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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN OV Recurrent - cARBOplatin, gemcitabine and beVACizumab

GYN OV Recurrent - cARBOplatin, gemcitabine and beVACizumab

Treatment Overview

Usually up to 6 cycles of cARBOplatin, gemcitabine and beVACizumab.

beVACizumab 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.

Cycles 1 to 6 - 21 days - cARBOplatin, gemcitabine and beVACizumab

Cycle length:
21

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

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days - cARBOplatin, gemcitabine and beVACizumab

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1, 2, 3
ondansetron 8 mg oral administration 1, 8
beVACizumab * 15 mg/kg intravenous 1 30 minutes
gemcitabine 1000 mg/m² intravenous 1, 8 30 minutes
cARBOplatin * 4 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 continuation

Medication Dose Route Days Max Duration
beVACizumab * 15 mg/kg intravenous 1 30 minutes

Full details

Cycles 1 to 6 - 21 days - cARBOplatin, gemcitabine and beVACizumab

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
beVACizumab * 15 mg/kg intravenous 30 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.
  • Initial dose may be administered over 30 minutes; if the previous dose is well tolerated, subsequent doses may also be administered over 30 minutes, or as per institutional practice.
gemcitabine 1000 mg/m² intravenous 30 minutes
cARBOplatin * 4 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
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

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

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • This dose may be reduced or omitted 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.
gemcitabine 1000 mg/m² intravenous 30 minutes

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

Day: 1

Medication Dose Route Max duration Details
beVACizumab * 15 mg/kg intravenous 30 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.
  • Initial dose may be administered over 30 minutes; if the previous dose is well tolerated, subsequent doses may also be administered over 30 minutes, or as per institutional practice.

Supportive Care Factors

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

Emetogenicity:

  • MEDIUM day 1; LOW day 8 cycles 1 to 6.
  • MINIMAL cycles 7 onwards.

References

Pfisterer, J., M. Plante, I. Vergote, et al. 2006. "Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG." J Clin Oncol 24(29):4699-4707., PMID: 16966687

Aghajanian, C., S. V. Blank, B. A. Goff, et al. 2012. "OCEANS: a randomized, double-blind, placebo-controlled phase III trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent epithelial ovarian, primary peritoneal, or fallopian tube cancer." J Clin Oncol 30(17):2039-2045., PMID: 22529265

Aghajanian, C., B. Goff, L. R. Nycum, et al. 2015. "Final overall survival and safety analysis of OCEANS, a phase 3 trial of chemotherapy with or without bevacizumab in patients with platinum-sensitive recurrent ovarian cancer." Gynecol Oncol 139(1):10-16., PMID: 26271155

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).

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.