Systemic Anti-Cancer Therapy Regimen Library
HN NPC NON-Metastatic - cARBOplatin chemoradiation followed by cARBOplatin and fluorouracil
Treatment Overview
This regimen consists of two parts: cARBOplatin chemoradiation followed by cARBOplatin and fluorouracil.
Commence cARBOplatin chemoradiation in relation to radiation therapy as per institutional policy.
Commence cARBOplatin and fluorouracil 3–4 weeks after completion of cARBOplatin chemoradiation as per institutional policy.
Cycles 1 to 6 - 7 days - cARBOplatin chemoradiation
Commence regimen in relation to radiation therapy as per institutional policy.
Cycle specific Supportive Care Factors:
Emetogenicity: MEDIUM.
Growth factor support: Growth factor prophylaxis not recommended.
Cycles 7 to 9 - 28 days - cARBOplatin and fluorouracil
Commence 3–4 weeks after completion of cARBOplatin chemoradiation as per institutional policy.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Cycle details
Cycles 1 to 6 - 7 days - cARBOplatin chemoradiation
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| cARBOplatin * | 2 AUC (area under the curve) | intravenous | 1 | 60 minutes |
| ondansetron | 8 mg | oral administration | 1 | |
| domperidone | 10 mg Three times daily | oral administration | 1 |
Commence regimen in relation to radiation therapy as per institutional policy.
Cycle specific Supportive Care Factors:
Emetogenicity: MEDIUM.
Growth factor support: Growth factor prophylaxis not recommended.
Cycles 7 to 9 - 28 days - cARBOplatin and fluorouracil
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| aprepitant | 125 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| cARBOplatin * | 5 AUC (area under the curve) | intravenous | 1 | 60 minutes |
| fluorouracil * | 4000 mg/m² | intravenous | 1 | 96 hours Min: 96 hours |
| ondansetron | 8 mg | oral administration | 1 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 |
Commence 3–4 weeks after completion of cARBOplatin chemoradiation as per institutional policy.
Cycle specific Supportive Care Factors:
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment.
Emetogenicity: HIGH - cARBOplatin.
Full details
Cycles 1 to 6 - 7 days - cARBOplatin chemoradiation
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| cARBOplatin * | 2 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 |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Cycles 7 to 9 - 28 days - cARBOplatin and fluorouracil
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| cARBOplatin * | 5 AUC (area under the curve) | intravenous | 60 minutes |
Instructions:
Hypersensitivity risk increases with number of cycles of cARBOplatin. |
| 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. |
|
| 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. |
|
| 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 |
|---|---|---|---|---|
| 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 |
|---|---|---|---|---|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Variable |
| Emetogenicity: | Variable |
| Growth factor support: | Variable |
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.