Systemic Anti-Cancer Therapy Regimen Library
Neuroendocrine tumour Advanced - capecitabine and temozolomide [ONCE daily dosing]
Treatment Overview
Cycle 1 (and all further cycles) - 28 days
capecitabine: Some clinicians may consider dose capping of capecitabine to 2500 mg total dose per day for patients with high BSA.
temozolomide: Some clinicians may consider a temozolomide dose of 150 mg/m2 ONCE daily for certain patients.
Cycle details
Cycle 1 (and all further cycles) - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration | 1 to 14 | |
| ondansetron | 8 mg Twice daily | oral administration | 10 to 14 | |
| temozolomide * | 200 mg/m² Once daily | oral administration | 10 to 14 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 | |
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration | 10 to 14 |
capecitabine: Some clinicians may consider dose capping of capecitabine to 2500 mg total dose per day for patients with high BSA.
temozolomide: Some clinicians may consider a temozolomide dose of 150 mg/m2 ONCE daily for certain patients.
Full details
Cycle 1 (and all further cycles) - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| 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 |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy. |
|
| temozolomide * | 200 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration |
Instructions:
When required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 11
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy. |
|
| temozolomide * | 200 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration |
Instructions:
When required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 12
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy. |
|
| temozolomide * | 200 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration |
Instructions:
When required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 13
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy. |
|
| temozolomide * | 200 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration |
Instructions:
When required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Day: 14
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| capecitabine * | 750 mg/m² Twice daily | oral administration |
Instructions:
Take each dose with food and a large glass of water. Round dose to closest multiple of 150 mg and/or 500 mg tablets.
|
|
| ondansetron | 8 mg Twice daily | oral administration |
Instructions:
ONE hour prior to chemotherapy and if required 8 to 12 hours after chemotherapy. |
|
| temozolomide * | 200 mg/m² Once daily | oral administration |
Instructions:
Take each dose on an empty stomach - one hour before OR two hours after food. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| docusate sodium + sennoside B | 2 Tablet(s) Twice daily | oral administration |
Instructions:
When required for constipation. Each tablet contains docusate sodium 50 mg + sennoside B 8 mg. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Constipation risk: | laxatives are usually prescribed |
| Diarrhoea risk: | Anti-diarrhoeals are usually prescribed with this treatment |
| Emetogenicity: | Variable |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis may be considered |
Emetogenicity:
- MINIMAL to LOW days 1 to 9 (capecitabine only). Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate.
- MEDIUM to HIGH days 10 to 14 (temozolomide). Routine antiemetic premedication may not be required for continuous dosing of oral anti-cancer medicines with MEDIUM to HIGH emetic risk; an individualised approach is appropriate.
References
Fine, R. L. , A. P. Gulati, D. Tsushima, et al. 2014. "Prospective phase II study of capecitabine and temozolomide (CAPTEM) for progressive, moderately, and well-differentiated metastatic neuroendocrine tumors." ASCO Meeting Abstracts 32(3_suppl):179
Dr Reddy’s New Zealand Ltd. Capercit New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/c/capercittab.pdf (Accessed 16 February 2021).
Douglas Pharmaceuticals Limited. Temaccord New Zealand Data Sheet 23 September 2019. https://www.medsafe.govt.nz/profs/Datasheet/t/temaccordcap.pdf (Accessed 17 January 2022).
* 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.