New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > BR Neoadjuvant/Adjuvant - FEC-D75 [fluorouracil, epirubicin and CYCLOPHOSPHamide followed by DOCEtaxel]

BR Neoadjuvant/Adjuvant - FEC-D75 [fluorouracil, epirubicin and CYCLOPHOSPHamide followed by DOCEtaxel]

Treatment Overview

This regimen consists of two parts: FEC [fluorouracil, epirubicin and CYCLOPHOSPHamide] followed by D75 [DOCEtaxel].

D75 [DOCEtaxel] 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.

Cycles 1 to 3 - 21 days - FEC [fluorouracil, epirubicin and CYCLOPHOSPHamide]

Cycle length:
21

Cycle 4 - 21 days - DOCEtaxel 75 mg/m2

Cycle length:
21

docetaxel:

  • This regimen commences with docetaxel at 75mg/m2 for the first dose, escalating to 100mg/m2 for subsequent cycles as tolerated.
  • 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 5 to 6 - 21 days - DOCEtaxel 100 mg/m2 [if tolerated]

Cycle length:
21

docetaxel:

  • This regimen commences with docetaxel at 75mg/m2 for the first dose, escalating to 100mg/m2 for subsequent cycles as tolerated.
  • 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 details

Cycles 1 to 3 - 21 days - FEC [fluorouracil, epirubicin and CYCLOPHOSPHamide]

Medication Dose Route Days Max Duration
olanzapine * 2.5 mg oral administration 1 to 4
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
ondansetron 8 mg oral administration 1
epirubicin 100 mg/m² intravenous 1 15 minutes
fluorouracil * 500 mg/m² intravenous 1 15 minutes
CYCLOPHOSPHamide 500 mg/m² intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
cyclIZINE 50 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Cycle 4 - 21 days - DOCEtaxel 75 mg/m2

Medication Dose Route Days Max Duration
dexamethasone * 8 mg Twice daily oral administration 0, 1, 2
DOCEtaxel 75 mg/m² intravenous 1 60 minutes
pegFILGRASTIM 6 mg subcutaneous injection 2
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

docetaxel:

  • This regimen commences with docetaxel at 75mg/m2 for the first dose, escalating to 100mg/m2 for subsequent cycles as tolerated.
  • 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 5 to 6 - 21 days - DOCEtaxel 100 mg/m2 [if tolerated]

Medication Dose Route Days Max Duration
dexamethasone * 8 mg Twice daily oral administration 0, 1, 2
DOCEtaxel 100 mg/m² intravenous 1 60 minutes
pegFILGRASTIM 6 mg subcutaneous injection 2
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

docetaxel:

  • This regimen commences with docetaxel at 75mg/m2 for the first dose, escalating to 100mg/m2 for subsequent cycles as tolerated.
  • 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.

Full details

Cycles 1 to 3 - 21 days - FEC [fluorouracil, epirubicin and CYCLOPHOSPHamide]

Day: 1

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
epirubicin 100 mg/m² intravenous 15 minutes
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
fluorouracil * 500 mg/m² intravenous 15 minutes
CYCLOPHOSPHamide 500 mg/m² intravenous 60 minutes
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy OR before bed.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.
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
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.

Cycle 4 - 21 days - DOCEtaxel 75 mg/m2

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:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set.
  • 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.
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.
pegFILGRASTIM 6 mg subcutaneous injection

Cycles 5 to 6 - 21 days - DOCEtaxel 100 mg/m2 [if tolerated]

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:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set.
  • 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.
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.
pegFILGRASTIM 6 mg subcutaneous injection

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Variable
Growth factor support: Variable
Hypersensitivity / Infusion related reaction risk: Variable

Emetogenicity:

  • HIGH cycles 1 to 3.
  • LOW cycles 4 to 6.

Growth factor support: Recommended for primary prophylaxis cycles 4 to 6.


Hypersensitivity / Infusion related reaction risk: HIGH – routine premedication recommended cycles 4 to 6.

References

Roche, H., P. Fumoleau, M. Spielmann, et al. 2006. "Sequential adjuvant epirubicin-based and docetaxel chemotherapy for node-positive breast cancer patients: the FNCLCC PACS 01 Trial." J Clin Oncol 24(36):5664-5671., PMID: 17116941

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)

Chouhan JD, Herrington JD. Single premedication dose of dexamethasone 20 mg IV before docetaxel administration. J Oncol Pharm Pract. 2011 Sep;17(3):155-9. doi: 10.1177/1078155210367950. Epub 2010 May 6., PMID: 20447949

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.

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

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., 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., 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.