Systemic Anti-Cancer Therapy Regimen Library
UGI GAST Metastatic - cISplatin, capecitabine and pembrolizumab [flat dose]
Treatment Overview
Usual max. 6 cycles of cISplatin. Capecitabine and pembrolizumab may continue for up to 2 years or until disease progression/toxicity.
Cycle 1 (and all further cycles) - 21 days
Emetogenicity: HIGH for cycles 1 to 6 (cISplatin); LOW thereafter.
Cycle details
Cycle 1 (and all further cycles) - 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 | |
| pembrolizumab * | 200 mg flat dosing | intravenous | 1 | 30 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 |
Emetogenicity: HIGH for cycles 1 to 6 (cISplatin); LOW thereafter.
Full details
Cycle 1 (and all further cycles) - 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. |
|
| pembrolizumab * | 200 mg flat dosing | intravenous | 30 minutes |
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 5 micron in-line or add-on filter. |
| 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 * | 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. |
|
| 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 * | 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. |
|
| 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 * | 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. |
|
| 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. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Anti-diarrhoeals are usually prescribed with this treatment |
| Emetogenicity: | Variable |
| Hydration: | Routine hydration recommended |
| Hypersensitivity / Infusion related reaction risk: | Low - routine premedication not recommended |
References
1. Charles S. Fuchs, Atsushi Ohtsu, Josep Tabernero, Eric Van Cutsem, Jiang Dian Wang, Baohoang Lam, Rita Dalal, Minori Koshiji, and Yung-Jue Bang. Preliminary safety data from KEYNOTE-059: Pembrolizumab plus 5-fluorouracil (5-FU) and cisplatin for first-line treatment of advanced gastric cancer. Journal of Clinical Oncology 2016 34:15_suppl, 4037-4037.
2. Dr Reddy’s New Zealand Ltd. Capercit New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/c/capercittab.pdf (Accessed 16 February 2021).
3. Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 12 November 2020. https://www.medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (Accessed 02 December 2020).
5. 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.