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Systemic Anti-Cancer Therapy Regimen Library

Home > GU URO Metastatic - PACLItaxel Q1W and pembrolizumab Q3W [flat dosing]

GU URO Metastatic - PACLItaxel Q1W and pembrolizumab Q3W [flat dosing]

Treatment Overview

Continue until disease progression or unacceptable toxicity (up to 2 years for pembrolizumab).

Cycle 1 - 21 days

Cycle length:
21

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Cycle 2 - 21 days

Cycle length:
21

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Cycle 3 (and all further cycles) - 21 days

Cycle length:
21

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Cycle details

Cycle 1 - 21 days

Medication Dose Route Days Max Duration
loratadine * 10 mg oral administration 1, 8, 15
famotidine * 20 mg oral administration 1, 8, 15
dexamethasone * 8 mg oral administration 1
dexamethasone * 4 mg oral administration 8
ondansetron * 8 mg oral administration 15
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
domperidone 10 mg Three times daily oral administration 1

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Cycle 2 - 21 days

Medication Dose Route Days Max Duration
loratadine * 10 mg oral administration 1
ondansetron * 8 mg oral administration 1, 8, 15
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
domperidone 10 mg Three times daily oral administration 1

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Cycle 3 (and all further cycles) - 21 days

Medication Dose Route Days Max Duration
ondansetron * 8 mg oral administration 1, 8, 15
PACLItaxel * 80 mg/m² intravenous 1, 8, 15 60 minutes
pembrolizumab 200 mg flat dosing intravenous 1 30 minutes
domperidone 10 mg Three times daily oral administration 1

PACLItaxel: Tapering schedule of pre-medications is for patients who did not experience a hypersensitivity reaction to the previous dose of weekly PACLItaxel.

Full details

Cycle 1 - 21 days

Day: 1

Medication Dose Route Max duration Details
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.

Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
dexamethasone * 8 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion with food.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.
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.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 8

Medication Dose Route Max duration Details
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.

Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
dexamethasone * 4 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion with food.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Day: 15

Medication Dose Route Max duration Details
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
famotidine * 20 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.

Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Cycle 2 - 21 days

Day: 1

Medication Dose Route Max duration Details
loratadine * 10 mg oral administration
Instructions:

ONE hour prior to PACLItaxel infusion.
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.
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.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 8

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Day: 15

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Cycle 3 (and all further cycles) - 21 days

Day: 1

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.
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.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.

Day: 8

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Day: 15

Medication Dose Route Max duration Details
ondansetron * 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
PACLItaxel * 80 mg/m² intravenous 60 minutes
Instructions:

Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size.

Please carry out graded challenge as per institutional policy.

Supportive Care Factors

Factor Value
Emetogenicity: Low
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

References

Giannatempo P, Raggi D, Marandino L, Bandini M, Farè E, Calareso G, Colecchia M, Gallina A, Ross JS, Alessi A, Briganti A, Montorsi F, Madison R, Necchi A. Pembrolizumab and nab-paclitaxel as salvage therapy for platinum-treated, locally advanced or metastatic urothelial carcinoma: interim results of the open-label, single-arm, phase II PEANUT study. Ann Oncol. 2020 Dec;31(12):1764-1772. doi: 10.1016/j.annonc.2020.09.012. Epub 2020 Sep 23., PMID: 32979512

Sridhar SS, Blais N, Tran B, Reaume MN, North SA, Stockler MR, Chi KN, Fleshner NE, Liu G, Robinson JW, Mukherjee SD, Rahim Y, Winquist E, Booth CM, Nguyen NT, Beardsley EK, Alimohamed NS, McDonald GT, Ding K, Parulekar WR. Efficacy and Safety of nab-Paclitaxel vs Paclitaxel on Survival in Patients With Platinum-Refractory Metastatic Urothelial Cancer: The Canadian Cancer Trials Group BL.12 Randomized Clinical Trial. JAMA Oncol. 2020 Nov 1;6(11):1751-1758. doi: 10.1001/jamaoncol.2020.3927., PMID: 32940628

Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 30 September 2022).

Merck Sharp & Dohme (New Zealand) Limited. Keytruda New Zealand Data Sheet 21 July 2022. https://www.medsafe.govt.nz/profs/Datasheet/k/Keytruda.pdf (Accessed 29 September 2022).

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.