New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > BR Metastatic - capecitabine 1000, trastuzumab and tucatinib

BR Metastatic - capecitabine 1000, trastuzumab and tucatinib

Treatment Overview

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 - Loading Dose

Cycle length:
21

Cycle 2 (and all further cycles) - 21 days - Maintenance Dose

Cycle length:
21

trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle details

Cycle 1 - 21 days - Loading Dose

Medication Dose Route Days Max Duration
trastuzumab * 8 mg/kg intravenous 1 90 minutes
capecitabine * 1000 mg/m² Twice daily oral administration 1 to 14
tucatinib 300 mg Twice daily oral administration 1 to 21
loperamide 2 mg oral administration 1

Cycle 2 (and all further cycles) - 21 days - Maintenance Dose

Medication Dose Route Days Max Duration
trastuzumab * 6 mg/kg intravenous 1 90 minutes
capecitabine * 1000 mg/m² Twice daily oral administration 1 to 14
tucatinib 300 mg Twice daily oral administration 1 to 21
loperamide 2 mg oral administration 1

trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.

Full details

Cycle 1 - 21 days - Loading Dose

Day: 1

Medication Dose Route Max duration Details
trastuzumab * 8 mg/kg intravenous 90 minutes
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.
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
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 3

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 4

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 5

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 6

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 7

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 8

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 9

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 10

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 11

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 12

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 13

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 14

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 15

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 16

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 17

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 18

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 19

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 20

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 21

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Cycle 2 (and all further cycles) - 21 days - Maintenance Dose

Day: 1

Medication Dose Route Max duration Details
trastuzumab * 6 mg/kg intravenous 90 minutes
Instructions:

If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.
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
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 3

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 4

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 5

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 6

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 7

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 8

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 9

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 10

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 11

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 12

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 13

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 14

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 15

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 16

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 17

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 18

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 19

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 20

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Day: 21

Medication Dose Route Max duration Details
tucatinib 300 mg Twice daily oral administration
Instructions:

Swallow whole with a glass of water, do not crush, chew.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Minimal to low

Emetogenicity: MINIMAL to LOW—Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate.

References

Curigliano G, Mueller V, Borges V, Hamilton E, Hurvitz S, Loi S, Murthy R, Okines A, Paplomata E, Cameron D, Carey LA, Gelmon K, Hortobagyi GN, Krop I, Loibl S, Pegram M, Slamon D, Ramos J, Feng W, Winer E. Tucatinib versus placebo added to trastuzumab and capecitabine for patients with pretreated HER2+ metastatic breast cancer with and without brain metastases (HER2CLIMB): final overall survival analysis. Ann Oncol. 2022 Mar;33(3):321-329. doi: 10.1016/j.annonc.2021.12.005. Epub 2021 Dec 23. Erratum in: Ann Oncol. 2023., PMID: 34954044

Schaller, G., I. Fuchs, T. Gonsch, et al. 2007. "Phase II study of capecitabine plus trastuzumab in human epidermal growth factor receptor 2 overexpressing metastatic breast cancer pretreated with anthracyclines or taxanes." J Clin Oncol 25(22):3246-3250., PMID: 17577021

von Minckwitz, G., A. du Bois, M. Schmidt, et al. 2009. "Trastuzumab beyond progression in human epidermal growth factor receptor 2-positive advanced breast cancer: a german breast group 26/breast international group 03-05 study." J Clin Oncol 27(12):1999-2006., PMID: 19289619

Roche Products (New Zealand) Limited. Herceptin (trastuzumab) New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/h/Herceptininf.pdf (Accessed 16 February 2021).

AA-Med Pty Ltd. Tukysa® (tucatinib) Australian Product Information 13 August 2020. https://www.tga.gov.au/sites/default/files/auspar-tucatinib-210317-pi.pdf (Accessed 11/6/2024).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142. , PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14. , PMID: 29443651

* 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.