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Medical Oncologist: Beaumont Hospital / Cancer Centre BH V.

071231
Department of Medical Oncology P 080121
DIAGNOSIS: Anaplastic Date Wgt Name:
Oligodendroglioma Hgt (cm): _____ MRN:
STAGE: Address:
REGIMEN:
Wgt (kg): _____
Avastin
BSA:_______m2 DOB:
No. of cycles; Length of Cycle: 2
weekly Date: 07/12/2021
Gender: M / F

Bevacizumab 10mg/kg Cycle 1 Cycle 2 Cycle 3 Cycle 4 Cycle 5 Cycle 6


Day 1 Day 1 Day 1 Day 1 Day 1 Day 1
in 100mls NACL iv infusion Date
every two weeks
(multiples of 12.5mgs]
Dose change
Infusion rate:
1st dose over 90 mins
2nd dose over 60 mins PRESCRIBED
DOSE
Subsequent doses over 30 mins

Dr’s signature
(to proceed)

Pharmacist

Dose admin.

Given by
100% dose = (mg)
Checked by

Signature: Date:
Protocol modifications as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/default.htm
Anti-emetic guidelines as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/SupportiveCare/default.htm
Medical Oncologist: Beaumont Hospital / Cancer Centre BH V. 071231
Department of Medical Oncology P 080121
DIAGNOSIS: COLON CANCER Date Wgt Name:
STAGE: Hgt (cm): _____ MRN:
Address:
REGIMEN:
Avastin
Wgt (kg): _____

No. of cycles; Length of Cycle: BSA:_______m2 DOB:


Q 3 weekly
Date: 07/12/2021
Gender: M / F

Bevacizumab 7.5mg/kg Cycle 7 Cycle 8 Cycle 9 Cycle 10 Cycle 11 Cycle 12


Day 1 Day 1 Day 1 Day 1 Day 1 Day 1
in 100mls NACL iv infusion Date
every three weeks,
(multiples of 12.5mg )
Dose change

Infusion rate: PRESCRIBED


st DOSE
1 dose over 90 mins
2nd dose over 60 mins
Subsequent doses over 30 mins
Dr’s signature
(to proceed)

Pharmacist

Dose admin.

Given by

Checked by
100% dose = (mg)

Signature: Date:
Protocol modifications as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/default.htm
Anti-emetic guidelines as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/SupportiveCare/default.htm

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