GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel Treatment Overview This regimen consists of two parts: cISplatin chemoradiation followed by cARBOplatin and PACLItaxel. Do not confuse with the chemotherapy-only regimen: GYN END Adjuvant - cARBOplatin and PACLItaxel [chemotherapy-only]. Part 1: cISplatin chemoradiation Commence within 4 to 6 weeks of surgery and in relation to radiation therapy as per institutional policy. Part 2: cARBOplatin and PACLItaxel Commence within 3 weeks after completion of radiation therapy. Supportive Care Factors Factor Value Emetogenicity: High Growth factor support: Variable Hydration: Variable Hypersensitivity / Infusion related reaction risk: Variable References de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2018. "Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 19(3):295-309., PMID: 29449189 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2016. "Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 17(8):1114-1126., PMID: 27397040 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2019. "Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial." Lancet Oncol 20(9):1273-1285., PMID: 31345626 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/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021). Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020). * 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.
Part 1: cISplatin chemoradiation (GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel) Treatment Overview Commence within 4 to 6 weeks of surgery and in relation to radiation therapy as per institutional policy. Cycle 1 - 28 days Cycle length: 28 Cycle details Cycle 1 - 28 days Medication Dose Route Days Max Duration olanzapine * 5 mg oral administration 1 to 4, 22 to 25 aprepitant 125 mg oral administration 1, 22 aprepitant 80 mg oral administration 2, 3, 23, 24 dexamethasone * 12 mg oral administration 1, 22 dexamethasone * 8 mg oral administration 2, 3, 4, 23, 24, 25 ondansetron 8 mg oral administration 1, 22 magnesium sulfate heptahydrate 10 mmol intravenous 1, 22 60 minutes cISplatin * 50 mg/m² intravenous 1, 22 60 minutes sodium chloride 0.9 % intravenous 1, 22 60 minutes ondansetron 8 mg oral administration 1, 22 cycliZINE 50 mg Three times daily oral administration 1 Full details Cycle 1 - 28 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. magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes Instructions: In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion. cISplatin * 50 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: 22 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. magnesium sulfate heptahydrate 10 mmol intravenous 60 minutes Instructions: In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion. cISplatin * 50 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. Day: 23 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: 24 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: 25 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. Supportive Care Factors Factor Value Emetogenicity: High Hydration: Routine hydration recommended References de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2018. "Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 19(3):295-309., PMID: 29449189 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2016. "Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 17(8):1114-1126., PMID: 27397040 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2019. "Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial." Lancet Oncol 20(9):1273-1285., PMID: 31345626 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/contents/infusion-reactions-to-systemic-chemotherapy (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.
50 mg Three times daily by oral administration
Commence within 4 to 6 weeks of surgery and in relation to radiation therapy as per institutional policy.
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.
Part 1: cISplatin chemoradiation (GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel)
Gynaecological - cISplatin chemoradiation
A drug treatment regimen for Gynaecological - cISplatin chemoradiation
de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2018. "Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 19(3):295-309., PMID: 29449189
de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2016. "Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 17(8):1114-1126., PMID: 27397040
de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2019. "Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial." Lancet Oncol 20(9):1273-1285., PMID: 31345626
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/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021).
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.
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake.
ONE hour prior to chemotherapy with food.
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion.
In 1000 mL of sodium chloride 0.9%, prior to cISplatin infusion.
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.
After cISplatin infusion. If cISplatin is infused in 1000 mL, centres may choose to omit this bag of fluid.
EIGHT hours after chemotherapy OR before bed.
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.
Part 2: cARBOplatin and PACLItaxel (GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel) Treatment Overview Commence within 3 weeks after completion of radiation therapy. This regimen follows cISplatin chemoradiation, not to be confused with GYN END Adjuvant - cARBOplatin and PACLItaxel [chemotherapy-only]. Cycles 1 to 4 - 21 days Cycle length: 21 Cycle details Cycles 1 to 4 - 21 days Medication Dose Route Days Max Duration dexamethasone * 20 mg oral administration 0 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 ondansetron 8 mg oral administration 1 loratadine * 10 mg oral administration 1 famotidine * 20 mg oral administration 1 PACLItaxel * 175 mg/m² intravenous 1 3 hours cARBOplatin * 5 AUC (area under the curve) intravenous 1 60 minutes ondansetron 8 mg oral administration 1 domperidone 10 mg Three times daily oral administration 1 Full details Cycles 1 to 4 - 21 days Day: 0 Medication Dose Route Max duration Details dexamethasone * 20 mg oral administration Instructions: Take the night prior to PACLItaxel infusion with food. If the initial infusion(s) of PACLItaxel are well tolerated, clinicians may decide at their discretion, to omit this dose. Day: 1 Medication Dose Route Max duration Details 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. 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. PACLItaxel * 175 mg/m² intravenous 3 hours 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. cARBOplatin * 5 AUC (area under the curve) intravenous 60 minutes Instructions: Hypersensitivity risk increases with number of cycles of cARBOplatin. ondansetron 8 mg oral administration Instructions: EIGHT hours after chemotherapy OR before bed. 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: 2 Medication Dose Route Max duration Details 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 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. Supportive Care Factors Factor Value Emetogenicity: High Growth factor support: Recommended for secondary prophylaxis Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended References de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2018. "Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 19(3):295-309., PMID: 29449189 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2016. "Toxicity and quality of life after adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): an open-label, multicentre, randomised, phase 3 trial." Lancet Oncol 17(8):1114-1126., PMID: 27397040 de Boer, S. M., M. E. Powell, L. Mileshkin, et al. 2019. "Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post-hoc survival analysis of a randomised phase 3 trial." Lancet Oncol 20(9):1273-1285., PMID: 31345626 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/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021). Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020). * 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.
5 AUC (area under the curve) over 60 minutes by intravenous
10 mg Three times daily by oral administration
Commence within 3 weeks after completion of radiation therapy. This regimen follows cISplatin chemoradiation, not to be confused with GYN END Adjuvant - cARBOplatin and PACLItaxel [chemotherapy-only].
Hypersensitivity / Infusion related reaction risk
High - routine premedication recommended
GYN - cARBOplatin and PACLItaxel [following chemoradiation]
Part 2: cARBOplatin and PACLItaxel (GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel)
Gynaecological - cARBOplatin and PACLItaxel [following chemoradiation]
A drug treatment regimen for Gynaecological - cARBOplatin and PACLItaxel [following chemoradiation]
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
Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020).
Take the night prior to PACLItaxel infusion with food. If the initial infusion(s) of PACLItaxel are well tolerated, clinicians may decide at their discretion, to omit this dose.
ONE hour prior to PACLItaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine.
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.
Hypersensitivity risk increases with number of cycles of cARBOplatin.
When required for nausea and/or vomiting. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
This regimen consists of two parts: cISplatin chemoradiation followed by cARBOplatin and PACLItaxel. Do not confuse with the chemotherapy-only regimen: GYN END Adjuvant - cARBOplatin and PACLItaxel [chemotherapy-only].
GYN END Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel
Gynaecological Endometrial Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel
A drug treatment regimen for Gynaecological Endometrial Adjuvant - cISplatin chemoradiation followed by cARBOplatin and PACLItaxel
Commence within 3 weeks after completion of radiation therapy.