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.
CRBPPACL+NIVL+IPIL
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.
First-line treatment of metastatic or recurrent squamous non-small cell lung cancer (NSCLC), with no known epidermal growth factor (EGFR) or anasplatic lymphoma kinase (ALK) genomic tumour aberrations, in patients with good performance status
nivolumab
New Drug Funding Program
(Nivolumab plus Ipilimumab - In Combination with Platinum Doublet Chemotherapy for First Line Metastatic or Recurrent Non-Small Cell Lung Cancer)
(NDFP Website
)
ipilimumab
New Drug Funding Program
(Nivolumab plus Ipilimumab - In Combination with Platinum Doublet Chemotherapy for First Line Metastatic or Recurrent Non-Small Cell Lung Cancer)
(NDFP Website
)
Cycle 1:
|
nivolumab * | 4.5 mg /kg | IV | Day 1 |
|
|
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| ipilimumab | 1 mg /kg | IV | Day 1 |
| PACLitaxel | 175-200 mg /m² | IV | Day 1 |
| CARBOplatin | AUC 6 | IV | Day 1 |
|
Cycle 2: |
|||
|
nivolumab * | 4.5 mg /kg | IV | Day 1 |
|
|
|||
| PACLitaxel | 175-200 mg /m² | IV | Day 1 |
| CARBOplatin | AUC 6 | IV | Day 1 |
Give every 21 days for 2 cycles only, unless disease progression or unacceptable toxicity occurs.
After completion of cycles 1 and 2, continue with nivolumab q3 weeks and ipilimumab q6 weeks [see NIVL+IPIL(MNT) for details].
Pre-medications (prophylaxis for infusion reaction):
Nivolumab:
-
Routine pre-medication is not recommended.
-
May consider pre-medication with antipyretics and H1-receptor antagonists if an IR has occurred in the past.
Ipilimumab:
- Consider an antipyretic and H1-receptor antagonist
- For ipilimumab-related drug fever, premedicate with acetaminophen for subsequent doses and may repeat the antipyretic at 6-12 hours after the ipilimumab infusion.
PACLitaxel:
Pre-medications* (prophylaxis for infusion reaction):
- Dexamethasone 20 mg PO 12-and 6-hours OR Dexamethasone 20 mg IV 30 minutes pre-infusion†
- Diphenhydramine 25-50 mg IV/PO 30-60 minutes pre-infusion
- Ranitidine 50 mg IV OR Famotidine 20 mg IV 30-60 minutes pre-infusion
* Consider discontinuing pre-medications for paclitaxel if there was no IR in the first 2 doses.
† Oral and IV dexamethasone are both effective at reducing overall IR rates. Some evidence suggests that oral dexamethasone may be more effective for reducing severe reactions; however, adverse effects and compliance remain a concern.
Antiemetic Regimen: Moderate + NK1 antagonist (Carboplatin AUC ≥ 5)
Also refer to CCO Antiemetic Recommendations.
Paz-Ares L, Ciuleanu TE, Cobo M, et al. First-line nivolumab plus ipilimumab combined with two cycles of chemotherapy in patients with non-small-cell lung cancer (CheckMate 9LA): an international, randomised, open-label, phase 3 trial. Lancet Oncol . 2021 Feb;22(2):198-211. doi: 10.1016/S1470-2045(20)30641-0.
pCODR Expert review committee final recommendation: Nivolumab in combination with ipilimumab and two cycles of platinum-based chemotherapy, March 2021.
September 2023 Updated "Administrative Information" with pharmacy and nursing workload.
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.
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