Third Line Chemotherapy
Irinotecan & Bevacizumab (Avastin), with Vinblastine consolidation.

This was Eleanor’s third chemotherapy regimen. Eleanor began this 18 month protocol on 4th October 2019, and it ended on the 18th February 2021. It is given in two phases, one 12 month phase (fortnightly), with a consolidation 6 month phase (weekly).

This phase of the treatment is blood count dependent prior to treatment each fortnight, as follows…

  • Blood Counts – FBC, U&Es & LFTs checked weekly and always 24 – 48 hours pre chemotherapy.
  • If Neutrophils equal to or greater than 1.0 & Platelets equal to or greater than 100 – continue with treatment.
  • If Neutrophils less than 1.0 and or Platelets less than 100 re-test blood counts.
  • Treatment will be delayed until count recovery.

Cycle 01 Day 01 – 04.10.19 – Bevacizumab 230mg (delivered via IV over 1h30m) & Irinotecan 108mg (delivered via IV over 1h30m)
Cycle 01 Day 15  – 18.10.19 – Bevacizumab 230mg (delivered via IV over 1h) & Irinotecan 108mg (delivered via IV over 1h30m)

Dosages increased due to body weight/height recalculation…

Cycle 02 Day 01 – 01.11.19 – Bevacizumab 240mg (delivered via IV over 30m) & Irinotecan 112mg (delivered via IV over 1h30m)
Cycle 02 Day 15 – 15.11.19 – Bevacizumab 240mg (delivered via IV over 30m) & Irinotecan 112mg (delivered via IV over 1h30m)
Cycle 03 Day 01 – 29.11.19 – Bevacizumab 240mg (delivered via IV over 30m) & Irinotecan 112mg (delivered via IV over 1h30m)
Cycle 03 Day 15 – 13.12.19 – Bevacizumab 240mg (delivered via IV over 30m) & Irinotecan 112mg (delivered via IV over 1h30m)

On the 23rd December Eleanor woke up in the morning with a high temperature, we managed this at home, she started to feel better and her temperature dropped, we headed out for her matinee performance at The Old Vic… shortly after getting home that evening, her temperature quickly rose again. Eleanor was promptly admitted to Kingston Hospital and was diagnosed with Flu A. After a night in hospital and some IV Flu treatments, we managed to get her home in time for Christmas Eve!

Dosages increased due to body weight/height recalculation…

Cycle 04 Day 01 – 27.12.19 – Bevacizumab 250mg (delivered via IV over 30m) & Irinotecan 114mg (delivered via IV over 1h30m)
Cycle 04 Day 15 – 10.01.20 – Bevacizumab 250mg (delivered via IV over 30m) & Irinotecan 114mg (delivered via IV over 1h30m)

Dosages increased due to body weight/height recalculation…

Cycle 05 Day 01 – 24.01.20 – Bevacizumab 265mg (delivered via IV over 30m) & Irinotecan 118mg (delivered via IV over 1h30m)
Cycle 05 Day 15 – 07.02.20 – Bevacizumab 265mg (delivered via IV over 30m) & Irinotecan 118mg (delivered via IV over 1h30m)
Cycle 06 Day 01 – 21.02.20 – Bevacizumab 265mg (delivered via IV over 30m) & Irinotecan 118mg (delivered via IV over 1h30m)
Cycle 06 Day 15 – 06.03.20 – Bevacizumab 265mg (delivered via IV over 30m) & Irinotecan 118mg (delivered via IV over 1h30m)

Dosages increased due to body weight/height recalculation…

Cycle 07 Day 01 – 20.03.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)
Cycle 07 Day 15 – 03.04.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)
Cycle 08 Day 01 – 17.04.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)
Cycle 08 Day 15 – 01.05.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)
Cycle 09 Day 01 – 15.05.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)
Cycle 09 Day 15 – 29.05.20 – Bevacizumab 270mg (delivered via IV over 30m) & Irinotecan 122mg (delivered via IV over 1h30m)

