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Systemic Anti-Cancer Therapy Regimen Library

Home > HSCT Autologous conditioning - CE [cARBOplatin and etoposide] [Part TWO of TICE for Metastatic germ cell tumour]

HSCT Autologous conditioning - CE [cARBOplatin and etoposide] [Part TWO of TICE for Metastatic germ cell tumour]

Treatment Overview

This regimen is Part TWO of TICE.

For Part ONE, see GU GCT Metastatic - TI [PACLItaxel and IFOSFamide] [Part ONE of TICE]


TICE consists of TWO parts (see also Additional details for Treatment Schema):

  • Part ONE: 2 cycles of TI [PACLItaxel and IFOSFamide], followed by
  • Part TWO: 3 cycles of CE [cARBOplatin and etoposide] conditioning with autologous stem cell transplant (below).

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 3 - 21 days

Cycle length:
21

Hydration is recommended as per institutional practice and may need an individualised approach.


cARBOplatin:

  • Directly measured GFR (mL/minute) is the preferred kidney function value in the Calvert formula. Measured GFR is the direct measurement of the clearance of an exogenous marker such as a radioisotope tracer. 
  • Consider commencing cARBOplatin at a dose of 7 AUC for heavily pre-treated patients e.g. patients who have received 7 or more cycles of cISplatin.
  • Do NOT cap doses.

Cycle details

Cycles 1 to 3 - 21 days

Medication / Procedure Dose Route Days Max Duration
cARBOplatin * 8 AUC (area under the curve) Once daily intravenous -4, -3, -2 60 minutes
etoposide (as phosphate) * 400 mg/m² Once daily intravenous -4, -3, -2 60 minutes
paracetamol * 1000 mg flat dosing oral administration 0
proMETHazine * 12.5 mg intravenous 0 1 minutes
Autologous stem cell transplant intravenous 0
pegFILGRASTIM 6 mg subcutaneous injection 1

Hydration is recommended as per institutional practice and may need an individualised approach.


cARBOplatin:

  • Directly measured GFR (mL/minute) is the preferred kidney function value in the Calvert formula. Measured GFR is the direct measurement of the clearance of an exogenous marker such as a radioisotope tracer. 
  • Consider commencing cARBOplatin at a dose of 7 AUC for heavily pre-treated patients e.g. patients who have received 7 or more cycles of cISplatin.
  • Do NOT cap doses.

Full details

Cycles 1 to 3 - 21 days

Day: -4

Medication Dose Route Max duration Details
cARBOplatin * 8 AUC (area under the curve) Once daily intravenous 60 minutes
Instructions:
  • Directly measured GFR (mL/minute) is the preferred kidney function value in the Calvert formula.
  • Consider commencing cARBOplatin at a dose of 7 AUC for heavily pre-treated patients e.g. patients who have received 7 or more cycles of cISplatin.
  • Do NOT cap doses.
  • Hypersensitivity risk increases with number of cycles of cARBOplatin.
Additional details:
etoposide (as phosphate) * 400 mg/m² Once daily intravenous 60 minutes Additional details:

Day: -3

Medication Dose Route Max duration Details
cARBOplatin * 8 AUC (area under the curve) Once daily intravenous 60 minutes
Instructions:
  • Directly measured GFR (mL/minute) is the preferred kidney function value in the Calvert formula.
  • Consider commencing cARBOplatin at a dose of 7 AUC for heavily pre-treated patients e.g. patients who have received 7 or more cycles of cISplatin.
  • Do NOT cap doses.
  • Hypersensitivity risk increases with number of cycles of cARBOplatin.
Additional details:
etoposide (as phosphate) * 400 mg/m² Once daily intravenous 60 minutes Additional details:

Day: -2

Medication Dose Route Max duration Details
cARBOplatin * 8 AUC (area under the curve) Once daily intravenous 60 minutes
Instructions:
  • Directly measured GFR (mL/minute) is the preferred kidney function value in the Calvert formula.
  • Consider commencing cARBOplatin at a dose of 7 AUC for heavily pre-treated patients e.g. patients who have received 7 or more cycles of cISplatin.
  • Do NOT cap doses.
  • Hypersensitivity risk increases with number of cycles of cARBOplatin.
Additional details:
etoposide (as phosphate) * 400 mg/m² Once daily intravenous 60 minutes Additional details:

