Systemic Anti-Cancer Therapy Regimen Library
UGI GAST AND OES Metastatic - mFOLFOX6 [oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid] and nivolumab
Treatment Overview
Usually up to 12 cycles of mFOLFOX6 in combination with nivolumab.
Continue nivolumab monotherapy for up to 2 years, or until disease progression or unacceptable toxicity.
Cycles 1 to 12 - 14 days - mFOLFOX6 and nivolumab
Cycles 13 to 52 - 14 days - nivolumab monotherapy
nivolumab monotherapy: Alternative dosing schedule 480 mg every 28 days.
Cycle details
Cycles 1 to 12 - 14 days - mFOLFOX6 and nivolumab
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration | 1, 2, 3 | |
| ondansetron | 8 mg | oral administration | 1 | |
| nivolumab * | 240 mg flat dosing | intravenous | 1 | 30 minutes |
| oxaliplatin * | 85 mg/m² | intravenous | 1 | 120 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 |
Cycles 13 to 52 - 14 days - nivolumab monotherapy
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| nivolumab * | 240 mg flat dosing | intravenous | 1 | 30 minutes |
nivolumab monotherapy: Alternative dosing schedule 480 mg every 28 days.
Full details
Cycles 1 to 12 - 14 days - mFOLFOX6 and nivolumab
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. |
|
| nivolumab * | 240 mg flat dosing | intravenous | 30 minutes |
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 1.2 micron in-line filter. |
| 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 with number of cycles of oxaliplatin. |
| 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. 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 |
|---|---|---|---|---|
| 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 |
|---|---|---|---|---|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion. |
Cycles 13 to 52 - 14 days - nivolumab monotherapy
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| nivolumab * | 240 mg flat dosing | intravenous | 30 minutes |
Instructions:
Administer via a sterile, non-pyrogenic, low protein binding 0.2 to 1.2 micron in-line filter. |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Variable |
| Emetogenicity: | Variable |
| Hypersensitivity / Infusion related reaction risk: | Low - routine premedication not recommended |
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with mFOLFOX6 treatment.
Emetogenicity:
- mFOLFOX6 and nivolumab: MEDIUM.
- nivolumab monotherapy: MINIMAL.
References
Pharmacy Retailing (NZ) limited t/a Healthcare Logistics. Oxaliplatin Accord New Zealand Data Sheet. https://www.medsafe.govt.nz/profs/Datasheet/o/oxaliccordinf.pdf (Accessed 16 February 2021).
Castells, M.C., Matulonis, U.A., and Horton, TM. Infusion reactions to systemic chemotherapy. Savarese DMF and Feldweg AM, ed. UpToDate. Waltham, MA: UpToDate Inc. https://www.uptodate.com (Accessed 26 March 2021).
* 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.