⩾3 haematological toxicity (on day of treatment) and grade 3 peripheral neuropathy or grade 2 neuropathy persisting between cycles.
A treatment delay due to persistence of haematological toxicity or grade >1 non haematological toxicity on day of recycling occurred in 18 and 11 patients in PET and ET arm, respectively.
In case of haematological toxicity on day 8 (ANC<1.5 × 10 l−1, PLT<100 × 10 l−1), the gemcitabine treatment of day 8 was delayed for 1 week.
In case of persistent haematological toxicity on day 15, the gemcitabine day 8 treatment was omitted and chemotherapy was repeated on day 21 with a 25% dose reduction for both drugs.
The dose of gemcitabine on day 8 was reduced to 50% in case of neutrophils between 0.5 and 1.5 × 10 l−1, platelets between 50 and 100 × 10 l−1 or grade 3 nonhaematologic toxicity on day 8. Gemcitabine was omitted on day 8 in case of neutrophils <0.5 × 10 l−1, platelets <50 × 10 l−1 or grade 4 nonhaematologic toxicity.
There is, however, some consensus that schedules using cisplatin 100 mg m−2 on day 1 of a 28 day cycle are less able to deliver the full dose of gemcitabine due to frequent dose omissions and reductions for haematological toxicity on day 15 (Abratt et al, 1998).
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In one patient at this dose level, however, therapy had to be stopped on day 8 due to toxicity.
The most important toxicity was myelosuppression, which occurred almost always on day 8 (docetaxel nadir).
The gemcitabine and cisplatin doses were reduced for toxicity on the day of treatment as follows: 75% of the drug dosage was given to patients with an absolute neutrophil count of 500 900 mm−3 or with a platelet count of 50 000–74 000 mm−3, and doses were reduced 50% if patients had an absolute neutrophil count of less than 500 mm−3 or a platelet count of 50 000 mm−3.
All toxicities improved on day 28.
This regimen was well tolerated, with most haematological toxicities occurring on day 15, the planned rest day.
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