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Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG SCLC Extensive - cARBOplatin, etoposide [IV/oral] and durvalumab

LUNG SCLC Extensive - cARBOplatin, etoposide [IV/oral] and durvalumab

Treatment Overview

Usually 4 cycles of cARBOplatin, etoposide [IV/oral] and durvalumab.

Continue durvalumab monotherapy until disease progression or toxicity.

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide [IV/oral] and durvalumab [Q3W]

Cycle length:
21

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycle 5 (and all further cycles) - 28 days - durvalumab [Q4W] continuation

Cycle length:
28

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycle details

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide [IV/oral] and durvalumab [Q3W]

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
durvalumab 1500 mg flat dosing intravenous 1 60 minutes
cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes
etoposide (as phosphate) * 100 mg/m² intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
etoposide * 200 mg/m² Once daily oral administration 2, 3
domperidone 10 mg Three times daily oral administration 1

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycle 5 (and all further cycles) - 28 days - durvalumab [Q4W] continuation

Medication Dose Route Days Max Duration
durvalumab 1500 mg flat dosing intravenous 1 60 minutes

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended until weight increases to greater than 30 kg.

Full details

Cycles 1 to 4 - 21 days - cARBOplatin, etoposide [IV/oral] and durvalumab [Q3W]

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.
durvalumab 1500 mg flat dosing intravenous 60 minutes
Instructions:
  • Administer via a sterile, low protein binding 0.2 or 0.22 micron in-line filter.
  • For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended.
cARBOplatin * 5 AUC (area under the curve) intravenous 60 minutes
Instructions:
Hypersensitivity risk increases with number of cycles of cARBOplatin.
etoposide (as phosphate) * 100 mg/m² intravenous 60 minutes
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
aprepitant 80 mg oral administration
Instructions:
ONCE daily in the morning.
dexamethasone * 8 mg oral administration
Instructions:

ONCE daily in the morning with food.

  • Dose and duration may be individualised at clinician’s discretion.
etoposide * 200 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine, discuss with your pharmacist.
  • Round dose to closest multiple of 50 mg and/or 100 mg capsule.

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.

  • Dose and duration may be individualised at clinician’s discretion.
etoposide * 200 mg/m² Once daily oral administration
Instructions:
  • Take each dose on an empty stomach - one hour before OR two hours after food.
  • Grapefruit or grapefruit juice may interact with this medicine, discuss with your pharmacist.
  • Round dose to closest multiple of 50 mg and/or 100 mg capsule.

Cycle 5 (and all further cycles) - 28 days - durvalumab [Q4W] continuation

Day: 1

Medication Dose Route Max duration Details
durvalumab 1500 mg flat dosing intravenous 60 minutes
Instructions:
  • Administer via a sterile, low protein binding 0.2 or 0.22 micron in-line filter.
  • For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended.

Supportive Care Factors

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

Emetogenicity:

  • HIGH (cARBOplatin AUC≥4) cycles 1 to 4;
  • MINIMAL durvalumab alone.

References

Paz-Ares L, Dvorkin M, Chen Y, et al; CASPIAN investigators. Durvalumab plus platinum-etoposide versus platinum-etoposide in first-line treatment of extensive-stage small-cell lung cancer (CASPIAN): a randomised, controlled, open-label, phase 3 trial. Lancet. 2019 Nov 23;394(10212):1929-1939., PMID: 31590988

AstraZeneca Limited. IMFINZI (durvalumab) New Zealand Data Sheet 20 Novemeber 2023. https://www.medsafe.govt.nz/profs/datasheet/i/imfinziinf.pdf (Accessed on 03 December 2024).

Link Pharmaceuticals Limited. Vepesid New Zealand Data Sheet 19 March 2024. https://www.medsafe.govt.nz/profs/Datasheet/v/Vepesidcapinj.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).

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.