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Systemic Anti-Cancer Therapy Regimen Library

Home > CRC ACA - mitomycin and capecitabine chemoradiation

CRC ACA - mitomycin and capecitabine chemoradiation

Treatment Overview

Commence regimen in relation to radiation therapy as per institutional policy.

Cycle 1 - 42 days

Cycle length:
42

Cycle details

Cycle 1 - 42 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1
mitomycin * 12 mg/m² Cap dose per administration at: 20 mg intravenous 1 15 minutes
capecitabine * 825 mg/m² Twice daily oral administration 1 to 5,
8 to 12,
15 to 19,
22 to 26,
29 to 33,
36 to 40
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Full details

Cycle 1 - 42 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:

ONE hour prior to chemotherapy.

Alternative is dexamethasone 4 mg.
mitomycin * 12 mg/m² Cap dose per administration at: 20 mg intravenous 15 minutes
Instructions:

Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration.
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.
domperidone 10 mg Three times daily oral administration
Instructions:

When required for nausea and/or vomiting.

The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics.
loperamide 2 mg oral administration
Instructions:
Take TWO capsules (=4 mg) at onset of loose bowel motions and a further ONE capsule (=2 mg) for every loose bowel motion (maximum of EIGHT capsules in 24 hours), or use as directed by oncologist or haematologist.

Day: 2

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 3

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 4

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 5

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 8

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 9

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 10

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 11

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 12

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 15

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 16

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 17

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 18

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 19

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 22

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 23

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 24

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 25

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 26

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 29

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 30

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 31

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 32

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 33

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 36

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 37

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 38

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 39

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 40

Medication Dose Route Max duration Details
capecitabine * 825 mg/m² Twice daily oral administration
Instructions:
  • Take on the days of radiation therapy.
  • Take each dose with food and a large glass of water.
  • Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Variable

Emetogenicity:

  • LOW day 1.
  • MINIMAL to LOW (capecitabine): Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate. 

References

Seo, Y., M. T. Kinsella, H. L. Reynolds, et al. 2009. "Outcomes of Chemoradiotherapy With 5-Fluorouracil and Mitomycin C for Anal Cancer in Immunocompetent Versus Immunodeficient Patients." International Journal of Radiation Oncology Biology Physics 75(1):143-149., PMID: 19203845

Fraunholz, I., W. Christian, E. Klaus, et al. 2010. "Concurrent Chemoradiotherapy with 5-Fluorouracil and Mitomycin C for Invasive Anal Carcinoma in Human Immunodeficiency Virus-Positive Patients Receiving Highly Active Antiretroviral Therapy." International Journal of Radiation Oncology Biology Physics. 76 (5): 1425-1432., PMID: 19744801

Bartelink, H., F. Roelofsen, F. Eschwege, et al. 1997. "Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups." J Clin Oncol 15(5):2040-2049., PMID: 9164216

1996. UK Co-ordinating Committee on Cancer Research. 1996 "Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. UKCCCR Anal Cancer Trial Working Party. " Lancet 348(9034):1049-1054., PMID: 8874455

Flam, M., M. John, T. F. Pajak, et al. 1996. "Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study." J.Clin Oncol. 14(9):2527-2539., PMID: 8823332

Twelves, C., A. Wong, M. P. Nowacki, et al. 2005. "Capecitabine as adjuvant treatment for stage III colon cancer." N.Engl.J.Med. 352(26):2696-2704., PMID: 15987918

Oliveira, S. C., C. M. Moniz, R. Riechelmann, et al. 2016. "Phase II Study of Capecitabine in Substitution of 5-FU in the Chemoradiotherapy Regimen for Patients with Localized Squamous Cell Carcinoma of the Anal Canal." J Gastrointest Cancer 47(1):75-81., PMID: 26691173

Glynne-Jones, R., H. Meadows, S. Wan, et al. 2008. "EXTRA--a multicenter phase II study of chemoradiation using a 5 day per week oral regimen of capecitabine and intravenous mitomycin C in anal cancer." Int J Radiat Oncol Biol Phys 72(1):119-126., PMID: 18472366

Goodman, K.A., D. Rothenstein, C. Lajhem, et al. 2014. "Capecitabine Plus Mitomycin in Patients Undergoing Definitive Chemoradiation for Anal Squamous Cell Carcinoma." Int J Radiat Oncol. 9(1):1-7., PMID: 28721892

Thind, G., B. Johal, M. Follwell, et al. 2014. "Chemoradiation with capecitabine and mitomycin-C for stage I-III anal squamous cell carcinoma." Radiat Oncol 9:124., PMID: 24885554

Meulendijks, D., L. Dewit, N. B. Tomasoa, et al. 2014. "Chemoradiotherapy with capecitabine for locally advanced anal carcinoma: an alternative treatment option." Br J Cancer 111(9):1726-1733., PMID: 25167226

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.