Systemic Anti-Cancer Therapy Regimen Library
CRC Metastatic - mFOLFOX6 [oxaliplatin, foliNIc acid and fluorouracil] [high dose foliNIc acid] and beVACizumab
Treatment Overview
This regimen has been updated (April 2026) to remove fluorouracil bolus following the recommendation of the New Zealand Society for Oncology (NZSO) Gastrointestinal Cancers Special Interest Group (GISIG).
Users please note that this is a new regimen with a new SNOMED CT code. The earlier regimen which includes fluorouracil bolus can be found here.
This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.
Cycle 1 (and all further cycles) - 14 days
Cycle details
Cycle 1 (and all further cycles) - 14 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| beVACizumab | 5 mg/kg | intravenous | 1 | 30 minutes |
| oxaliplatin | 85 mg/m² | intravenous | 1 | 120 minutes |
| foliNIc acid (as calcium folinate) | 400 mg/m² | intravenous | 1 | 120 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 |
|---|---|---|---|---|
| dexamethasone * | 8 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 | 30 minutes |
Instructions:
|
| oxaliplatin | 85 mg/m² | intravenous | 120 minutes |
Instructions:
To run concurrently with folinic acid.
|
| foliNIc acid (as calcium folinate) | 400 mg/m² | intravenous | 120 minutes |
Instructions:
To run concurrently with oxaliplatin. |
| 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 |
Emetogenicity: Women 50 years and under should be considered high risk for oxaliplatin-induced nausea and vomiting, so antiemetic prophylaxis regimen should include an NK1 (e.g. aprepitant 125 mg day 1 and 80 mg days 2 and 3) based on trial evidence.
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.