Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
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regimen-monograph
CISPPACL
A - Regimen Name
CISPPACL Regimen
PACLitaxel-CISplatin
Disease Site
Lung
Intent
Palliative
Regimen Category
Standard : Standard therapy endorsed by the Disease Site Group or a regimen widely used by most Regional Cancer Centres in this disease site. The category is unrelated to the source or availability of funding.
Rationale and Uses
• First-line treatment of advanced non-small cell lung cancer (NSCLC)
OR
• Treatment of advanced NSCLC (EGFR mutation positive) after disease progression with first-line gefitinib
OR
• Treatment of advanced NSCLC after other first-line therapy abandoned within the first 2 doses due to toxicity
Supplementary Public Funding
PACLitaxel
New Drug Funding Program (Paclitaxel - Non-Small Cell Lung Cancer (NSCLC))
B - Drug Regimen
| PACLitaxel
(Round to nearest 3 mg) |
200-225 mg /m² | IV | Day 1 |
| CISplatin
(Round to nearest 1 mg) |
75 mg /m² | IV | Day 1 |
C - Cycle Frequency
REPEAT EVERY 21 DAYS
For a usual total of 4 to 6 cycles in responding patients, unless disease progression or unacceptable toxicity occurs
D - Premedication and Supportive Measures
Antiemetic Regimen:
High
Other Supportive Care:
- Paclitaxel: Patients should be pretreated with a corticosteroid as well as an antihistamine and a H2 blocker: For example:
- DEXAMETHASONE 20mg PO 12 & 6 hours or 20mg IV 30 minutes before paclitaxel
- DIPHENHYDRAMINE 50mg IV 30 minutes before paclitaxel
- RANITIDINE 50mg IV 30 minutes before paclitaxel
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities
See Appendix 6 for general recommendations.
Neurotoxicity
Grade 3 or 4: REDUCE Paclitaxel to 80% usual dose.
Other toxicity: Refer to drug monographs for management of hypersensitivity.
Hepatic Impairment
|
Bilirubin / LFTs
|
Dose
|
|
1. If Bilirubin or AST/ALT 2-4 x ULN
|
Give Maximum dose of Paclitaxel of 135mg/m2
|
|
2. If Bilirubin or AST/ALT > 4 x ULN
|
OMIT Paclitaxel dose
or give maximum dose of 50mg/m2
|
Renal Impairment
PACLitaxel: No adjustment required
CISplatin: See specific protocol. In general, renal function should have normalized before patients are retreated. If continued treatment is considered to be mandatory, the following dose modifications could be considered at the physician's discretion.
|
Creatinine clearance
|
Cisplatin (% previous dose)
|
|
46-60
|
75%
|
|
30-45
|
50%
|
|
<30
|
Discontinue
|
F - Adverse Effects
Refer to PACLitaxel, CISplatin drug monograph(s) for additional details of adverse effects
| Most Common Side Effects | Less Common Side Effects, but may be |
|
|
H - Drug Administration and Special Precautions
Refer to PACLitaxel, CISplatin drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Clinical toxicity assessment (including local toxicity, neurotoxicity, ototoxicity)
- CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary
- Baseline and regular liver and renal function tests (including electrolytes and magnesium) and urinalysis
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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J - Administrative Information
Approximate Patient Visit
7 hours
Pharmacy Workload (average time per visit)
44.249 minutes
Nursing Workload (average time per visit)
64.833 minutes
K - References
Bonomi P, Kim K, Fairdough D, Cella D et al: Comparison of survival and quality of life in advanced NSCLC patients treated with two dose levels of paclitaxel combined with cisplatin versus etoposide with cisplatin. Result of an Eastern Co-operative Oncology Group Trial. JCO, 18(3) Feb, 2000: 623-631
Langer C, Manola J, Bernardo P, et al. Cisplatin-based therapy for elderly patients with advanced non-small-cell lung cancer: implications of Eastern Cooperative Oncology Group 5592, a randomized trial. J Nat Can Inst . 94(13): 1029-30, 2002.
Schiller JH, Harrington D, Belani CP, Langer C, Sandler A, Krook J, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. New Engl J Med 2002;346:92-8.
PEBC Advice Documents or Guidelines
October 2017 Formatted public funding info and renal impairment section; modified Nov 2011
L - Other Notes
There is no convincing evidence that any new agent (gemcitabine, vinorelbine, docetaxel, paclitaxel, irinotecan, pemetrexed) in combination with platinum is superior to any other platinum plus new agent combination.
For patients receiving platinum-based doublet therapy, a recommendation in favour of cisplatin over carboplatin is made based on a probable modest improvement in survival and an improvement in response. Cisplatin regimens result in more frequent nausea/vomiting and nephropathy, while thrombocytopenia is worse with carboplatin. Given the poor prognosis in this population, the relative toxicities and QOL differences should be given strong consideration.
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 27, 2026
