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Systemic Anti-Cancer Therapy Regimen Library

Home > GYN GTD - TP-TE [PACLItaxel, cISplatin - PACLItaxel and etoposide] [relapsed or high risk]

GYN GTD - TP-TE [PACLItaxel, cISplatin - PACLItaxel and etoposide] [relapsed or high risk]

Treatment Overview

Continuous for 8 weeks beyond normal ß-hCG.


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 (and all further cycles) - 28 days

Cycle length:
28

Cycle details

Cycle 1 (and all further cycles) - 28 days

Medication Dose Route Days Max Duration
dexamethasone * 20 mg oral administration 0, 14, 15
olanzapine * 2.5 mg oral administration 1 to 4
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, 4
ondansetron 8 mg oral administration 1
loratadine * 10 mg oral administration 1, 15
PACLItaxel * 135 mg/m² intravenous 1, 15 3 hours
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 60 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
filgrastim 5 microgram/kg Once daily subcutaneous injection 7 to 10,
21 to 24
etoposide (as phosphate) * 150 mg/m² intravenous 15 60 minutes
cyclIZINE 50 mg Three times daily oral administration 1

Full details

Cycle 1 (and all further cycles) - 28 days

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
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
  • Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment.
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.

PACLItaxel * 135 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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 60 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.
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.
cyclIZINE 50 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

  • Warning: may cause drowsiness.
  • Consider starting dose at 25 mg and increasing as tolerated/required.
  • The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
  • Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
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
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
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: 4

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

  • This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.

Day: 7

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 8

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 9

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 10

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 14

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: 15

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

ONE hour prior to paclitaxel infusion with food.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

PACLItaxel * 135 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.
etoposide (as phosphate) * 150 mg/m² intravenous 60 minutes

Day: 21

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 22

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 23

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Day: 24

Medication Dose Route Max duration Details
filgrastim 5 microgram/kg Once daily subcutaneous injection
Instructions:
Round dose to nearest prefilled syringe dose of 300 micrograms or 480 micrograms.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Growth factor support: Recommended for primary prophylaxis
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

Emetogenicity: HIGH day 1; LOW day 15.

References

Wang J, Short D, Sebire NJ, Lindsay I, Newlands ES, Schmid P, Savage PM, Seckl MJ. Salvage chemotherapy of relapsed or high-risk gestational trophoblastic neoplasia (GTN) with paclitaxel/cisplatin alternating with paclitaxel/etoposide (TP/TE). Ann Oncol. 2008 Sep;19(9):1578-83. doi: 10.1093/annonc/mdn181. Epub 2008 May 2., PMID: 18453518

Seckl MJ, Sebire NJ, Fisher RA, Golfier F, Massuger L, Sessa C; ESMO Guidelines Working Group. Gestational trophoblastic disease: ESMO Clinical /Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013 Oct;24 Suppl 6:vi39-50. doi: 10.1093/annonc/mdt345. Epub 2013 Sep 1., PMID: 23999759

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).

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.