Systemic Anti-Cancer Therapy Regimen Library
DOCEtaxel and trastuzumab (BR Neoadjuvant - DOCEtaxel and trastuzumab followed by FEC [fluorouracil, epirubicin and CYCLOPHOSPHamide] followed by trastuzumab)
Treatment Overview
This regimen commences with DOCEtaxel at 75mg/m2 for the first dose, escalating to 100mg/m2 for subsequent cycles as tolerated.
This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.
Cycle 1 - 21 days - DOCEtaxel 75mg/m2 and trastuzumab Loading Dose
dexamethasone: Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
Cycles 2 to 3 - 21 days - DOCEtaxel 100mg/m2 and trastuzumab Maintenance Dose
dexamethasone: Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
DOCEtaxel: Escalate dose to 100 mg/m2 (as above) if tolerated.
trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.
Cycle details
Cycle 1 - 21 days - DOCEtaxel 75mg/m2 and trastuzumab Loading Dose
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration | 0, 1, 2 | |
| DOCEtaxel * | 75 mg/m² | intravenous | 1 | 60 minutes |
| trastuzumab | 8 mg/kg | intravenous | 1 | 90 minutes |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 |
dexamethasone: Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
Cycles 2 to 3 - 21 days - DOCEtaxel 100mg/m2 and trastuzumab Maintenance Dose
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration | 0, 1, 2 | |
| DOCEtaxel * | 100 mg/m² | intravenous | 1 | 60 minutes |
| trastuzumab | 6 mg/kg | intravenous | 1 | 90 minutes |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 |
dexamethasone: Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
DOCEtaxel: Escalate dose to 100 mg/m2 (as above) if tolerated.
trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.
Full details
Cycle 1 - 21 days - DOCEtaxel 75mg/m2 and trastuzumab Loading Dose
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
|
| DOCEtaxel * | 75 mg/m² | intravenous | 60 minutes |
Instructions:
|
| trastuzumab | 8 mg/kg | intravenous | 90 minutes | |
| domperidone | 10 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting.
|
|
| loperamide | 2 mg | oral administration |
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
Cycles 2 to 3 - 21 days - DOCEtaxel 100mg/m2 and trastuzumab Maintenance Dose
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
|
| DOCEtaxel * | 100 mg/m² | intravenous | 60 minutes |
Instructions:
|
| trastuzumab | 6 mg/kg | intravenous | 90 minutes |
Instructions:
If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes. |
| domperidone | 10 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting.
|
|
| loperamide | 2 mg | oral administration |
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Anti-diarrhoeals are usually prescribed with this treatment |
| Emetogenicity: | Low |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
References
Roche Products (New Zealand) Limited. Herceptin (trastuzumab) New Zealand Data Sheet 19 March 2021. https://www.medsafe.govt.nz/profs/Datasheet/h/Herceptininf.pdf (Accessed 20 May 2024).
Pfizer New Zealand Limited. DBL DOCEtaxel New Zealand Data Sheet 5 February 2024. https://www.medsafe.govt.nz/profs/Datasheet/d/dblDOCEtaxelinj.pdf (Accessed 20 May 2024).
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.