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Systemic Anti-Cancer Therapy Regimen Library

Home > GU Bladder Urothelial Neoadjuvant - cISplatin and gemcitabine

GU Bladder Urothelial Neoadjuvant - cISplatin and gemcitabine

Treatment Overview

For GFR less than 50 mL/minute consider substituting cISplatin with cARBOplatin.

Cycles 1 to 4 - 21 days

Cycle length:
21

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 * 1000 mg/m² intravenous 1, 8 30 minutes
magnesium sulfate heptahydrate 10 mmol intravenous 1 60 minutes
cISplatin 70 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

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 * 1000 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 70 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.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

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 * 1000 mg/m² intravenous 30 minutes

Supportive Care Factors

Factor Value
Emetogenicity: Variable
Hydration: Routine hydration recommended

Emetogenicity: HIGH day 1, LOW day 8.

References

Grossman, H. B., R. B. Natale, C. M. Tangen, et al. 2003. "Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer." N Engl J Med 349(9):859-866., PMID: 12944571

Advanced Bladder Cancer Meta-analysis, Collaboration. 2003. "Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis." Lancet 361(9373):1927-1934., PMID: 12801735

Advanced Bladder Cancer Meta-analysis, Collaboration. 2005. "Neoadjuvant chemotherapy in invasive bladder cancer: update of a systematic review and meta-analysis of individual patient data advanced bladder cancer (ABC) meta-analysis collaboration." Eur Urol 48(2);202-5., PMID: 15939524

Advanced Bladder Cancer Meta-analysis Collaboration. "Neo-adjuvant chemotherapy for invasive bladder cancer." Cochrane Database of Systematic Reviews 2004. Edited and republished 2012.

von der, Maase H., S. W. Hansen, J. T. Roberts, et al. 2000. "Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study." J.Clin Oncol. 18(17):3068-3077., PMID: 11001674

Yuh, B., N. Ruel, & T. Wilson. et al. 2013. "Pooled analysis of clinical outcomes with neoadjuvant cisplatin and gemcitabine chemotherapy for muscle invasive bladder cancer." J Urol. 189(5);1682-6., PMID: 23123547

Herchenhorn, D., R. Dienstmann, F. A. Peixoto, et al. 2007. "Phase II trial of neoadjuvant gemcitabine and cisplatin in patients with resectable bladder carcinoma." Int Braz J Urol 33(5):630-638; discussion 638., PMID: 17980060

Pal, S. K., N. H. Ruel, T. G. Wilson, et al. 2012. "Retrospective analysis of clinical outcomes with neoadjuvant cisplatin-based regimens for muscle-invasive bladder cancer." Clin Genitourin Cancer 10(4):246-250., PMID: 22981208

Yeshchina, O., G. M. Badalato, M. S. Wosnitzer, et al. 2012. "Relative efficacy of perioperative gemcitabine and cisplatin versus methotrexate, vinblastine, adriamycin, and cisplatin in the management of locally advanced urothelial carcinoma of the bladder." Urology 79(2):384-390., PMID: 22196406

Scosyrev, E., E. M. Messing, E. van Wijngaarden, et al. 2012. "Neoadjuvant gemcitabine and cisplatin chemotherapy for locally advanced urothelial cancer of the bladder." Cancer 118(1):72-81., PMID: 21720989

Kaneko, G., E. Kikuchi, K. Matsumoto, et al. 2011. "Neoadjuvant gemcitabine plus cisplatin for muscle-invasive bladder cancer." Jpn J Clin Oncol 41(7):908-914., PMID: 21665907

Weight, C. J., J. A. Garcia, D. E. Hansel, et al. 2009. "Lack of pathologic down-staging with neoadjuvant chemotherapy for muscle-invasive urothelial carcinoma of the bladder: a contemporary series." Cancer 115(4):792-799., PMID: 19127557

Dash, A., J. A. th Pettus, H. W. Herr, et al. 2008. "A role for neoadjuvant gemcitabine plus cisplatin in muscle-invasive urothelial carcinoma of the bladder: a retrospective experience." Cancer 113(9):2471-2477., PMID: 18823036

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://wwwuptodate.com (Accessed 26 March 2021).

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.