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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN OV Advanced - cARBOplatin, PACLItaxel and beVACizumab

GYN OV Advanced - cARBOplatin, PACLItaxel and beVACizumab

Treatment Overview

This regimen consists of three parts: 1 cycle of cARBOplatin and PACLItaxel, followed by 5 cycles of cARBOplatin, PACLItaxel and beVACizumab, followed by 13 cycles of beVACizumab.


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

Cycle length:
21

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


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH - cARBOplatin.

Hypersensitivity risk: HIGH – routine premedication recommended.

Cycles 2 to 6 - 21 days

Cycle length:
21

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


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH - cARBOplatin.

Hypersensitivity risk: HIGH – routine premedication recommended.

Cycles 7 to 19 - 21 days

Cycle length:
21

Cycle specific Supportive Care Factors:

Emetogenicity: MINIMAL.

Cycle details

Cycle 1 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 20 mg flat dosing 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
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.


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH - cARBOplatin.

Hypersensitivity risk: HIGH – routine premedication recommended.

Cycles 2 to 6 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 20 mg flat dosing 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
beVACizumab * 7.5 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.


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH - cARBOplatin.

Hypersensitivity risk: HIGH – routine premedication recommended.

Cycles 7 to 19 - 21 days

Medication Dose Route Days Max Duration
beVACizumab * 7.5 mg/kg intravenous 1 90 minutes

Cycle specific Supportive Care Factors:

Emetogenicity: MINIMAL.

Full details

Cycle 1 - 21 days

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg flat dosing 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.
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

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg flat dosing 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.
beVACizumab * 7.5 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.

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 7 to 19 - 21 days

Day: 1

Medication Dose Route Max duration Details
beVACizumab * 7.5 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

References

Perren, T. J., A. M. Swart, J. Pfisterer, et al. 2011. "A phase 3 trial of bevacizumab in ovarian cancer." N Engl J Med 365(26):2484-2496., PMID: 22204725

Pujade-Lauraine, E., A.M. Oza, T.J. Perren et al. 2013. "ICON7: Final Overall Survival Results In The GCIG Phase III Randomised Trial Of Bevacizumab In Newly Diagnosed Ovarian Cancer." International Journal of Gynecological Cancer, 23(8): 53-54.

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).

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).

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)

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

* 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.