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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN CX Locally advanced - cISplatin [Q1W] chemoradiation and pembrolizumab

GYN CX Locally advanced - cISplatin [Q1W] chemoradiation and pembrolizumab

Treatment Overview

This regimen consists of:

  • pembrolizumab and weekly cisplatin with concurrent radiation therapy for 5 or 6 weeks (depending on duration of radiation therapy), then
  • pembrolizumab continuation for up to 2 years, or until disease progression or unacceptable toxicity.

Cycles 1 to 2 - 21 days - cISplatin Q1W and pembrolizumab Q3W

Cycle length:
21

cisplatin:

  • Some institutions may choose to cap cisplatin dose at 70 mg (flat dose).
  • Commence cisplatin in relation to radiotherapy as per institutional policy.
  • Continue weekly cisplatin with concurrent radiation therapy for 5 weeks (omit cisplatin dose day 15, cycle 2) or 6 weeks depending on duration of radiation therapy.

Cycles 3 to 5 - 21 days - pembrolizumab Q3W continuation

Cycle length:
21

Cycles 6 to 20 - 42 days - pembrolizumab Q6W continuation

Cycle length:
42

Cycle details

Cycles 1 to 2 - 21 days - cISplatin Q1W and pembrolizumab Q3W

Medication Dose Route Days Max Duration
aprepitant 125 mg oral administration 1, 8, 15
aprepitant 80 mg oral administration 2, 3, 9,
10, 16, 17
dexamethasone * 8 mg oral administration 1, 8, 15
dexamethasone * 4 mg oral administration 2, 3, 9,
10, 16, 17
ondansetron 8 mg oral administration 1, 8, 15
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1, 8, 15 60 minutes
cISplatin * 40 mg/m² intravenous 1, 8, 15 60 minutes
sodium chloride 0.9 % intravenous 1, 8, 15 60 minutes
ondansetron 8 mg oral administration 1, 8, 15
domperidone 10 mg Three times daily oral administration 1

cisplatin:

  • Some institutions may choose to cap cisplatin dose at 70 mg (flat dose).
  • Commence cisplatin in relation to radiotherapy as per institutional policy.
  • Continue weekly cisplatin with concurrent radiation therapy for 5 weeks (omit cisplatin dose day 15, cycle 2) or 6 weeks depending on duration of radiation therapy.

Cycles 3 to 5 - 21 days - pembrolizumab Q3W continuation

Medication Dose Route Days Max Duration
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes

Cycles 6 to 20 - 42 days - pembrolizumab Q6W continuation

Medication Dose Route Days Max Duration
pembrolizumab 400 mg flat dosing intravenous 1 30 minutes

Full details

Cycles 1 to 2 - 21 days - cISplatin Q1W and pembrolizumab Q3W

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.
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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
  • Some institutions may choose to cap dose at 70 mg (flat dose).
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
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 * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 3

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
dexamethasone * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 8

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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cisplatin.
  • Some institutions may choose to cap dose at 70 mg (flat dose).
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 9

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
dexamethasone * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 10

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
dexamethasone * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 15

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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 40 mg/m² intravenous 60 minutes
Instructions:

Omit this dose in cycle 2 (week 6) if radiotherapy complete, or as per institutional practice.

  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • Ensure patient has passed urine as per institutional policy.
  • Hypersensitivity risk increases with number of cycles of cISplatin.
  • Some institutions may choose to cap dose at 70 mg (flat dose).
sodium chloride 0.9 % intravenous 60 minutes
Quantity:1000 mL
Instructions:

After cisplatin infusion.

  • If cisplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
ondansetron 8 mg oral administration
Instructions:

EIGHT hours after chemotherapy OR before bed.

Day: 16

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
dexamethasone * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Day: 17

Medication Dose Route Max duration Details
aprepitant 80 mg oral administration
Instructions:

ONCE daily in the morning.
dexamethasone * 4 mg oral administration
Instructions:

Take in the morning with food.

  • This dose may be reduced or omitted at clinician’s discretion.

Cycles 3 to 5 - 21 days - pembrolizumab Q3W 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.

Cycles 6 to 20 - 42 days - pembrolizumab Q6W continuation

Day: 1

Medication Dose Route Max duration Details
pembrolizumab 400 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.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hydration: Variable
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

Emetogenicity:

  • cisplatin and pembrolizumab: HIGH.
  • pembrolizumab alone: MINIMAL.

Hydration: Routine hydration recommended with cisplatin.

References

Nierengarten MB. Overall survival benefit of pembrolizumab plus chemoradiotherapy for patients with high-risk locally advanced cervical cancer. Cancer. 2025 Jan 15;131(2):e35688., PMID: 39829085

Lorusso D, Xiang Y, Hasegawa K, et al; ENGOT-cx11/GOG-3047/KEYNOTE-A18 investigators. Pembrolizumab or placebo with chemoradiotherapy followed by pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): a randomised, double-blind, phase 3 clinical trial. Lancet. 2024 Apr 6;403(10434):1341-1350. doi: 10.1016/S0140-6736(24)00317-9. Epub 2024 Mar 20, PMID: 38521086

Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 11 August 2025. https://www.medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (Accessed 11 November 2025).

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://wwwuptodate.com (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.