Day: 0

Medication / Procedure Dose Route Max duration Details
paracetamol * 1000 mg flat dosing oral administration
Instructions:

ONE hour prior to return of autologous stem cells, or as per institutional practice.
proMETHazine * 12.5 mg intravenous 1 minutes
Instructions:

ONE hour prior to return of autologous stem cells, or as per institutional practice.
Autologous stem cell transplant intravenous
Instructions:

Administer as per institutional practice.

Day: 1

Medication Dose Route Max duration Details
pegFILGRASTIM 6 mg subcutaneous injection

Additional details

Section 1: Treatment Schema

Section 2: Dosing for bodyweight

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for hepatitis B virus: Required for anti–HBc positive patients at risk of reactivation
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
Emetogenicity: High
Gastroprotection: Gastroprotection may be considered
Growth factor support: Recommended for primary prophylaxis
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Irradiated blood components: Irradiation of blood components is recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Sinusoidal obstruction syndrome prophylaxis: Sinsuoidal obstruction prophylaxis may be considered
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis may be considered

References

Wood L, Kollmannsberger C, Jewett M et al. 2010 "Canadian consensus guidelines for the management of testicular germ cell cancer". Can Urol Assoc J. 2010 Apr;4(2):e19-38., PMID: 20368885

Einhorn LH, Williams SD, Chamness A et al. 2007 " High-dose chemotherapy and stem-cell rescue for metastatic germ-cell tumors". N Engl J Med. Jul 26;357(4):340-8., PMID: 17652649

Agarwal R, Dvorak CC, Stockerl-Goldstein KE et al. 2009. High-dose chemotherapy followed by stem cell rescue for high-risk germ cell tumors: the Stanford experience. Bone Marrow Transplant. 2009 Apr;43(7):547-52., PMID: 18997833

Lorch A, Bascoul-Mollevi C, Kramar A et al. 2011 Conventional-dose versus high-dose chemotherapy as first salvage treatment in male patients with metastatic germ cell tumors: evidence from a large international database. J Clin Oncol. Jun 1;29(16):2178-84., PMID: 21444870

Pico JL, Rosti G, Kramar A et al. 2005 A randomised trial of high-dose chemotherapy in the salvage treatment of patients failing first-line platinum chemotherapy for advanced germ cell tumours.Ann Oncol. 2005 Jul;16(7):1152-9., PMID: 15928070

Beyer, J., S. Stenning, A. Gerl, et al. 2002. "High-dose versus conventional-dose chemotherapy as first-salvage treatment in patients with non-seminomatous germ-cell tumors: a matched-pair analysis." Ann Oncol 13(4):599-605., PMID: 12056711

Lorch A, Kollmannsberger C, Hartmann JT et al. 2007 " Single versus sequential high-dose chemotherapy in patients with relapsed or refractory germ cell tumors: a prospective randomized multicenter trial of the German Testicular Cancer Study Group ". J Clin Oncol. Jul 1;25(19):2778-84., PMID: 17602082

Kondagunta GV, Bacik J, Sheinfeld J et al. 2007 "Paclitaxel plus Ifosfamide followed by high-dose carboplatin plus etoposide in previously treated germ cell tumors". J Clin Oncol. Jan 1;25(1):85-90., PMID: 17194908

Feldman, D. R., J. Sheinfeld, D. F. Bajorin, et al. 2010. "TI-CE high-dose chemotherapy for patients with previously treated germ cell tumors: results and prognostic factor analysis." J Clin Oncol 28(10):1706-1713., PMID: 20194867

Bubalo J, Carpenter PA, et al; American Society for Blood and Marrow Transplantation practice guideline committee. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant. 2014 May;20(5):600-16. doi: 10.1016/j.bbmt.2014.01.019. Epub 2014 Jan 23., PMID: 24462742

New Zealand Blood Service Transfusion Medicine Handbook Third Edition, 2016.

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.