Systemic Anti-Cancer Therapy Regimen Library
LUNG NSCLC Metastatic - cISplatin and pemetrexed
Treatment Overview
Usually up to 4 cycles of cISplatin and pemetrexed.
Pemetrexed may continue until disease progression or unacceptable toxicity.
Cycles 1 to 4 - 21 days - cISplatin and pemetrexed
folic acid: Starting 7 days before the first cycle, continue ONCE daily until 21 days after the last dose of pemetrexed.
hydroxocobalamin: Starting 7 days before the first cycle and then repeat ONCE every 9 weeks until 21 days after the last dose of pemetrexed.
Cycle 5 (and all further cycles) - 21 days - pemetrexed maintenance
folic acid: Take ONCE daily until 21 days after the last dose of pemetrexed.
hydroxocobalamin: Repeat ONCE every 9 weeks (every 3 cycles) until 21 days after the last dose of pemetrexed.
Cycle details
Cycles 1 to 4 - 21 days - cISplatin and pemetrexed
| 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 | |
| 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: Starting 7 days before the first cycle, continue ONCE daily until 21 days after the last dose of pemetrexed.
hydroxocobalamin: Starting 7 days before the first cycle and then repeat ONCE every 9 weeks until 21 days after the last dose of pemetrexed.
Cycle 5 (and all further cycles) - 21 days - pemetrexed maintenance
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 4 mg Twice daily | oral administration | 0, 1, 2 | |
| folic acid * | 800 microgram Once daily | oral administration | 1 | |
| hydroxocobalamin * | 1 mg | intramuscular injection | 1 | |
| pemetrexed | 500 mg/m² | intravenous | 1 | 10 minutes |
| domperidone | 10 mg Three times daily | oral administration | 1 |
folic acid: Take ONCE daily until 21 days after the last dose of pemetrexed.
hydroxocobalamin: Repeat ONCE every 9 weeks (every 3 cycles) until 21 days after the last dose of pemetrexed.
Full details
Cycles 1 to 4 - 21 days - cISplatin and pemetrexed
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. |
|
| 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. 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 5 (and all further cycles) - 21 days - pemetrexed maintenance
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 4 mg Twice daily | oral administration |
Instructions:
Take in with food. |
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 4 mg Twice daily | oral administration |
Instructions:
Take in with food. |
|
| folic acid * | 800 microgram Once daily | oral administration |
Instructions:
800 microgram = 0.8 mg. Take ONCE daily until 21 days after the last dose of pemetrexed. |
|
| hydroxocobalamin * | 1 mg | intramuscular injection |
Instructions:
1 mg = 1000 microgram. Administer ONCE every 9 weeks until 21 days after the last dose of pemetrexed. |
|
| pemetrexed | 500 mg/m² | intravenous | 10 minutes | |
| 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 |
|---|---|---|---|---|
| dexamethasone * | 4 mg Twice daily | oral administration |
Instructions:
Take in with food. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Emetogenicity: | Variable |
| Hydration: | Routine hydration recommended |
Emetogenicity: HIGH (cISplatin and pemetrexed) cycles 1 to 4; LOW pemetrexed maintenance
References
Paz-Ares, L. G., F. de Marinis, M. Dediu, et al. 2013. "PARAMOUNT: Final overall survival results of the phase III study of maintenance pemetrexed versus placebo immediately after induction treatment with pemetrexed plus cisplatin for advanced nonsquamous non-small-cell lung cancer." J Clin Oncol 31(23):2895-2902.
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).
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
* 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.