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Systemic Anti-Cancer Therapy Regimen Library

Home > CRC ACA Advanced - cARBOplatin and PACLItaxel

CRC ACA Advanced - cARBOplatin and PACLItaxel

Treatment Overview

Cycle 1 - 28 days

Cycle length:
28

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 - 28 days

Cycle length:
28

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

Cycles 3 to 6 - 28 days

Cycle length:
28

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 - 28 days

Medication Dose Route Days Max Duration
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, 15
loratadine * 10 mg oral administration 1, 8, 15
famotidine * 20 mg oral administration 1, 8, 15
dexamethasone * 4 mg oral administration 8
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
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 - 28 days

Medication Dose Route Days Max Duration
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, 8, 15
loratadine * 10 mg oral administration 1
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
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.

Cycles 3 to 6 - 28 days

Medication Dose Route Days Max Duration
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, 8, 15
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
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 - 28 days

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.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLitaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
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.
cARBOplatin * 5 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
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

Day: 8

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

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLitaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
dexamethasone * 4 mg oral administration
Instructions:

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

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLitaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
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 - 28 days

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.
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.
cARBOplatin * 5 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
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

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.

Cycles 3 to 6 - 28 days

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.
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.
cARBOplatin * 5 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
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

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: Variable
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

Emetogenicity: HIGH (cARBOplatin AUC≥4) day 1; LOW days 8 and 15.

References

Rao, S., F. Sclafani, C. Eng, et al. 2020. "International Rare Cancers Initiative Multicenter Randomized Phase II Trial of Cisplatin and Fluorouracil Versus Carboplatin and Paclitaxel in Advanced Anal Cancer: InterAAct." J Clin Oncol 38(22):2510-2518., PMID: 32530769

Abbas, A., E. Nehme and M. Fakih. 2011. "Single-agent paclitaxel in advanced anal cancer after failure of cisplatin and 5-fluorouracil chemotherapy." Anticancer Res 31(12):4637-4640., PMID: 22199342

Kim, R., J. Byer, W. J. Fulp, et al. 2014. "Carboplatin and Paclitaxel Treatment Is Effective in Advanced Anal Cancer." Oncology 87(2):125-132., PMID: 25012155

Eng, C., J. Rogers, G.J Chang, et al. 2012. "Choice of chemotherapy in the treatment of metastatic squamous cell carcinoma of the anal canal." J Clin Oncol 30(15_suppl):4060-4060.

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.