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Systemic Anti-Cancer Therapy Regimen Library

Home > UGI PANC Metastatic - PAXG [PACLItaxel nanoparticle albumin bound [Abraxane], gemcitabine, cISplatin and capecitabine]

UGI PANC Metastatic - PAXG [PACLItaxel nanoparticle albumin bound [Abraxane], gemcitabine, cISplatin and capecitabine]

Treatment Overview

Cycle 1 (and all further cycles) - 14 days

Cycle length:
14

Cycle details

Cycle 1 (and all further cycles) - 14 days

Medication Dose Route Days Max Duration
olanzapine * 2.5 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
PACLItaxel nanoparticle albumin bound 150 mg/m² intravenous 1 30 minutes
gemcitabine * 800 mg/m² intravenous 1 30 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 30 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
capecitabine * 625 mg/m² Twice daily oral administration 1 to 14
ondansetron 8 mg oral administration 1
cyclIZINE 50 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Full details

Cycle 1 (and all further cycles) - 14 days

Day: 1

Medication Dose Route Max duration Details
olanzapine * 2.5 mg oral administration
Instructions:

ONE hour prior to chemotherapy. An additional 2.5 mg may be taken daily if required.

  • 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.

    PACLItaxel nanoparticle albumin bound 150 mg/m² intravenous 30 minutes
    Instructions:

    Do not administer via an in-line filter with a pore size of less than 15 micron.
    gemcitabine * 800 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 * 30 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.
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
    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.
    loperamide 2 mg oral administration
    Instructions:
    Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

    Day: 2

    Medication Dose Route Max duration Details
    olanzapine * 2.5 mg oral administration
    Instructions:

    ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

    • 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.

    • Dose and duration may be individualised at clinician’s discretion.
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 3

    Medication Dose Route Max duration Details
    olanzapine * 2.5 mg oral administration
    Instructions:

    ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

    • 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.

    • Dose and duration may be individualised at clinician’s discretion.
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 4

    Medication Dose Route Max duration Details
    olanzapine * 2.5 mg oral administration
    Instructions:

    ONCE daily, regular daily dose. An additional 2.5 mg may be taken daily if required.

    • 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.

    • Dose and duration may be individualised at clinician’s discretion.
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 5

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 6

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 7

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 8

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 9

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 10

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 11

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 12

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 13

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Day: 14

    Medication Dose Route Max duration Details
    capecitabine * 625 mg/m² Twice daily oral administration
    Instructions:
    • Take each dose with food and a large glass of water.
    • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

    Supportive Care Factors

    Factor Value
    Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
    Emetogenicity: Variable
    Hydration: Routine hydration recommended

    Emetogenicity:

    • HIGH day 1.
    • MINIMAL to LOW days 2 to 14 (capecitabine). Routine antiemetic premedication is not usually required; an individualised approach is appropriate.

    References

    Reni M, Zanon S, Peretti U, et al. Nab-paclitaxel plus gemcitabine with or without capecitabine and cisplatin in metastatic pancreatic adenocarcinoma (PACT-19): a randomised phase 2 trial. Lancet Gastroenterol Hepatol. 2018 Oct;3(10):691-697. doi: 10.1016/S2468-1253(18)30196-1. Epub 2018 Jul 7. , PMID: 30220407

    Viatris Ltd. CAPECITABINE VIATRIS New Zealand Data Sheet 14 Feb 2023. https://www.medsafe.govt.nz/profs/datasheet/c/CapecitabineViatristab.pdf (Accessed 18 September 2025).

    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 Aug;21(4):e630-41. , 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://wwwuptodate.com (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.