New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > LUNG NSCLC Metastatic - cISplatin and gemcitabine

LUNG NSCLC Metastatic - cISplatin and gemcitabine

Treatment Overview

Cycles 1 to 4 - 21 days

Cycle length:
21

Emetogenicity: HIGH day 1; LOW day 8.

Cycle details

Cycles 1 to 4 - 21 days

Medication Dose Route Days Max Duration
olanzapine * 5 mg oral administration 1 to 4
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, 4
ondansetron 8 mg oral administration 1, 8
gemcitabine 1250 mg/m² intravenous 1, 8 30 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

Emetogenicity: HIGH day 1; LOW day 8.

Full details

Cycles 1 to 4 - 21 days

Day: 1

Medication Dose Route Max duration Details
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.
dexamethasone * 12 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
gemcitabine 1250 mg/m² intravenous 30 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
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.
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food.

Day: 3

Medication Dose Route Max duration Details
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.
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food.

Day: 4

Medication Dose Route Max duration Details
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.
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. Alternative is dexamethasone 4 mg.
gemcitabine 1250 mg/m² intravenous 30 minutes

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hydration: Routine hydration recommended

References

1. Harper, P. 2003. "Update on gemcitabine/carboplatin in patients with advanced non-small cell lung cancer." Semin.Oncol. 30(4 Suppl 10):2-12, PMID: 12917815

2. Hotta, K., K. Matsuo, H. Ueoka, et al. 2004. "Meta-analysis of randomized clinical trials comparing Cisplatin to Carboplatin in patients with advanced non-small-cell lung cancer." J.Clin Oncol. 22(19):3852-3859., PMID: 15326195

3. 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.

4. Treat, J., G. Scagliotti, & G. Peng, et al. 2012. "Comparison of pemetrexed plus cisplatin with other first-line doublets in advanced non-small cell lung cancer (NSCLC): a combined analysis of three phase 3 trials." Lung Cancer 76 (2): 222-7., PMID: 22115704

5. Le Chevalier, T., G. Scagliotti, R. Natale, et al. 2005. "Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes." Lung Cancer. 47(1):69-80., PMID: 15603856

6. Schiller, J. H., D. Harrington, C. P. Belani, et al. 2002. "Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer." N.Engl.J.Med. 346(2):92-98., PMID: 11784875

7. Sauer, R., H. Becker, W. Hohenberger, et al. 2004. "Preoperative versus postoperative chemoradiotherapy for rectal cancer." N.Engl.J.Med. 351(17):1731-1740., PMID: 15496622

8. 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

9. 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.