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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN END Advanced - cARBOplatin, PACLItaxel and trastuzumab

GYN END Advanced - cARBOplatin, PACLItaxel and trastuzumab

Treatment Overview

Usually up to 6 cycles of cARBOplatin, PACLItaxel and trastuzumab.

trastuzumab may continue until disease progression or unacceptable toxicity.  


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.

Cycle 1 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Loading Dose

Cycle length:
21

cARBOplatin: Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.

Cycles 2 to 6 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Maintenance Dose

Cycle length:
21

cARBOplatin: Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.


trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle 7 (and all further cycles) - 21 days - trastuzumab Continuation

Cycle length:
21

trastuzumab: If the initial loading dose of well tolerated, subsequent doses may be administered over 30 minutes.

Cycle details

Cycle 1 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Loading Dose

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
trastuzumab * 8 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

cARBOplatin: Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.

Cycles 2 to 6 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Maintenance Dose

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
trastuzumab * 6 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

cARBOplatin: Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.


trastuzumab: If the initial loading dose is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle 7 (and all further cycles) - 21 days - trastuzumab Continuation

Medication Dose Route Days Max Duration
trastuzumab * 6 mg/kg intravenous 1 90 minutes

trastuzumab: If the initial loading dose of well tolerated, subsequent doses may be administered over 30 minutes.

Full details

Cycle 1 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Loading Dose

Day: 0

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

Take the night prior to PACLItaxel infusion with food.

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.
trastuzumab * 8 mg/kg intravenous 90 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.
  • Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.
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.

Cycles 2 to 6 - 21 days - cARBOplatin, PACLItaxel and trastuzumab Maintenance Dose

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.
trastuzumab * 6 mg/kg intravenous 90 minutes
Instructions:

If the initial loading dose is well tolerated, 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.
  • Consider escalating to, or commencing cARBOplatin at a dose of 6 AUC in patients with good performance status.
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 - trastuzumab Continuation

Day: 1

Medication Dose Route Max duration Details
trastuzumab * 6 mg/kg intravenous 90 minutes
Instructions:

If the initial loading dose is well tolerated, 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

Fader AN, Roque DM, Siegel E, et al., Randomized Phase II Trial of Carboplatin-Paclitaxel Versus Carboplatin-Paclitaxel-Trastuzumab in Uterine Serous Carcinomas That Overexpress Human Epidermal Growth Factor Receptor 2/neu. J Clin Oncol. 2018 Jul 10;36(20):2044-2051. doi: 10.1200/JCO.2017.76.5966. Epub 2018 Mar 27., PMID: 29584549

Sandoz New Zealand Limited. Paclitaxel Ebewe New Zealand Data Sheet 27 November 2023. https://www.medsafe.govt.nz/profs/datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 29 April 2024).

Clinical & Regulatory Services Limited. Herzuma® New Zealand Data Sheet 12 December 2023. https://www.medsafe.govt.nz/profs/datasheet/h/herzumainf.pdf (Accessed 24 September 2024).

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

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

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.