Systemic Anti-Cancer Therapy Regimen Library
BR Adjuvant - TCH [DOCEtaxel, cARBOplatin and trastuzumab]
Treatment Overview
This regimen contains a biological anti-cancer medicine where one or more biosimilars may exist. These have been reviewed by the regulator (Medsafe) and by haematologists and/or oncologists nationally. Where haematologists and/or oncologists 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. If a prescriber thinks there is a difference, then a specific brand will be named when prescribing.
Cycle 1 - 21 days - Loading Dose
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.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Growth factor support: Recommended for primary prophylaxis.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Cycles 2 to 6 - 21 days - Maintenance Dose
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.
If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Growth factor support: Recommended for primary prophylaxis.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Cycles 7 to 17 - 21 days - Trastuzumab Q3W Continuation
If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.
Cycle specific Supportive Care Factors:
Emetogenicity: MINIMAL.
Cycle details
Cycle 1 - 21 days - Loading Dose
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration | 0 | |
| aprepitant | 125 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| DOCEtaxel * | 75 mg/m² | intravenous | 1 | 60 minutes |
| cARBOplatin * | 6 AUC (area under the curve) | intravenous | 1 | 60 minutes |
| trastuzumab | 8 mg/kg | intravenous | 1 | 90 minutes |
| ondansetron | 8 mg | oral administration | 1 | |
| pegFILGRASTIM | 6 mg | subcutaneous injection | 2 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 |
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.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Growth factor support: Recommended for primary prophylaxis.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Cycles 2 to 6 - 21 days - Maintenance Dose
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration | 0 | |
| aprepitant | 125 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| DOCEtaxel * | 75 mg/m² | intravenous | 1 | 60 minutes |
| cARBOplatin * | 6 AUC (area under the curve) | intravenous | 1 | 60 minutes |
| trastuzumab | 6 mg/kg | intravenous | 1 | 90 minutes |
| ondansetron | 8 mg | oral administration | 1 | |
| pegFILGRASTIM | 6 mg | subcutaneous injection | 2 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 |
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.
If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Growth factor support: Recommended for primary prophylaxis.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Cycles 7 to 17 - 21 days - Trastuzumab Q3W Continuation
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| trastuzumab | 6 mg/kg | intravenous | 1 | 90 minutes |
If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.
Cycle specific Supportive Care Factors:
Emetogenicity: MINIMAL.
Full details
Cycle 1 - 21 days - 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 |
|---|---|---|---|---|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| DOCEtaxel * | 75 mg/m² | intravenous | 60 minutes |
Instructions:
Prepare solution in PVC-free bag and administer via polyethylene lined administration set. Please carry out graded challenge as per institutional policy. |
| cARBOplatin * | 6 AUC (area under the curve) | intravenous | 60 minutes |
Instructions:
Hypersensitivity risk increases with number of cycles of cARBOplatin. |
| trastuzumab | 8 mg/kg | intravenous | 90 minutes | |
| 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. |
|
| 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 |
|---|---|---|---|---|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
|
| pegFILGRASTIM | 6 mg | subcutaneous injection |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Cycles 2 to 6 - 21 days - 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 |
|---|---|---|---|---|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| DOCEtaxel * | 75 mg/m² | intravenous | 60 minutes |
Instructions:
Prepare solution in PVC-free bag and administer via polyethylene lined administration set. Please carry out graded challenge as per institutional policy. |
| cARBOplatin * | 6 AUC (area under the curve) | intravenous | 60 minutes |
Instructions:
Hypersensitivity risk increases with number of cycles of cARBOplatin. |
| 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. |
| 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. |
|
| 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 |
|---|---|---|---|---|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
|
| pegFILGRASTIM | 6 mg | subcutaneous injection |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Cycles 7 to 17 - 21 days - Trastuzumab Q3W Continuation
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| 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. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Variable |
| Emetogenicity: | Variable |
| Growth factor support: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Variable |
References
2. Slamon D, Eirmann W, Robert N et al. 2006. "Phase III trial comparing AC-T with AC-TH and with TCH in the adjuvant treatment of HER2 positive early breast cancer patients: Second interim analysis (BCIRG006)" SABCS
3. Slamon, D., W. Eiermann, N. Robert, et al. 2015 "Ten year follow-up of BCIRG-006 comparing doxorubicin plus cyclophosphamide followed by docetaxel (AC-T) with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab (AC-TH) with docetaxel, carboplatin, and trastuzumab (TCH) in HER2-positive early breast cancer" San Antonio Breast Cancer Symposium. Abstract S5-04. Presented December 11, 2015
4. Pfizer New Zealand Limited. DBL Docetaxel New Zealand Data Sheet 07 August 2020. https://www.medsafe.govt.nz/profs/Datasheet/d/dbldocetaxelinj.pdf (Accessed 26 November 2020)
5. 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)
7. 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).
8. Rogers, E. S., E. Witton, J. Stewart, and D. Porter. "Efficacy and safety of a single dose of dexamethasone pre docetaxel treatment: The Auckland experience." Annals of Oncology 25 (2014): iv537.
* 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.