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Systemic Anti-Cancer Therapy Regimen Library

Home > HN NPC NON-Metastatic - cISplatin [Q3W] chemoradiation followed by cISplatin and fluorouracil

HN NPC NON-Metastatic - cISplatin [Q3W] chemoradiation followed by cISplatin and fluorouracil

Treatment Overview

This regimen consists of two parts: cISplatin [Q3W] chemoradiation followed by cISplatin and fluorouracil.

Commence cISplatin [Q3W] chemoradiation in relation to radiation therapy as per institutional policy.

Commence cISplatin and fluorouracil 3-4 weeks after completion of cISplatin [Q3W] chemoradiation as per institutional policy.

Cycles 1 to 3 - 21 days - cISplatin [Q3W] chemoradiation

Cycle length:
21

Commence regimen in relation to radiation therapy as per institutional policy.


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH.

Growth factor support: Growth factor prophylaxis not recommended.

Hydration: Routine hydration recommended.

Cycles 4 to 6 - 28 days - cISplatin and fluorouracil

Cycle length:
28

Commence 3-4 weeks after completion of cISplatin [Q3W] chemoradiation as per institutional policy.


Cycle specific Supportive Care Factors:

Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.

Emetogenicity: HIGH.

Hydration: Routine hydration recommended.

Cycle details

Cycles 1 to 3 - 21 days - cISplatin [Q3W] chemoradiation

Medication Dose Route Days Max Duration
olanzapine * 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
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
mannitol 10 % intravenous 1 30 minutes
cISplatin 100 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
cycliZINE 50 mg Three times daily oral administration 1

Commence regimen in relation to radiation therapy as per institutional policy.


Cycle specific Supportive Care Factors:

Emetogenicity: HIGH.

Growth factor support: Growth factor prophylaxis not recommended.

Hydration: Routine hydration recommended.

Cycles 4 to 6 - 28 days - cISplatin and fluorouracil

Medication Dose Route Days Max Duration
olanzapine * 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
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin 80 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
fluorouracil * 4000 mg/m² intravenous 1 96 hours Min: 96 hours
ondansetron 8 mg oral administration 1
cycliZINE 50 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Commence 3-4 weeks after completion of cISplatin [Q3W] chemoradiation as per institutional policy.


Cycle specific Supportive Care Factors:

Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.

Emetogenicity: HIGH.

Hydration: Routine hydration recommended.

Full details

Cycles 1 to 3 - 21 days - cISplatin [Q3W] chemoradiation

Day: 1

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONE hour prior to chemotherapy. 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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
mannitol 10 % intravenous 30 minutes
Quantity:400 mL
Instructions:
After magnesium infusion, prior to cISplatin infusion.
cISplatin 100 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.
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 * 5 mg oral administration
Instructions:
ONCE daily. 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.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. 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.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. 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.

Cycles 4 to 6 - 28 days - cISplatin and fluorouracil

Day: 1

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONE hour prior to chemotherapy. 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.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin 80 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.
fluorouracil * 4000 mg/m² intravenous 96 hours Min: 96 hours
Instructions:
Continuous infusion via pump over 96 hours (equivalent to 1000mg/m²/day).
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.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. 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.

Day: 3

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. 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.

Day: 4

Medication Dose Route Max duration Details
olanzapine * 5 mg oral administration
Instructions:
ONCE daily. 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.

Supportive Care Factors

Factor Value
Diarrhoea risk: Variable
Emetogenicity: High
Growth factor support: Variable
Hydration: Routine hydration recommended

References

Al-Sarraf, M., M. LeBlanc, P. G. Giri, et al. 1998. "Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099." J.Clin Oncol 16(4):1310-1317., PMID: 9552031

Wee, J., E. H. Tan, B. C. Tai, et al. 2005. "Randomized trial of radiotherapy versus concurrent chemoradiotherapy followed by adjuvant chemotherapy in patients with American Joint Committee on Cancer/International Union against cancer stage III and IV nasopharyngeal cancer of the endemic variety." J Clin Oncol 23(27):6730-6738., PMID: 16170180

Lee, A. W., S. Y. Tung, D. T. Chua, et al. 2010. "Randomized trial of radiotherapy plus concurrent-adjuvant chemotherapy vs radiotherapy alone for regionally advanced nasopharyngeal carcinoma." J Natl Cancer Inst 102(15):1188-1198., PMID: 20634482

Baujat, B., H. Audry, J. Bourhis, et al. 2006. "Chemotherapy in locally advanced nasopharyngeal carcinoma: an individual patient data meta-analysis of eight randomized trials and 1753 patients." Int.J.Radiat.Oncol Biol.Phys. 64(1):47-56., PMID: 16377415

Langendijk, J. A., C. R. Leemans, J. Buter, et al. 2004. "The additional value of chemotherapy to radiotherapy in locally advanced nasopharyngeal carcinoma: a meta-analysis of the published literature." J.Clin Oncol. 22(22):4604-4612., PMID: 15542811

Ouyang, P. Y., Xie, C. & Mao, Y. P. et al. 2013 "Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials." Ann Oncol 24(8):2136-46., PMID: 23613477

Staar S, Rudat V, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1161-71. , PMID: 11483325

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.