Breast

• Any metastatic breast carcinoma with one or more of the following:
  • KPS < 60, ECOG >2
  • Ca++ > 11.2
  • Spinal cord compression with decreased ability to walk
  • C-reactive protein > 10 and albumin < 3.5
  • Peritoneal or leptomeningeal metastases
• Any metastatic breast carcinoma with three or more of the following:
  • KPS < 80, ECOG > 2
  • LDH > 500
  • Any liver metastasis
  • 2 different sites of metastasis
  • Disease free interval from presentation to metastases < 24 months
  • Recurrent or refractory disease after initial chemoRx
  • ER – , PR –
• Metastatic breast carcinoma and brain metastases with one or more of the following:
  • KPS < 80, ECOG > 2
  • 2 or more brain metastases plus extracranial metastases
  • ER -, PR –

Brain (Glioblastoma)

• with one or more of the following:
  • KPS < 70, ECOG > 2
  • Suboptimal resection or unresectable
  • Progressive or refractory despite initial treatment
• with two or more of the following:
  • KPS < 90, ECOG > 1
  • Age > 55
  • Recurrent disease after initial treatment
  • Lesion in critical hemispheric region
  • Tumor volume > 50cm3 before resection
  • Hgb < 12
  • Platelet count > upper limit of normal

Colorectal

• Metastatic colorectal carcinoma with one or more of the following:
  • KPS < 70, ECOG 2 or greater
  • Age > 75
  • Brain metastases with KPS < 80, age > 70
• Metastatic colorectal carcinoma with two or more of the following:
  • KPS < 90, ECOG 1 or greater
  • Peritoneal carcinomatosis
  • More than 2 metastatic sites
  • Malignant ascites
  • Refractory disease after chemoRx

Esophageal/Gastric

• Locally advanced or metastatic esophageal/gastric with one or more of the following:
  • KPS < 80, ECOG > 1
  • Recurrent or refractory disease with disease-free interval < 6 months
• Locally advanced or metastatic esophageal/gastric with two or more of the following:
  • KPS < 90, ECOG 1 or greater
  • Liver or peritoneal metastases
  • Alkaline phosphatase > 100
  • LDH > 200
  • Hgb < 11

Hepatobiliary/Pancreatic Carcinoma

• Locally advanced or metastatic biliary tract or pancreatic with one or more of the following:
  • KPS < 90, ECOG 1 or greater
  • Total bilirubin > 10
  • Recurrent or refractory after initial chemoRx
  • Liver, peritoneal, or distant metastases
  • Portal vein thrombosis
  • Albumin < 3.5
  • LDH > 500
  • Episode of DVT or PE
  • Malignant ascites
• Any hepatocellular carcinoma with one or more of the following:
  • KPS < 60, ECOG > 2
  • Tumor diameter > 10 cm
  • Any brain metastasis
• Unresectable locally advanced or metastatic hepatocellular carcinoma with two or more of the following:
  • KPS < 90, ECOG 1 or greater
  • Extrahepatic metastases
  • Symptomatic cirrhosis:
    • Jaundice
    • Ascites
    • Fatigue
    • bleeding
  • AFP > 400
  • Portal vein thrombosis

Head and Neck Squamous Cell

• Recurrent, refractory, or metastatic head and neck squamous cell carcinoma with one or more of the following:
  • KPS < 90, ECOG 1 or greater
  • Recurrence of disease with any metastasis
  • Greater than 10% weight loss
  • Muscle invasion or residual tumor at primary site
  • Pretreatment
  • Hgb < 11
  • Ca++ > 11.2

Thyroid

• Anaplastic thyroid cancer with one or more of the following:
  • Extracapsular extension or metastases
  • Unresectable disease or incomplete resection

Melanoma

• Advanced or metastatic melanoma with one or more of the following:
  • KPS < 80, ECOG 2 or greater
  • LDH x 2 upper limit of normal
  • Ca++ > 11.2
  • Metastases to brain or spine
  • Metastases to liver and one other site

