Systemic Anti-Cancer Therapy Regimen Library
LUNG NSCLC Metastatic - cARBOplatin, gemcitabine and pembrolizumab
Treatment Overview
Usually up to 4 cycles of cARBOplatin, gemcitabine and pembrolizumab.
pembrolizumab may continue for up to 2 years or until disease progression or unacceptable toxicity.
Cycles 1 to 4 - 21 days - cARBOplatin, gemcitabine and pembrolizumab
Cycles 5 to 35 - 21 days - pembrolizumab continuation
Cycle details
Cycles 1 to 4 - 21 days - cARBOplatin, gemcitabine and pembrolizumab
| 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, 8 | |
| pembrolizumab * | 200 mg flat dosing | intravenous | 1 | 30 minutes |
| gemcitabine * | 1000 mg/m² | intravenous | 1, 8 | 30 minutes |
| cARBOplatin * | 5 AUC (area under the curve) | intravenous | 1 | 60 minutes |
| ondansetron | 8 mg | oral administration | 1 | |
| domperidone | 10 mg Three times daily | oral administration | 1 |
Cycles 5 to 35 - 21 days - pembrolizumab continuation
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| pembrolizumab | 200 mg flat dosing | intravenous | 1 | 30 minutes |
Full details
Cycles 1 to 4 - 21 days - cARBOplatin, gemcitabine and pembrolizumab
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. |
|
| pembrolizumab * | 200 mg flat dosing | intravenous | 30 minutes |
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter. |
| gemcitabine * | 1000 mg/m² | intravenous | 30 minutes | |
| cARBOplatin * | 5 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.
|
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.
|
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy.
|
|
| gemcitabine * | 1000 mg/m² | intravenous | 30 minutes |
Cycles 5 to 35 - 21 days - pembrolizumab continuation
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| pembrolizumab | 200 mg flat dosing | intravenous | 30 minutes |
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Emetogenicity: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Low - routine premedication not recommended |
Emetogenicity:
- cARBOplatin, gemcitabine and pembrolizumab: HIGH (cARBOplatin AUC ≥ 5) day 1, LOW day 8.
- pembrolizumab alone: MINIMAL.
References
Crombie, C., Burns, W. & Karapetis, C. et al. 2009. "Randomised phase II trial of gemcitabine and either day 1 or day 8 carboplatin for advanced non-small-cell lung cancer: Is thrombocytopaenia predictable?" Asia- Pacific Journal of Clinical Oncology 5: 24-31.
Merck Sharp & Dohme (New Zealand) Ltd. Keytruda New Zealand Data Sheet 06 November 2024. https://www.medsafe.govt.nz/profs/datasheet/k/Keytruda.pdf (Accessed 26 November 2024).
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).
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.