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Systemic Anti-Cancer Therapy Regimen Library

Home > BR Metastatic - PACLItaxel Q1W and pembrolizumab Q3W

BR Metastatic - PACLItaxel Q1W and pembrolizumab Q3W

Treatment Overview

Continue until disease progression or unacceptable toxicity (up to 2 years for pembrolizumab).

Cycle 1 - 21 days - tapering hypersensitivity pre-medications

Cycle length:
21

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle 2 (and all further cycles) - 21 days - no hypersensitivity pre-medications

Cycle length:
21

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle details

Cycle 1 - 21 days - tapering hypersensitivity pre-medications

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1
dexamethasone * 4 mg oral administration 8
loratadine * 10 mg oral administration 1, 8, 15
ondansetron * 8 mg oral administration 15
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
domperidone 10 mg Three times daily oral administration 1

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Cycle 2 (and all further cycles) - 21 days - no hypersensitivity pre-medications

Medication Dose Route Days Max Duration
ondansetron * 8 mg oral administration 1, 8, 15
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
domperidone 10 mg Three times daily oral administration 1

paclitaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly paclitaxel.

Full details

Cycle 1 - 21 days - tapering hypersensitivity pre-medications

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

pembrolizumab 200 mg flat dosing intravenous 30 minutes
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 4 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.

Day: 15

Medication Dose Route Max duration Details
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.

Cycle 2 (and all further cycles) - 21 days - no hypersensitivity pre-medications

Day: 1

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
pembrolizumab 200 mg flat dosing intravenous 30 minutes
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 8

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.

Day: 15

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

  • Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.

Supportive Care Factors

Factor Value
Emetogenicity: Low
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

References

Cortes J, Rugo HS, Cescon DW, et al; KEYNOTE-355 Investigators. Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. N Engl J Med. 2022 Jul 21;387(3):217-226. doi: 10.1056/NEJMoa2202809. , PMID: 35857659

Sandoz New Zealand Limited. Paclitaxel Ebewe New Zealand Data Sheet 27 November 2025. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 27 May 2025).

Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 29 April 2025. https://www.medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (Accessed 27 May 2025).

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641. , PMID: 25089112

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.