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regimen-monograph
CISPDOXOPACL
Regimens that may eventually be ‘evidenced informed’, but are still undergoing review. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
| DOXOrubicin
(Round to nearest 1 mg) |
45 mg /m² | IV | Day 1 |
| CISplatin
(Round to nearest 1 mg) |
50 mg /m² | IV | Day 1 |
|
(continued on next page)
|
|||
| PACLitaxel
*
(Round to nearest 3 mg) |
160 mg /m² | IV over 3 hours | Day 2 |
|
* Paclitaxel is given on day 2 because of previous reports suggesting that the cardiotoxicity associated with paclitaxel and doxorubicin combination was decreased when these agents were administered 16 to 24 hours apart.
|
|||
| filgrastim | 5 mcg /kg | SC | Daily, on Days 3 -12 |
REPEAT EVERY 21 DAYS
For a usual total of 7 cycles unless disease progression or unacceptable toxicity
Moderate
Low (Paclitaxel)
Other Supportive Care:
- Patients Should be pretreated with a corticosteroid as well as an antihistamine and a H2 Blocker on Day 2: For example:
- DEXAMETHASONE* 20mg PO 12 & 6 hours before Paclitaxel OR 20 mg IV 30 minutes before Paclitaxel
- DIPHENHYDRAMINE 50mg IV 30 minutes before Paclitaxel
- RANITIDINE 50mg IV 30 minutes before Paclitaxel
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
Refer to Appendix 6 for general recommendations
Neurotoxicity
Grade 3: OMIT Paclitaxel, Cisplatin and Doxorubicin doses until symptoms no worse than Grade 1, then restart therapy but REDUCE Paclitaxel and Cisplatin to 80% dose (suggested). Discontinue therapy for recurrent Grade 3 neurotoxicity.
Hepatic Impairment
| Bilirubin |
Dose
|
|
If Bilirubin 1-2.5 x ULN
|
REDUCE Doxorubicin to 50% dose
|
|
If Bilirubin 2-4 x ULN
|
Give MAXIMUM DOSE of Paclitaxel of 135mg/m2
And REDUCE Doxorubicin to 25% dose
|
|
If Bilirubin > 4 x ULN
|
OMIT Paclitaxel dose or
Give MAXIMUM DOSE of Paclitaxel 50mg/m2
And OMIT Doxorubicin
|
Renal Impairment
| Renal function | Dose |
|
If CrCl = 0.5-1 mL/sec or
Serum Creatinine=136-185µmol/L
|
REDUCE Cisplatin* to 50% dose |
|
If CrCl < 0.5mL/sec or
Serum Creatinine>185µmol/L
|
OMIT Cisplatin* dose
|
* Upon the discretion of the prescriber, less dose reduction may be suggested. See CISPLATIN drug monograph.
Most frequently occurring adverse effects
- Neurotoxicity and ototoxicity
- Cardiotoxicity (especially at doses > 450mg/m2 or with risk factors, including prior mitoxantrone, epirubicin or other cardiotoxic drugs)
- Nephrotoxicity
- Myelosuppression
- Nausea and vomiting
- Hypersensitivity reactions
- Myalgia and arthralgia
- Fatigue
- Stomatitis
- Diarrhea
- Vesicant
- Alopecia
Recommended Clinical Monitoring
- Clinical toxicity (including local toxicity, stomatitis, neurotoxicity, ototoxicity, cardiotoxicity) assessment.
- Baseline and regular cardiac examination for patients with cardiac risk factors (including prior therapy with Epirubicin, Mitoxantrone and other cardiotoxic drug) and cumulative doxorubicin doses > 450mg/m2.
- 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 (including electrolytes and magnesium) tests.
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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Kwon JS, Elit L, Finn M et al. A compariaon of two prophylactic regimens for hypersensitivity recations to paclitaxel. Gynecol Oncol 2002 Mar; 84(3): 420-5.
Fleming GF, Brunetto VL, Cella D, Look KY, Reid G, Munkarah A, et al. Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrialcarcinoma: A Gynecologic Oncology Group study. J Clin Oncol 2004;22:2159-66.
Paclitaxel in combination with cisplatin/doxorubicin chemotherapy improves both response rate and median survival; however, the use of this three-drug combination is associated with increased toxicity (i.e. neurotoxicity).
December 2011: Modified section F
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.
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Last Updated: July 21, 2026