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Systemic Anti-Cancer Therapy Regimen Library

CRC Metastatic - mFOLFIRI [irinotecan, foliNIc acid and fluorouracil] and beVACizumab [low dose foliNIc acid]

Treatment Overview

Cycle 1 (and all further cycles) - 14 days

Cycle length:
14

Cycle details

Cycle 1 (and all further cycles) - 14 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1
dexamethasone * 8 mg oral administration 1, 2, 3
beVACizumab 5 mg/kg intravenous 1 90 minutes
atropine sulfate * 600 microgram intravenous 1 2 minutes
irinotecan 180 mg/m² intravenous 1 90 minutes
foliNIc acid (as calcium folinate) 50 mg flat dosing intravenous 1 2 minutes
fluorouracil 400 mg/m² intravenous 1 15 minutes
fluorouracil 2400 mg/m² intravenous 1 46 hours Min: 46 hours
ondansetron 8 mg oral administration 1
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Full details

Cycle 1 (and all further cycles) - 14 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy.
dexamethasone * 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy with food.
beVACizumab 5 mg/kg intravenous 90 minutes
Instructions:
In 100 mL sodium chloride 0.9% via STANDARD secondary line. Blood pressure and urinalysis to be checked pre-administration. If protein is up to 3+, proceed with infusion. If beVACizumab is well tolerated, the second dose may be given over 60 minutes and subsequent doses may be given over 30 minutes.
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:
600 microgram = 0.6 mg. Some centres may wish to give a reduced dose of 300 micrograms (= 0.3 mg) in line with institutional policy.
irinotecan 180 mg/m² intravenous 90 minutes
foliNIc acid (as calcium folinate) 50 mg flat dosing intravenous 2 minutes
fluorouracil 400 mg/m² intravenous 15 minutes
fluorouracil 2400 mg/m² intravenous 46 hours Min: 46 hours
Instructions:
Continuous infusion via pump over 46 hours.
ondansetron 8 mg oral administration
Instructions:
EIGHT hours after chemotherapy or before bed.
domperidone 10 mg Three times daily oral administration
Instructions:
When required for nausea and/or vomiting.
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
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food.

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Medium
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

References

1. Ackland, S. P., S. Clarke, R. Perez-Carrión, et al. 2008. "Updated efficacy data from AVIRI: A large phase IV trial of first-line bevacizumab plus FOLFIRI in patients with mCRC." ASCO 2008 Gastrointestinal Cancers Symposium.

2. Hurwitz, H., L. Fehrenbacher, W. Novotny, et al. 2004. "Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer." N.Engl.J Med. 350(23):2335-2342., PMID: 15175435

* 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.