BCOP cheat sheet

Mosteller BSA (m²) = square root of [(height in cm × weight in kg) ÷ 3600]; many protocols cap BSA at 2.0 m² when calculating cytotoxic doses.

Calvert equation: carboplatin dose (mg) = target AUC × (CrCl + 25); use Cockcroft-Gault creatinine clearance and cap CrCl at 125 mL/min.

Vincristine is capped at 2 mg total dose, diluted for infusion, and never dispensed in a syringe because intrathecal administration is fatal.

Doxorubicin cardiotoxicity thresholds: 550 mg/m² cumulative, or 400 mg/m² with mediastinal radiation; dexrazoxane reduces risk when therapy continues beyond threshold.

High-dose methotrexate: leucovorin rescue is titrated to serial serum levels drawn at 24/48/72 hours; glucarpidase is used when methotrexate exceeds 1 micromolar with renal dysfunction.

Intravenous busulfan every 6 hours in conditioning is titrated to a per-dose AUC near 900-1350 micromolar-minutes using first-dose pharmacokinetic sampling.

Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) require ibrutinib reduction to 140 mg daily, while strong inducers (rifampin, phenytoin) lower TKI exposure.

Pharmacogenomic dosing: DPYD status for fluoropyrimidines, UGT1A1*28 for irinotecan neutropenia risk, and TPMT/NUDT15 for thiopurines.

Checkpoint inhibitors use flat dosing (pembrolizumab 200 mg every 3 weeks or 400 mg every 6 weeks; nivolumab 240 mg every 2 weeks or 480 mg every 4 weeks) rather than BSA.

Febrile neutropenia: single temperature 38.3 C or 38.0 C sustained one hour with ANC below 500/microliter (or below 1000 and predicted to fall); anti-pseudomonal beta-lactam within 60 minutes.

A MASCC score of 21 or higher defines low-risk febrile neutropenia and supports oral outpatient therapy such as ciprofloxacin plus amoxicillin-clavulanate.

ASTCT CRS grading: grade 1 fever only; grade 2 hypotension without vasopressors or low-flow oxygen; grade 3 vasopressor or high-flow oxygen; grade 4 life-threatening; tocilizumab 8 mg/kg for grade 2 or higher.

ICANS is scored with the ICE tool; grade 3 or higher is treated with dexamethasone 10 mg IV every 6 hours, and tocilizumab is not indicated for neurotoxicity alone.

Anthracycline extravasation: dexrazoxane 1000 mg/m2 on days 1 and 2 and 500 mg/m2 on day 3, first dose within 6 hours; cold compress for anthracyclines and vinca alkaloids, warm for oxaliplatin.

Irinotecan acute cholinergic diarrhea and cramping: atropine 0.25-1 mg IV; late diarrhea beginning after 24 hours: loperamide 4 mg then 2 mg every 2 hours until 12 hours diarrhea-free.

Immune-mediated colitis grade 2 or higher: hold checkpoint inhibitor and start prednisone 1-2 mg/kg daily; add infliximab 5 mg/kg if no improvement in 2-3 days after excluding infection.

Tumor lysis syndrome: aggressive IV hydration, allopurinol for low risk, rasburicase for high risk or elevated uric acid after screening for G6PD deficiency.

Capecitabine hand-foot syndrome grade 2: interrupt until grade 1 or less then resume, with dose reduction on resumption after grade 3 toxicity.

Equianalgesic doses: oral morphine 30 mg is approximately oral oxycodone 20 mg, oral hydromorphone 6-7.5 mg, or IV morphine 10 mg; reduce 25-50 percent for incomplete cross-tolerance.

Breakthrough pain dose equals 10-15 percent of the total daily opioid; more than four rescue doses per day indicates the baseline regimen needs titration.

Opioid-induced constipation: prophylactic stimulant laxative; methylnaltrexone or naloxegol for laxative-refractory cases when mechanical obstruction is excluded.

Highly emetogenic chemotherapy antiemetics: NK1 antagonist plus 5-HT3 antagonist plus dexamethasone plus olanzapine; dexamethasone continues 3-4 days after chemotherapy.

Bone-modifying agents for solid tumor bone metastases: denosumab 120 mg subcutaneously every 4 weeks or zoledronic acid 4 mg IV every 4 weeks, with calcium and vitamin D supplementation.

Zoledronic acid: infuse 4 mg over at least 15 minutes; reduce to 3.5 mg for creatinine clearance 30-60 mL/min and avoid below 30 mL/min.

Hospice eligibility requires a prognosis of 6 months or less if the disease follows its expected course; palliative care may be delivered concurrently with active treatment.

Survivorship after anthracyclines or chest radiation: serial echocardiography plus screening for secondary malignancy, endocrine dysfunction, and fertility effects.

Cisplatin survivors: monitor creatinine, magnesium, and audiograms at follow-up because nephrotoxicity and ototoxicity are cumulative.

Phase I: primary endpoints are dose-limiting toxicities and the maximum tolerated dose, with the recommended phase 2 dose chosen from safety, pharmacokinetic, and early activity data using 3+3 escalation.

Phase II screens for activity (objective response rate, progression-free survival); phase III confirms benefit with overall survival or progression-free survival in a randomized population.

RECIST 1.1: no more than 5 target lesions total and 2 per organ, at least 10 mm longest diameter for non-nodal lesions and 15 mm short axis for nodes; progression requires a 20 percent increase in the sum.

CTCAE version 5.0 grades toxicity 1 through 5, where grade 3 is severe, grade 4 is life-threatening, and grade 5 is death.

Informed consent must be documented before any study-specific procedure; IRB approval, trial registration, and adherence to the Declaration of Helsinki are required.

Investigational product accountability: document receipt, storage conditions, dispensing, returns, and destruction, and reconcile counts at monitoring visits.

Intention-to-treat analysis preserves randomization; non-inferiority trials must report both intention-to-treat and per-protocol analyses against a prespecified margin.

Interim analyses use prespecified alpha-spending (for example O'Brien-Fleming boundaries) and are reviewed by an independent data safety monitoring board that can recommend stopping for benefit, harm, or futility.

Phase 0 microdosing studies use subtherapeutic doses of 1/100 or less of the therapeutic dose to characterize pharmacokinetics and target engagement.