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Systemic Anti-Cancer Therapy Regimen Library

Home > BR Metastatic - cARBOplatin [2 AUC], gemcitabine and pembrolizumab

BR Metastatic - cARBOplatin [2 AUC], gemcitabine and pembrolizumab

Treatment Overview

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

Cycle 1 (and all further cycles) - 21 days

Cycle length:
21

Cycle details

Cycle 1 (and all further cycles) - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1, 2, 3,
8, 9, 10
ondansetron * 8 mg oral administration 1, 8
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
gemcitabine * 1000 mg/m² intravenous 1, 8 30 minutes
cARBOplatin * 2 AUC (area under the curve) intravenous 1, 8 60 minutes
ondansetron * 8 mg oral administration 1, 8
domperidone 10 mg Three times daily oral administration 1

Full details

Cycle 1 (and all further cycles) - 21 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
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.
gemcitabine * 1000 mg/m² intravenous 30 minutes
cARBOplatin * 2 AUC (area under the curve) intravenous 60 minutes
Instructions:

Hypersensitivity risk increases with number of cycles of carboplatin.
ondansetron * 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.
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: 2

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

ONCE daily in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 3

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

ONCE daily in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 8

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
gemcitabine * 1000 mg/m² intravenous 30 minutes
cARBOplatin * 2 AUC (area under the curve) intravenous 60 minutes
Instructions:

Hypersensitivity risk increases with number of cycles of carboplatin.
ondansetron * 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.

Day: 9

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

ONCE daily in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 10

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

ONCE daily in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Supportive Care Factors

Factor Value
Emetogenicity: Medium
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not 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

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

Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021)

* 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.