New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG NSCLC Neoadjuvant - cISplatin, pemetrexed and nivolumab

LUNG NSCLC Neoadjuvant - cISplatin, pemetrexed and nivolumab

Treatment Overview

Cycles 1 to 3 - 21 days

Cycle length:
21

folic acid: Give folic acid 800 microgram (0.8 mg) orally ONCE daily starting 7 days before the first cycle of pemetrexed and continue until 21 days after the last dose of pemetrexed.


hydroxocobalamin: Give hydroxocobalamin 1 mg (1000 microgram) intramuscularly ONCE every 9 weeks, first dose 7 days before the first cycle of pemetrexed and repeat in the 3rd cycle.

Cycle details

Cycles 1 to 3 - 21 days

Medication Dose Route Days Max Duration
folic acid * 800 microgram Once daily oral administration -7
hydroxocobalamin 1 mg intramuscular injection -7
dexamethasone * 4 mg Twice daily oral administration 0 to 4
olanzapine * 5 mg oral administration 1 to 4
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
ondansetron 8 mg oral administration 1
nivolumab * 360 mg flat dosing intravenous 1 30 minutes
pemetrexed 500 mg/m² intravenous 1 10 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 75 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

folic acid: Give folic acid 800 microgram (0.8 mg) orally ONCE daily starting 7 days before the first cycle of pemetrexed and continue until 21 days after the last dose of pemetrexed.


hydroxocobalamin: Give hydroxocobalamin 1 mg (1000 microgram) intramuscularly ONCE every 9 weeks, first dose 7 days before the first cycle of pemetrexed and repeat in the 3rd cycle.

Full details

Cycles 1 to 3 - 21 days

Day: -7

Medication Dose Route Max duration Details
folic acid * 800 microgram Once daily oral administration
Instructions:

800 microgram = 0.8 mg.

Start 7 days before the first cycle, continue until 21 days after the last dose of pemetrexed.
hydroxocobalamin 1 mg intramuscular injection
Instructions:

1 mg = 1000 microgram.

Start 7 days before the first cycle and then repeat ONCE after 9 weeks.

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 4 mg Twice daily oral administration
Instructions:
Take with food.

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 4 mg Twice daily oral administration
Instructions:
Take with food.
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.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
nivolumab * 360 mg flat dosing intravenous 30 minutes
Instructions:

Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 1.2 micron in-line filter.
pemetrexed 500 mg/m² intravenous 10 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
cISplatin * 75 mg/m² intravenous 60 minutes
Instructions:
  • In 500 - 1000 mL of sodium chloride 0.9%, depending on stability.
  • To be infused approximately 30 minutes after completion of pemetrexed infusion.
  • 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
dexamethasone * 4 mg Twice daily oral administration
Instructions:
Take with food.
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.

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 4 mg Twice daily oral administration
Instructions:
Take with food.
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.

Day: 4

Medication Dose Route Max duration Details
dexamethasone * 4 mg Twice daily oral administration
Instructions:
Take with food.
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.

Supportive Care Factors

Factor Value
Emetogenicity: High
Hydration: Routine hydration recommended
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

References

Forde PM, Spicer J, Lu S, et al. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985., PMID: 35403841

Juno Pharmaceuticals NZ Ltd. Pemetrexed Juno New Zealand Datasheet 17 August 2017. https://www.medsafe.govt.nz/profs/Datasheet/p/PemetrexedJunoinf.pdf (Accessed 16 July 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 (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.