Systemic Anti-Cancer Therapy Regimen Library
HN NPC NON-Metastatic - gemcitabine and cISplatin followed by cISplatin chemoradiation
Treatment Overview
This regimen consists of two parts: gemcitabine and cISplatin followed by cISplatin chemoradiation.
Commence cISplatin chemoradiation 3–4 weeks after the first day of the last cycle of gemcitabine and cISplatin induction, and in relation to radiation therapy as per institutional policy.
Cycles 1 to 3 - 21 days - gemcitabine and cISplatin
Cycle specific Supportive Care Factors:
Emetogenicity: HIGH day 1; LOW day 8.
Hydration: Routine hydration recommended.
Cycles 4 to 6 - 21 days - cISplatin chemoradiation
Commence 3–4 weeks after the first day of the last cycle of gemcitabine and cISplatin induction, and 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.
Cycle details
Cycles 1 to 3 - 21 days - gemcitabine and cISplatin
| 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, 8 | |
| gemcitabine * | 1000 mg/m² | intravenous | 1, 8 | 30 minutes |
| 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 |
| ondansetron | 8 mg | oral administration | 1 | |
| cycliZINE | 50 mg Three times daily | oral administration | 1 |
Cycle specific Supportive Care Factors:
Emetogenicity: HIGH day 1; LOW day 8.
Hydration: Routine hydration recommended.
Cycles 4 to 6 - 21 days - cISplatin 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 3–4 weeks after the first day of the last cycle of gemcitabine and cISplatin induction, and 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.
Full details
Cycles 1 to 3 - 21 days - gemcitabine and cISplatin
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. |
|
| gemcitabine * | 1000 mg/m² | intravenous | 30 minutes | |
| 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. |
| 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. |
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 |
Cycles 4 to 6 - 21 days - cISplatin 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. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Emetogenicity: | Variable |
| Growth factor support: | Variable |
| Hydration: | Routine hydration recommended |
References
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.