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Systemic Anti-Cancer Therapy Regimen Library

Home > Neuroendocrine neoplasm Advanced - mFOLFOXIRI [irinotecan, oxaliplatin, foliNIc acid and fluorouracil] [high dose foliNIc acid]

Neuroendocrine neoplasm Advanced - mFOLFOXIRI [irinotecan, oxaliplatin, foliNIc acid and fluorouracil] [high dose foliNIc acid]

Treatment Overview

Cycle 1 (and all further cycles) - 14 days

Cycle length:
14

oxaliplatin:

  • Consideration should be given to limiting oxaliplatin to 6 cycles.
  • If oxaliplatin is continued, oxaliplatin should be limited to 12 cycles.
  • Maintenance therapy may be continued in patients who are stable or responding to treatment.

foliNIc acid: In a clinical trial (Falcone et al, see below), levofolinic acid 200 mg/m2 was used and is equivalent to foliNIc acid (as calcium folinate) 400 mg/m2.

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
aprepitant 80 mg oral administration 2, 3
dexamethasone * 12 mg oral administration 1
dexamethasone * 8 mg oral administration 2, 3, 4
ondansetron 8 mg oral administration 1
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) * 400 mg/m² intravenous 1 120 minutes
fluorouracil * 3200 mg/m² intravenous 1 48 hours Min: 48 hours
ondansetron 8 mg oral administration 1
cyclIZINE 50 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

oxaliplatin:

  • Consideration should be given to limiting oxaliplatin to 6 cycles.
  • If oxaliplatin is continued, oxaliplatin should be limited to 12 cycles.
  • Maintenance therapy may be continued in patients who are stable or responding to treatment.

foliNIc acid: In a clinical trial (Falcone et al, see below), levofolinic acid 200 mg/m2 was used and is equivalent to foliNIc acid (as calcium folinate) 400 mg/m2.

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.
atropine sulfate * 600 microgram intravenous 2 minutes
Instructions:

Only if required for acute diarrhoea or cholinergic symptoms.

  • Alternatively, dose may be administered subcutaneously.
  • 600 microgram = 0.6 mg.
  • Some centres may wish to give a reduced dose of 300 microgram (= 0.3 mg) in line with institutional policy.
  • Dose may be repeated up to a maximum dose of 1200 microgram (= 1.2 mg).
irinotecan * 165 mg/m² intravenous 90 minutes
oxaliplatin * 85 mg/m² intravenous 120 minutes
Instructions:
  • To run concurrently with foliNIc acid.
  • 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 with number of cycles of oxaliplatin.
foliNIc acid (as calcium folinate) * 400 mg/m² intravenous 120 minutes
Instructions:
To run concurrently with oxaliplatin.
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.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

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.

Dose and duration may be individualised at clinician’s discretion.

Supportive Care Factors

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

References

Borghesani M, Reni A, Zaninotto E, et al. Outcomes of upfront treatment with mFOLFIRINOX regimen in G3 GEP-NENs: A monocentric retrospective experience. Paper presented at: 18th Annual ENETS Conference for the Diagnosis and Treatment of Neuroendocrine Tumor Disease; February 25-27,2021; Virtual Conference.

Zhu J, Strosberg JR, Dropkin E, Strickler JH. Treatment of high-grade metastatic pancreatic neuroendocrine carcinoma with FOLFIRINOX. J Gastrointest Cancer 2015;46:166-169. , PMID: 25662891

Falcone, A., S. Ricci, I. Brunetti, et al. 2007. "Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest." J Clin Oncol 25(13):1670-1676., PMID: 17470860

Regimen details sometimes vary slightly from the published literature after recommendation by expert committee consensus.

* 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.