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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN CX Advanced - cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab

GYN CX Advanced - cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab

Treatment Overview

Usually up to 6 cycles of cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab. Patients with ongoing clinical benefit may continue cARBOplatin and PACLItaxel beyond 6 cycles at clinician discretion.

BeVACizumab and pembrolizumab may continue until disease progression or unacceptable toxicity (up to 2 years for pembrolizumab).


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 6 - 21 days - cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab

Cycle length:
21

Cycle 7 (and all further cycles) - 21 days - beVACizumab and pembrolizumab continuation

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days - cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab

Medication Dose Route Days Max Duration
dexamethasone * 20 mg oral administration 0
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
dexamethasone * 8 mg oral administration 2, 3
ondansetron 8 mg oral administration 1
loratadine * 10 mg oral administration 1
famotidine * 20 mg oral administration 1
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
beVACizumab * 15 mg/kg intravenous 1 90 minutes
PACLItaxel * 175 mg/m² intravenous 1 3 hours
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

Cycle 7 (and all further cycles) - 21 days - beVACizumab and pembrolizumab continuation

Medication Dose Route Days Max Duration
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
beVACizumab 15 mg/kg intravenous 1 90 minutes

Full details

Cycles 1 to 6 - 21 days - cARBOplatin, PACLItaxel, beVACizumab and pembrolizumab

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg oral administration
Instructions:

Take the night prior to PACLItaxel infusion with food.

If the initial infusion(s) of PACLItaxel are well tolerated, clinicians may decide at their discretion, to omit this dose.

Day: 1

Medication Dose Route Max duration Details
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.
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.
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.
beVACizumab * 15 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.
PACLItaxel * 175 mg/m² intravenous 3 hours
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.

Cycle 7 (and all further cycles) - 21 days - beVACizumab and pembrolizumab continuation

Day: 1

Medication Dose Route Max duration Details
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.
beVACizumab 15 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hypersensitivity / Infusion related reaction risk: Variable

Emetogenicity:

  • HIGH (cARBOplatin AUC≥4) cycles 1 to 6.
  • MINIMAL cycle 7 onwards.

Hypersensitivity/Infusion related reaction risk:

  • HIGH—Routine premedication recommended cycles 1 to 6.
  • LOW—Routine premedication not recommended cycle 7 onwards.

References

Tewari, K. S., M. W. Sill, H. J. Long, 3rd, et al. 2014. "Improved survival with bevacizumab in advanced cervical cancer." N Engl J Med 370(8):734-743., PMID: 24552320

Kitagawa, R., N. Katsumata, T. Shibata, et al. 2015. "Paclitaxel Plus Carboplatin Versus Paclitaxel Plus Cisplatin in Metastatic or Recurrent Cervical Cancer: The Open-Label Randomized Phase III Trial JCOG0505." J Clin Oncol 33(19):2129-2135., PMID: 25732161

Tewari, K. S., M. W. Sill, R. T. Penson, et al. 2017. "Bevacizumab for advanced cervical cancer: final overall survival and adverse event analysis of a randomised, controlled, open-label, phase 3 trial (Gynecologic Oncology Group 240)." Lancet., PMID: 28756902

Roche Products (New Zealand) Limited. Avastin New Zealand Data Sheet. 15 January 2021 https://www.medsafe.govt.nz/profs/datasheet/a/Avastininf.pdf (Accessed 14 October 2021).

Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020).

Colombo N, Dubot C, Lorusso D, Caceres MV, Hasegawa K, Shapira-Frommer R, Tewari KS, Salman P, Hoyos Usta E, Yañez E, Gümüş M, Olivera Hurtado de Mendoza M, Samouëlian V, Castonguay V, Arkhipov A, Toker S, Li K, Keefe SM, Monk BJ; KEYNOTE-826 Investigators. Pembrolizumab for Persistent, Recurrent, or Metastatic Cervical Cancer. N Engl J Med. 2021 Nov 11;385(20):1856-1867. doi: 10.1056/NEJMoa2112435. Epub 2021 Sep 18., PMID: 34534429

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).

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. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14. , PMID: 29443651

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. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

* 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.