New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG MESO Metastatic - cISplatin, pemetrexed and beVACizumab

LUNG MESO Metastatic - cISplatin, pemetrexed and beVACizumab

Treatment Overview

Usually up to 6 cycles of cISplatin, pemetrexed and beVACizumab.

beVACizumab may continue until disease progression or unacceptable toxicity.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 6 - 21 days - cISplatin, pemetrexed and beVACizumab

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 continue until 21 days after the last dose of pemetrexed.

Cycle 7 (and all further cycles) - 21 days - beVACizumab continuation

Cycle length:
21

Cycle details

Cycles 1 to 6 - 21 days - cISplatin, pemetrexed and beVACizumab

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
beVACizumab * 15 mg/kg intravenous 1 90 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 continue until 21 days after the last dose of pemetrexed.

Cycle 7 (and all further cycles) - 21 days - beVACizumab continuation

Medication Dose Route Days Max Duration
beVACizumab * 15 mg/kg intravenous 1 90 minutes

Full details

Cycles 1 to 6 - 21 days - cISplatin, pemetrexed and beVACizumab

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 every 9 weeks until 21 days after the last dose of pemetrexed.

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.
beVACizumab * 15 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.
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.

Cycle 7 (and all further cycles) - 21 days - beVACizumab continuation

Day: 1

Medication Dose Route Max duration Details
beVACizumab * 15 mg/kg intravenous 90 minutes
Instructions:
  • Blood pressure and urinalysis should be checked before each administration. If urine dipstick protein is less than or equal to 3+, proceed with infusion.
  • If the initial dose of beVACizumab is well tolerated, the second dose may be administered over 60 minutes, and the third and subsequent doses may be administered over 30 minutes.

Supportive Care Factors

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

Emetogenicity:

  • HIGH cycles 1 to 6;
  • MINIMAL beVACizumab alone.

Hydration: Routine hydration recommended in cycles 1 to 6.

References

Zalcman, G., J. Mazieres, J. Margery, et al. 2016. "Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial." Lancet 387(10026):1405-1414., PMID: 26719230

Ceresoli, G. L., P. A. Zucali, A. G. Favaretto, et al. 2006. "Phase II study of pemetrexed plus carboplatin in malignant pleural mesothelioma." J Clin Oncol 24(9):1443-1448., PMID: 16549838

Reidy, D. L., K. Y. Chung, J. P. Timoney, et al. 2007. "Bevacizumab 5 mg/kg can be infused safely over 10 minutes." J Clin Oncol. 25(19):2691-2695., PMID: 17602073

Juno Pharmaceuticals NZ Ltd. (2021, May 18). Pemetrexed Juno Medsafe Datasheet 17 August 2017. Retrieved from Medsafe: https://www.medsafe.govt.nz/profs/Datasheet/p/PemetrexedJunoinf.pdf

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).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers. ESMO Open. 2017 Jan 16;1(6):e000142. doi: 10.1136/esmoopen-2016-000142., PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol. 2018 Apr 20;36(12):1260-1265. doi: 10.1200/JCO.2017.77.4893. Epub 2018 Feb 14., PMID: 29443651

* 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.