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.
AC-NPAC(W); AC-NPAC(W)+TRAS
Adjuvant
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
This 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). 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.
Neo-adjuvant or adjuvant treatment for node-positive and high risk node-negative early breast cancer, in patients who experienced hypersensitivity reactions to taxanes or have significant contraindications to taxanes and/or their pre-medications.
Trastuzumab may be used concurrently with nab-paclitaxel or after completion of nab-paclitaxel in HER-2 positive breast cancer.
(Refer to the NDFP eligibility form for detailed funding criteria)
nab-PACLitaxel
New Drug Funding Program
(Nab-Paclitaxel - Hypersensitivity Reactions to Taxanes)
(NDFP Website
)
trastuzumab
New Drug Funding Program
(Trastuzumab (Biosimilar) - Adjuvant Treatment for Breast Cancer)
Note: Different trastuzumab products are not interchangeable.
Nab-PACLitaxel is not-interchangeable with other PACLitaxel formulations.
AC: (x 4 cycles)
| DOXOrubicin | 60 mg /m² | IV | Day 1; q21 days |
| cyclophosphamide | 600 mg /m² | IV | Day 1; q21 days |
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nab-PACLITAXEL Weekly: (x 12 doses) |
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nab-PACLitaxel * | 125 mg /m² | IV | Day 1; q7 days |
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For patients with HER2 positive tumours, Trastuzumab may be given for one year, starting concurrently with nab-paclitaxel or after 12 weekly cycles of nab-paclitaxel: |
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| trastuzumab | 8 mg /kg | IV loading dose | Day 1, cycle 1 only |
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| trastuzumab | 6 mg /kg | IV maintenance dose | q21 Days |
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Alternative chemotherapy schedule: AC: (x 4 cycles) |
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| DOXOrubicin | 60 mg /m² | IV | Day 1; q14 Days |
| cyclophosphamide | 600 mg /m² | IV | Day 1; q14 Days |
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nab-PACLITAXEL Weekly: (x 12 doses) |
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nab-PACLitaxel * | 125 mg /m² | IV | Day 1; q7 days |
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Alternative Trastuzumab schedule: For patients with HER2 positive tumours, Trastuzumab may be given for one year, starting concurrently with paclitaxel or after 12 weekly cycles of paclitaxel: |
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| trastuzumab | 4 mg /kg | IV loading dose | Day 1, cycle 1 only |
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| trastuzumab | 2 mg /kg | IV maintenance dose | Weekly (q7 Days) |
AC X 4 cycles then weekly nab-Paclitaxel X 12 doses
Trastuzumab: To start concurrently with or after paclitaxel. Refer to TRAS regimen for cycles after the chemotherapy is completed
High (AC)
Low (nab-Paclitaxel)
- Also refer to CCO Antiemetic Recommendations.
Low
AC(Q3W)-NPAC(W)
High
AC(Q2W)-NPAC(W): Use G-CSF prophylaxis for patients at high risk of febrile neutropenia. See G-CSF recommendations.
Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.
Pre-medications (prophylaxis for infusion reaction):
Nab-paclitaxel:
- No pre-medication to prevent hypersensitivity is required.
Ontario Health drug monographs:
Cyclophosphamide drug monograph, Ontario Health (Cancer Care Ontario).
Doxorubicin drug monograph, Ontario Health (Cancer Care Ontario).
Nab-paclitaxel drug monograph, Ontario Health (Cancer Care Ontario).
Trastuzumab drug monograph, Ontario Health (Cancer Care Ontario).
AC-PACL±TRAS:
Henderson IC, Berry D, Demetri G, Cirrincione C, et al. Improved outcomes from adding sequential paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 2003; 21(6): 976-83.
Romond EH, Perex EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. NEJM 2005; 353(16) 1673-84.
Sparano JA, Wang M, Martino S, et al. Weekly paclitaxel in the adjuvant treatment of breast cancer. NEJM 2008; 358(16): 1663-71.
Nab-Paclitaxel:
CADTH Reimbursement Recommendation: Nab-Paclitaxel (for patients who developed hypersensitivity reactions to taxanes). July 2024.
Gianni L, Mansutti M, Anton A, et al.. Comparing Neoadjuvant Nab-paclitaxel vs Paclitaxel Both Followed by Anthracycline Regimens in Women With ERBB2/HER2-Negative Breast Cancer-The Evaluating Treatment With Neoadjuvant Abraxane (ETNA) Trial: A Randomized Phase 3 Clinical Trial. JAMA Oncol. 2018 Mar 1;4(3):302-308.
Untch M, Jackisch C, Schneeweiss A, et al. Nab-paclitaxel versus solvent-based paclitaxel in neoadjuvant chemotherapy for early breast cancer (GeparSepto-GBG 69): a randomised, phase 3 trial. Lancet Oncol. 2016 Mar;17(3):345-356. Erratum in: Lancet Oncol. 2016 Jul;17(7):e270.
January 2026 new ST-QBP regimen
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.