Is sequencing important when administering chemotherapy on the same day? —Kathy Kerley, RN, OCN

I think the best or correct order for drug administration is very difficult to answer. Administering chemotherapy apart from neutrophil growth factors is well known, and unless desired as a radiation sensitizer, avoid the use of chemotherapy during radiation. But the sequence of various chemotherapy drugs in general does not matter, as the half life of each drug will make it impossible to determine what drug is at what level at any particular time, based on individual patient pharmacodynamics.

However, there are certain principles one can follow. For example, when administering a taxane in combination with a platinum, the taxane should always be given first. This is because myelosuppression has been observed in patients who received the platinum before the taxane. In published reports on various chemotherapy regimens, the original research articles may state the order in which the agents were administered, but this is rare. So basically, do not worry about order of chemotherapy drugs. —Donald R. Fleming, MD