Systemic Anti-Cancer Therapy Regimen Library
CRC Metastatic - mFOLFOXIRI [irinotecan, oxaliplatin, foliNIc acid and fluorouracil] with beVACizumab [low dose foliNIc acid]
Treatment Overview
Cycle 1 (and all further cycles) - 14 days
Cycle details
Cycle 1 (and all further cycles) - 14 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration | 1 to 4 | |
| aprepitant | 125 mg | oral administration | 1 | |
| dexamethasone * | 12 mg | oral administration | 1 | |
| ondansetron | 8 mg | oral administration | 1 | |
| beVACizumab | 5 mg/kg | intravenous | 1 | 90 minutes |
| atropine sulfate * | 600 microgram | intravenous | 1 | 2 minutes |
| irinotecan * | 165 mg/m² | intravenous | 1 | 90 minutes |
| oxaliplatin | 85 mg/m² | intravenous | 1 | 120 minutes |
| foliNIc acid (as calcium folinate) | 50 mg flat dosing | intravenous | 1 | 2 minutes |
| fluorouracil | 3200 mg/m² | intravenous | 1 | 48 hours Min: 48 hours |
| ondansetron | 8 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 8 mg | oral administration | 2, 3, 4 | |
| cyclIZINE | 50 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 |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment. |
|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 12 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| 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 * | 165 mg/m² | intravenous | 90 minutes | |
| oxaliplatin | 85 mg/m² | intravenous | 120 minutes |
Instructions:
Usual infusion time of two hours may be extended to up to 6 hours if needed to reduce likelihood and/or severity of adverse reactions. Hypersensitivity risk increases when patients are re-challenged with oxaliplatin. |
| foliNIc acid (as calcium folinate) | 50 mg flat dosing | intravenous | 2 minutes | |
| fluorouracil | 3200 mg/m² | intravenous | 48 hours Min: 48 hours |
Instructions:
Continuous infusion via pump over 48 hours. |
| ondansetron | 8 mg | oral administration |
Instructions:
EIGHT hours after chemotherapy or before bed. |
|
| cyclIZINE | 50 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. Warning: may cause drowsiness. Consider starting dose at 25 mg and increasing as tolerated/required. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation. |
|
| 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 |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| 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: | High |
| Hypersensitivity / Infusion related reaction risk: | Low - routine premedication not recommended |
References
* 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.