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Systemic Anti-Cancer Therapy Regimen Library

Home > UGI GAST AND OES Metastatic - cISplatin, capecitabine and trastuzumab

UGI GAST AND OES Metastatic - cISplatin, capecitabine and trastuzumab

Treatment Overview

Usually up to 6 cycles of cISplatin, capecitabine and trastuzumab.

Trastuzumab may continue until disease progression or unacceptable 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 - 21 days - cISplatin, capecitabine and trastuzumab loading dose

Cycle length:
21

Cycles 2 to 6 - 21 days - cISplatin, capecitabine and trastuzumab maintenance dose

Cycle length:
21

trastuzumab: If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle 7 (and all further cycles) - 21 days - trastuzumab continuation

Cycle length:
21

trastuzumab: If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle details

Cycle 1 - 21 days - cISplatin, capecitabine and trastuzumab loading dose

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
trastuzumab 8 mg/kg intravenous 1 90 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 80 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
capecitabine 1000 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

Cycles 2 to 6 - 21 days - cISplatin, capecitabine and trastuzumab maintenance dose

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
trastuzumab 6 mg/kg intravenous 1 90 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin * 80 mg/m² intravenous 1 60 minutes
sodium chloride 0.9 % intravenous 1 60 minutes
capecitabine 1000 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

trastuzumab: If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.

Cycle 7 (and all further cycles) - 21 days - trastuzumab continuation

Medication Dose Route Days Max Duration
trastuzumab 6 mg/kg intravenous 1 90 minutes

trastuzumab: If the initial loading dose of trastuzumab is well tolerated, subsequent doses may be administered over 30 minutes.

Full details

Cycle 1 - 21 days - cISplatin, capecitabine and trastuzumab loading dose

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.
trastuzumab 8 mg/kg intravenous 90 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 80 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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.

Cycles 2 to 6 - 21 days - cISplatin, capecitabine and trastuzumab maintenance dose

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.
trastuzumab 6 mg/kg intravenous 90 minutes
Instructions:

If the initial loading dose was well tolerated, subsequent doses may be administered over 30 minutes.
magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes
Instructions:

In 1000 mL of sodium chloride 0.9%, prior to cisplatin infusion.
cISplatin * 80 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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 1000 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.

Cycle 7 (and all further cycles) - 21 days - trastuzumab continuation

Day: 1

Medication Dose Route Max duration Details
trastuzumab 6 mg/kg intravenous 90 minutes
Instructions:

If the initial loading dose was well tolerated, subsequent doses may be administered over 30 minutes.

Supportive Care Factors

Factor Value
Diarrhoea risk: Variable
Emetogenicity: Variable
Hydration: Variable
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

Diarrhoea risk: Anti-diarrhoeals are usually prescribed with cycles 1 to 6.


Emetogenicity:

  • cISplatin, capecitabine and trastuzumab:
    • HIGH day 1.
    • MINIMAL to LOW days 2 to 14 (capecitabine)—Routine antiemetic premedication is not usually required; an individualised approach is appropriate.
  • trastuzumab continuation: MINIMAL.

Hydration: Routine hydration recommended cycles 1 to 6.

References

Bang, Y. J., E. Van Cutsem, A. Feyereislova, et al. 2010. "Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial." Lancet 376(9742):687-697., PMID: 20728210

Roche Products (New Zealand) Limited. Herceptin (trastuzumab) New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/h/Herceptininf.pdf (Accessed 16 February 2021).

Celltrion Healthcare New Zealand Limited. Herzuma New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/h/herzumainf.pdf (Accessed 16 February 2021).

Tabernero J, Vyas M, Giuliani R, Arnold D, Cardoso F, Casali PG, Cervantes A, Eggermont AMM, Eniu A, Jassem J, Pentheroudakis G, Peters S, Rauh S, Zielinski CC, Stahel RA, Voest E, Douillard JY, McGregor K, Ciardiello F. "Biosimilars: a position paper of the European Society for Medical Oncology, with particular reference to oncology prescribers." ESMO Open. 2017 Jan 16;1(6):e000142. , PMID: 28848668

Lyman GH, Balaban E, Diaz M, Ferris A, Tsao A, Voest E, Zon R, Francisco M, Green S, Sherwood S, Harvey RD, Schilsky RL. "American Society of Clinical Oncology Statement: Biosimilars in Oncology. J Clin Oncol." 2018 Apr 20;36(12):1260-1265. , PMID: 29443651

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 (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.