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Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG NSCLC Neoadjuvant - cARBOplatin, PACLItaxel and nivolumab

LUNG NSCLC Neoadjuvant - cARBOplatin, PACLItaxel and nivolumab

Treatment Overview

Cycles 1 to 3 - 21 days

Cycle length:
21

paclitaxel: In the trial, a lower initial dose of paclitaxel 175 mg/m2 was also considered and may be used as per institutional practice.


carboplatin: In the trial, a lower initial dose of carboplatin 5 AUC was also considered and may be used as per institutional practice.

Cycle details

Cycles 1 to 3 - 21 days

Medication Dose Route Days Max Duration
dexamethasone * 20 mg oral administration 0
aprepitant 125 mg oral administration 1
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
dexamethasone * 8 mg oral administration 2, 3
ondansetron 8 mg oral administration 1
loratadine * 10 mg oral administration 1
nivolumab 360 mg flat dosing intravenous 1 30 minutes
PACLItaxel * 200 mg/m² intravenous 1 3 hours
cARBOplatin * 6 AUC (area under the curve) intravenous 1 60 minutes
ondansetron 8 mg oral administration 1
domperidone 10 mg Three times daily oral administration 1

paclitaxel: In the trial, a lower initial dose of paclitaxel 175 mg/m2 was also considered and may be used as per institutional practice.


carboplatin: In the trial, a lower initial dose of carboplatin 5 AUC was also considered and may be used as per institutional practice.

Full details

Cycles 1 to 3 - 21 days

Day: 0

Medication Dose Route Max duration Details
dexamethasone * 20 mg oral administration
Instructions:

Take the night prior to paclitaxel infusion with food.

  • If the initial infusion(s) of paclitaxel are well tolerated, clinicians may decide at their discretion, to omit this dose.

Day: 1

Medication Dose Route Max duration Details
aprepitant 125 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 12 mg oral administration
Instructions:

ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to paclitaxel infusion.

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.
PACLItaxel * 200 mg/m² intravenous 3 hours
Instructions:
  • Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.
  • Please carry out graded challenge as per institutional policy.
  • A lower initial dose of paclitaxel 175 mg/m2 may be used, as per institutional practice.
cARBOplatin * 6 AUC (area under the curve) intravenous 60 minutes
Instructions:
  • Hypersensitivity risk increases with number of cycles of carboplatin.
  • A lower initial dose of cARBOplatin 5 AUC may be used, as per institutional practice.
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.

  • This dose may be reduced or omitted at clinician’s discretion.

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.

  • This dose may be reduced or omitted at clinician’s discretion.

Supportive Care Factors

Factor Value
Emetogenicity: High
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

References

Forde PM, Spicer J, Lu S, et al; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985., PMID: 35403841

Sandoz New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 27 November 2023. https://www.medsafe.govt.nz/profs/datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2024).

Bristol-Myers Squibb (NZ) Ltd. Opdivo (nivolumab) New Zealand Data Sheet 25 July 2024. https://www.medsafe.govt.nz/profs/datasheet/o/opdivoinf.pdf (Accessed 26 November 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/contents/infusion-reactions-to-systemic-chemotherapy (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.