NSCLC

• Any locally advanced or metastatic NSCLC with one or more of the following:
  • KPS < 70, ECOG > 2
  • Weight loss of 5% or albumin < 3
  • Liver metastases
  • Bone metastases
  • CNS metastases with symptoms, age > 65
  • Pericardial involvement
  • Pleural effusion with evidence of distant metastases
  • Hgb < 12
  • Ca > 11

(SCLC)

• Extensive Disease: median survival 6-12 months with Rx, 4 months without Rx

Female Genital

• Locally advanced or metastatic ovarian/endometrial/cervical with regional or distal spread and one or more of the following:
  • KPS < 60, ECOG > 2
  • Ca++ > 11.2
  • 2 or more brain metastases
  • Bowel obstruction without successful repair or urinary tract obstruction
  • Unresectable disease
• Locally advanced or metastatic ovarian/endometrial/cervical with regional or distal spread and two or more of the following:
  • KPS < 80, ECOG > 1
  • Recurrent or refractory disease
  • Disease-free interval < 6 months (diagnosis to recurrence)
  • Suboptimal resection with bulky residual disease
  • Weight loss > 5%
  • Extra-abdominal metastases

Male Genital

• Hormone-refractory metastatic prostate cancer with one or more of the following:
  • KPS < 60, ECOG > 2
  • Hgb < 10
  • Spinal cord compression with decreased ability to walk

Bladder and Renal Cell

• Locally advanced or metastatic bladder or renal cell cancer with one or more of the following:
  • KPS < 70, ECOG > 2
  • Greater than 2 brain metastases
  • Ca++ > 11.2
• Locally advanced or metastatic bladder or renal cell cancer with three or more of the following:
• KPS < 80, ECOG 2 or greater
• Hgb < 11.5
• LDH > 300
• Disease-free interval < 1 year
• Visceral metastases

Solid Cancers in general

• Any locally advanced or metastatic solid cancer with one or more of the following:
  • KPS < 60, ECOG > 2
  • Ca++ > 11.2
  • Episode of DVT or PE
  • Any brain metastasis with KPS < 70
  • More than 2 brain metastases and extracranial metastasis
  • Spinal cord compression with decreased ability to walk
  • Malignant pericardial effusion

Unknown Primary

• Any metastatic adenocarcinoma or undifferentiated carcinoma of unknown primary with one or more of the following:
  • KPS < 80, ECOG > 1
  • Hepatic, bone, or adrenal metastases
  • Recurrence of disease after chemoRx
  • Albumin < 3.5 or weight loss of > 10% in 6 months

Acute Leukemia

• Acute Lymphoblastic or myeloid leukemia with one or more of the following:
  • Age > 70
  • Extramedullary disease involving Central Nervous System
  • Refractory to 2 or more courses of chemoRx
  • Recurrence with disease-free interval of < 14 months
• Acute Lymphoblastic or myeloid leukemia with two or more of the following:
  • Age > 60
  • KPS < 80, ECOG 2 or greater
  • Central Nervous System involvement
  • Evidence of hemorrhage or infection
  • WBC > 25
  • LDH > 500

Chronic Leukemia

• Chronic myeloid leukemia in blast transformation with one or more of the following:
  • Age > 50 with predominant myeloid origin
  • Myeloid blast transformation with WBC > 50, plt < 100, or Hgb <10
  • Greater than 50% blasts in peripheral blood
• Chronic lymphocytic leukemia with one or more of the following:
  • Refractory to initial chemoRx
  • Recurrent disease after 2 or more courses of chemoRx

Lymphoma/Multiple Myeloma

• Non-Hodgkins lymphoma or multiple myeloma with one or more of the following:
  • Secondary extranodal or extramedullary involvement of CNS
  • Primary CNS lymphoma related to HIV
• Aggressive non-Hodgkins lymphoma or multiple myeloma that is refractory or recurrent after initial treatment – with 2 or more of the following:
  • KPS < 70, ECOG 2 or greater
  • Age > 65
  • LDH above normal
  • albumin < 3
  • multiple myeloma with plt < 80
  • multiple myeloma with serum creatinine 2 or greater