Gynaecology Chemotherapy Regimens

The information contained in these regimens is a statement of consensus of NCCP and ISMO or IHS professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. The treatment regimen to be used should take into account factors such as histology, molecular pathology, age, performance status, co-morbidities and the patient’s preference. Each treatment regimen has advantages and disadvantages, and there may be more than one good option.  In addition, treatment choices can change over time as more evidence becomes available. Use of these documents is the responsibility of the prescribing clinician and is subject to the HSE.ie terms of use.

Please email any comments or feedback on these regimens to oncologydrugs@cancercontrol.ie.

See Gynaecological Regimens - Cervical Cancer here

See Gynaecological Regimens - Gestational Trophoblastic Neoplasia (GTN) here

See Gynaecological Regimens - Ovarian Cancer here

Information on BRCA testing for Olaparib is available here

 Cervical Chemotherapy Regimens

Regimen Name Indication

CISplatin 40mg/m2 Weekly with Radiotherapy (RT)

Regimen

00385a

Chemoradiation treatment for locally advanced (stage IIB to IVA) cervical squamous cell carcinoma (SCC).

Gestational Trophoblastic Neoplasia (GTN)

Regimen Name Indication

Actinomycin D Therapy mg/kg –14 days

Regimen

00247a

Alternative treatment of low risk gestational trophoblastic disease (GTD) (risk score ≤ 6.

EMA/CO Therapy

Regimen

00248a

Treatment of high risk gestational trophoblastic neoplasia (GTN) (FIGO score ≥7).

00248b

Treatment of patients with low risk GTN who have not responded or have relapsed from single agent chemotherapy (methotrexate or actinomycin D).

Two Day Etoposide Cisplatin (EP) Therapy

Regimen

00267a

Emergency treatment of women with Gestational Trophoblastic Neoplasia (GTN) who are acutely unwell from liver or CNS disease and particularly those at risk of respiratory failure.

00267b

Hepatic Metastases.
Women with GTN who are acutely unwell from liver disease.

00267c

Cerebral Metastases.
Women with GTN who are acutely unwell from cerebral metastases.

Etoposide Cisplatin/Etoposide Methotrexate Actinomycin D(EP/EMA) Therapy

Regimen

00264a

Treatment of women with high-risk Gestational Trophoblastic Neoplasia (GTN) who have not responded or have relapsed from treatment with EMA/CO.

00264b

GTN and hepatic metastases.

Women with GTN and hepatic metastases at presentation.

Intrathecal Methotrexate for CNS prophylaxis in GTN

Regimen

00249a

Central nervous system (CNS) prophylaxis in patients with high risk gestational trophoblastic neoplasia (GTN).

00249b

Central nervous system (CNS) prophylaxis in patients with low risk gestational trophoblastic neoplasia (GTN) with lung metastases.

Methotrexate 8 day Charing Cross Regimen

Regimen

00246a

Treatment of low risk gestational trophoblastic disease (GTD) (FIGO score ≤ 6).

Paclitaxel/Etoposide alternating with Paclitaxel/Cisplatin (TE/TP) Therapy

Regimen

00266a

Treatment of women with high-risk Gestational Trophoblastic Neoplasia (GTN) who have not responded or have relapsed from treatment with EMA/CO.

Ovarian Chemotherapy Regimens

Regimen Name Indication

Bevacizumab 10 mg/kg –14 days

Regimen

00212b

In combination with paclitaxel, topotecan (given weekly), or pegylated liposomal doxorubicin is indicated for the treatment of adult patients with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor–targeted agents.

Bevacizumab 7.5mg/kg-21 days

 

Regimen

In combination with carboplatin and paclitaxel as first line treatment in FIGO stage III debulked but residual disease more than 1cm, or FIGO stage IV

00214c*

epithelial ovarian,

00214d*

fallopian tube, or

00214e*

primary peritoneal cancer.

Bevacizumab 15mg/kg-21 days

 

 

 

 

 

Regimen

00215a

In combination with carboplatin and paclitaxel is indicated for the front-line treatment of adult patients with advanced (International Federation of Gynecology and Obstetrics (FIGO) stages III B, III C and IV) epithelial ovarian, fallopian tube, or primary peritoneal cancer.

00215b

In combination with carboplatin and gemcitabine, is indicated for treatment of adult patients with first recurrence of platinum-sensitive epithelial ovarian, fallopian tube or primary peritoneal cancer who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor–targeted agents.

00215c

In combination with, topotecan given on days 1-5 every 3 weeks*, for the treatment of adult patients with platinum-resistant recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who received no more than two prior chemotherapy regimens and who have not received prior therapy with bevacizumab or other VEGF inhibitors or VEGF receptor–targeted agents.

CARBOplatin (AUC 4-6) Monotherapy- 28 day

Regimen

First line adjuvant therapy of

00251a

ovarian carcinoma of epithelial origin

00251b

primary peritoneal carcinoma

00251c

fallopian tube cancer

where combination therapy is not suitable.

