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Systemic Anti-Cancer Therapy Regimen Library

Home > UGI GAST AND OES Metastatic - CAPOX [capecitabine and oxaliplatin] and nivolumab

UGI GAST AND OES Metastatic - CAPOX [capecitabine and oxaliplatin] and nivolumab

Treatment Overview

Usually up to 6 cycles of CAPOX in combination with nivolumab.

Continue nivolumab monotherapy for up to 2 years, or until disease progression or unacceptable toxicity.  

Cycles 1 to 6 - 21 days - CAPOX and nivolumab

Cycle length:
21

Cycles 7 to 35 - 21 days - nivolumab monotherapy

Cycle length:
21

nivolumab monotherapy: Alternative dosing schedule 480 mg every 28 days.

Cycle details

Cycles 1 to 6 - 21 days - CAPOX and nivolumab

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1, 2, 3
ondansetron 8 mg oral administration 1
nivolumab * 360 mg flat dosing intravenous 1 30 minutes
oxaliplatin * 130 mg/m² intravenous 1 120 minutes
capecitabine * 1000 mg/m² Twice daily oral administration 1 to 14
ondansetron 8 mg oral administration 1
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Cycles 7 to 35 - 21 days - nivolumab monotherapy

Medication Dose Route Days Max Duration
nivolumab * 360 mg flat dosing intravenous 1 30 minutes

nivolumab monotherapy: Alternative dosing schedule 480 mg every 28 days.

Full details

Cycles 1 to 6 - 21 days - CAPOX 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 * 360 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 * 130 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.
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.
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.
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

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.
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 4

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 5

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 6

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 7

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 8

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 9

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 10

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 11

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 12

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 13

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Day: 14

Medication Dose Route Max duration Details
capecitabine * 1000 mg/m² Twice daily oral administration
Instructions:

Take each dose with food and a large glass of water.

Round dose to closest multiple of 150 mg and/or 500 mg tablets.

Cycles 7 to 35 - 21 days - nivolumab monotherapy

Day: 1

Medication Dose Route Max duration Details
nivolumab * 360 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 CAPOX treatment.

Emetogenicity:

  • CAPOX and nivolumab:
  • MEDIUM day 1.
  • MINIMAL to LOW day 2 to 14 (capecitabine). Antiemetics may be required with continuous dosing of oral anti-cancer medicines with MINIMAL to LOW emetic risk; an individualised approach is appropriate. 
  • nivolumab monotherapy: MINIMAL.

References

Jatoi, A., B. R. Murphy, N. R. Foster, et al. 2006. "Oxaliplatin and capecitabine in patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction and gastric cardia: a phase II study from the North Central Cancer Treatment Group." Ann Oncol 17(1):29-34., PMID: 16303863

Janjigian, Y. Y., K. Shitara, M. Moehler, et al. 2021. "First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial." Lancet 398(10294):27-40., PMID: 34102137

Shitara, K., J. A. Ajani, M. Moehler, et al. 2022. "Nivolumab plus chemotherapy or ipilimumab in gastro-oesophageal cancer." Nature 603(7903):942-948., PMID: 35322232

* 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.