Dosages increased due to body weight/height recalculation…

Cycle 10 Day 01 – 12.06.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)
Cycle 10 Day 15 – 26.06.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)
Cycle 11 Day 01 – 10.07.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)
Cycle 11 Day 15 – 24.07.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)
Cycle 12 Day 01 – 07.08.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)
Cycle 12 Day 15 – 21.08.20 – Bevacizumab 285mg (delivered via IV over 30m) & Irinotecan 124mg (delivered via IV over 1h30m)

This phase of the treatment is blood count dependent prior to each weekly treatment, as follows…

FBC (Full Blood Count) checked weekly 24 – 48 hours pre chemotherapy.

Starting dose 5mg/m2.

  • If neutrophil count is equal to or greater than 0.75 and platelet count is equal to or greater than 75, the next dose may be administered at full dose.
  • If neutrophil count is less than 0.75 but equal to or greater than 0.5 and/or platelet count is below 75 but equal to or greater than 50, dose reduced to 4 mg/m2.
  • If neutrophil count is below 0.5 and/or platelet count is below 50, withhold vinblastine until blood count recovery to neutrophil count = 0.75 and platelet count = 75. Resume Vinblastine at 4 mg/m².
  • Patients who at a reduced dose of 4 mg/ m² still demonstrate objective evidence of haematological toxicity affecting the weekly schedule will have their subsequent dose of the agent decreased to 3 mg/m²

Treatment 01 – 10.09.20 – Vinblastine 5.5mg
Treatment 02 – 17.09.20 – Vinblastine 5.5mg

We believe that Eleanor has been experiencing a very mild reaction to the Vinblastine, as she has exhibited small but temporary hives after her first 2 treatments. This is something that now needs monitoring, so from now on she will also be given a small IV dose of Chlorphenamine (Piriton) before each treatment, sadly this can make her a little drowsy after each treatment.

Treatment 03 – 24.09.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)
Treatment 04 – 01.10.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.5)
Treatment 05 – 08.10.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)

Treatment 06 – 15.10.20 – Vinblastine 5.5mg

On 17.10.20, Eleanor started to rapidly develop a sore throat and a cold which resulted in her spiking a persistent temperature. As she has a medically implanted device and is on chemotherapy, we are not allowed to manage this at home, so had no choice but to take her to our local hospital. All the while, Eleanor otherwise felt completely OK and was chatty and active. She was admitted and then discharged the following day on 18.10.20. A precautionary Covid-19 test was taken, as we are in a pandemic, and the result was negative as expected.

Treatment 07 – 22.10.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)

Treatment 08 – 29.10.20 – Vinblastine 5.5mg
Treatment 09 – 05.11.20 – Vinblastine 5.5mg
Treatment 10 – 12.11.20 – Vinblastine 5.5mg
Treatment 11 – 19.11.20 – Vinblastine 5.5mg
Treatment 12 – 26.11.20 – Vinblastine 5.5mg
Treatment 13 – 03.12.20 – Vinblastine 5.5mg

Treatment 14 – 10.12.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.6)
Treatment 15 – 17.12.20 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)

Treatment 16 – 24.12.20 – Vinblastine 5.5mg
Treatment 17 – 31.12.20 – Vinblastine 5.5mg
Treatment 18 – 07.01.21 – Vinblastine 5.5mg
Treatment 19 – 14.01.21 – Vinblastine 5.5mg
Treatment 20 – 21.01.21 – Vinblastine 5.5mg
Treatment 21 – 28.01.21 – Vinblastine 5.5mg
Treatment 22 – 04.02.21 – Vinblastine 5.5mg

Treatment 23 – 11.02.21 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)
Treatment 24 – 18.02.21 – Vinblastine 4.4mg (reduced dosage given because of a Neutrophil count of 0.7)

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