CARBOplatin (AUC 4-6) Monotherapy- 28 day

Regimen

First line therapy of advanced Stage 3 and 4

00251d

ovarian carcinoma of epithelial origin

00251e

primary peritoneal carcinoma

00251f

fallopian tube cancer

where surgery is not feasible and where combination therapy is not suitable.

CARBOplatin (AUC 4-6) Monotherapy- 28 day

Regimen

Treatment of recurrent, platinum-sensitive,

00251g

invasive ovarian carcinoma of epithelial origin

00251h

primary peritoneal carcinoma

00251i

fallopian tube cancer

CARBOplatin (AUC 4-6) Monotherapy- 21 day

Regimen

First line adjuvant therapy of

00261a

ovarian carcinoma of epithelial origin

00261b

primary peritoneal carcinoma

00261c

fallopian tube cancer

where combination therapy is not suitable.

CARBOplatin (AUC 4-6) Monotherapy- 21 day

Regimen

First line therapy of advanced Stage 3 and 4

00261d

ovarian carcinoma of epithelial origin

00261e

primary peritoneal carcinoma

00261f

fallopian tube cancer

where surgery is not feasible and where combination therapy is not suitable.

CARBOplatin (AUC 4-6) Monotherapy- 21 day

Regimen

Treatment of recurrent, platinum-sensitive,

00261g

invasive ovarian carcinoma of epithelial origin

00261h

primary peritoneal carcinoma

00261i

fallopian tube cancer.

Carboplatin (AUC5-7.5) and Paclitaxel 175mg/m2 Therapy

Regimen

00303a

Adjuvant treatment of high risk, stage I, epithelial ovarian cancer*

00303b

Treatment of advanced ovarian cancer

00303c

Treatment of primary peritoneal cancer

00303d

Treatment of fallopian tube cancer

00303e

Treatment of recurrent or advanced endometrial cancer (stage III or IV) *

00303f

Treatment of advanced/recurrent non small cell (NSC)cancer of the cervix *

00303g

Treatment of carcinoma of unknown primary site*

Carboplatin (AUC 5-6) and Weekly Paclitaxel 80mg/m2 Therapy

Regimen

00308a

Adjuvant treatment of high risk, stage I, epithelial ovarian cancer*

00308b

Treatment of advanced ovarian cancer*

00308c

Treatment of primary peritoneal cancer*

00308d

Treatment of fallopian tube cancer*

Gemcitabine 1000mg/m2 andCARBOplatin (AUC 4) Therapy-21 day

Regimen

00306a

Treatment of patients with locally advanced or metastatic epithelial ovarian carcinoma, in patients with relapsed disease following a recurrence-free interval of at least 6 months after platinum-based, first line therapy.

00306b

Treatment of patients with fallopian tube cancer with relapsed disease following a recurrence-free interval of at least 6 months after platinum-based, first line therapy*

00306c

Treatment of patients with primary peritoneal cancer with relapsed disease following a recurrence-free interval of at least 6 months after platinum-based, first line therapy*

Olaparib Monotherapy

Regimen

00341a

Maintenance treatment of adult patients with platinum -sensitive relapsed BRCA-mutated (germline and/or somatic) -high grade serous epithelial ovarian cancer who are in response (complete response or partial response) to platinum-based chemotherapy.

00341b

Maintenance treatment of adult patients with platinum -sensitive relapsed BRCA-mutated (germline and/or somatic) fallopian tube cancer who are in response (complete response or partial response) to platinum-based chemotherapy.

00341c

Maintenance treatment of adult patients with platinum -sensitive relapsed BRCA-mutated (germline and/or somatic)  primary peritoneal cancer who are in response (complete response or partial response) to platinum-based chemotherapy.

Pegylated Liposomal Doxorubicin (CAELYX) ® 28 days

Regimen

00205b

Treatment of advanced ovarian cancer in women who have failed a first-line platinum-based chemotherapy regimen.

Paclitaxel Monotherapy 80mg/m2-7day cycle

Regimen

00226b*

Second-line chemotherapy for metastatic ovarian cancer after failure of standard, platinum-containing therapy.

Topotecan Monotherapy-5 day

Regimen 

00311a

Treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy

00311c

Treatment of patients with metastatic carcinoma of the fallopian tubes after failure of first-line or subsequent therapy*

00311d

Treatment of patients with metastatic peritoneal  carcinoma after failure of first-line or subsequent therapy*

Topotecan Monotherapy-Weekly*

Regimen

00312a

Treatment of patients with metastatic carcinoma of the ovary after failure of first-line or subsequent therapy

00312b

Treatment of patients with metastatic carcinoma of the fallopian tubes after failure of first-line or subsequent therapy

00312c

Treatment of patients with metastatic peritoneal  carcinoma after failure of first-line or subsequent therapy

Trabectedin and Pegylated Liposomal Doxorubicin (PLD) Therapy

Regimen

00375a

Treatment of patients with relapsed platinum-sensitive ovarian cancer.

Intravenous Vinorelbine Therapy-21 days

Regimen

00232c*

Platinum refractory advanced ovarian carcinoma. 

*Unlicensed indication. See regimen for more details.