Systemic Anti-Cancer Therapy Regimen Library
LUNG NSCLC Metastatic - cARBOplatin, PACLItaxel, aTEZOLIzumab and beVACizumab
Treatment Overview
Usually maximum 6 cycles; aTEZOLIzumab and beVACizumab may continue until disease progression or 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.
Cycle 1 (and all further cycles) - 21 days
Cycle details
Cycle 1 (and all further cycles) - 21 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 20 mg flat dosing | 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 | |
| famotidine * | 20 mg | oral administration | 1 | |
| aTEZOLIzumab | 1200 mg | intravenous | 1 | 60 minutes |
| beVACizumab | 15 mg/kg | intravenous | 1 | 90 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 |
Full details
Cycle 1 (and all further cycles) - 21 days
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 20 mg flat dosing | 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. |
|
| famotidine * | 20 mg | oral administration |
Instructions:
ONE hour prior to PACLItaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine. |
|
| aTEZOLIzumab | 1200 mg | intravenous | 60 minutes |
Instructions:
If the initial dose is well tolerated, subsequent doses may be administered over 30 minutes. |
| 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. |
| 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. |
| cARBOplatin * | 6 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. 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. |
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. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Emetogenicity: | High |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
References
3. Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020)
4. Roche Products (New Zealand) Limited. Tecentriq New Zealand Data Sheet 06 August 2020. https://www.medsafe.govt.nz/profs/Datasheet/t/Tecentriqinf.pdf (Accessed 03 December 2020)
6. 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.