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Systemic Anti-Cancer Therapy Regimen Library

Home > HN SQCC Metastatic - cARBOplatin, PACLItaxel and pembrolizumab

HN SQCC Metastatic - cARBOplatin, PACLItaxel and pembrolizumab

Treatment Overview

Usually up to 6 cycles of cARBOplatin, PACLItaxel and pembrolizumab.

Pembrolizumab may continue for up to 2 years, or until disease progression or unacceptable toxicity.

Cycles 1 to 6 - 21 days - cARBOplatin, PACLItaxel and pembrolizumab

Cycle length:
21

Cycles 7 to 35 - 21 days - pembrolizumab Q3W [flat dosing]

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days - cARBOplatin, PACLItaxel and pembrolizumab

Medication Dose Route Days Max Duration
dexamethasone * 20 mg 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
pembrolizumab * 200 mg flat dosing intravenous 1 30 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

Cycles 7 to 35 - 21 days - pembrolizumab Q3W [flat dosing]

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

Full details

Cycles 1 to 6 - 21 days - cARBOplatin, PACLItaxel and pembrolizumab

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
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.
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.
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.
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 35 - 21 days - pembrolizumab Q3W [flat dosing]

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.

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hypersensitivity / Infusion related reaction risk: Variable

Emetogenicity:

  • cARBOplatin, PACLItaxel and pembrolizumab: HIGH (cARBOplatin AUC≥4).
  • pembrolizumab alone: MINIMAL.

Hypersensitivity/Infusion related reaction risk:

  • cARBOplatin, PACLItaxel and pembrolizumab: HIGH—Routine premedication recommended.
  • pembrolizumab alone: LOW—Routine premedication not recommended.

References

Dzienis M, Cundom J, Fuentes CS, et al. Pembrolizumab Plus Carboplatin and Paclitaxel as First-Line Therapy for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-B10): A Single-Arm Phase IV Trial. J Clin Oncol. 2024 Sep 1;42(25):2989-2999., PMID: 39038265

Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 28 June 2024. https://www.medsafe.govt.nz/profs/datasheet/k/Keytruda.pdf (Accessed 29 October 2024).

Sandoz New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 27 November 2023. https://www.medsafe.govt.nz/profs/datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 29 October 2024).

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.