Systemic Anti-Cancer Therapy Regimen Library
UGI GAST AND OES NON-Metastatic - FLOT [DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [high dose foliNIc acid]
Treatment Overview
8 cycles (4 neoadjuvant and 4 adjuvant).
Cycles 1 to 8 - 14 days
Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
Cycle details
Cycles 1 to 8 - 14 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration | 0, 1, 2 | |
| ondansetron | 8 mg | oral administration | 1 | |
| DOCEtaxel * | 50 mg/m² | intravenous | 1 | 60 minutes |
| oxaliplatin * | 85 mg/m² | intravenous | 1 | 120 minutes |
| foliNIc acid (as calcium folinate) * | 200 mg/m² | intravenous | 1 | 120 minutes |
| fluorouracil * | 2600 mg/m² | intravenous | 1 | 24 hours Min: 24 hours |
| ondansetron | 8 mg | oral administration | 1 | |
| domperidone | 10 mg Three times daily | oral administration | 1 | |
| loperamide | 2 mg | oral administration | 1 | |
| pegFILGRASTIM | 6 mg | subcutaneous injection | 3 |
Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg prior to DOCEtaxel infusion.
Full details
Cycles 1 to 8 - 14 days
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 8 mg Twice daily | oral administration |
Instructions:
Take with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| DOCEtaxel * | 50 mg/m² | intravenous | 60 minutes |
Instructions:
Prepare solution in PVC-free bag and administer via polyethylene lined administration set. Please carry out graded challenge as per institutional policy. |
| 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) * | 200 mg/m² | intravenous | 120 minutes |
Instructions:
To run concurrently with oxaliplatin. |
| fluorouracil * | 2600 mg/m² | intravenous | 24 hours Min: 24 hours |
Instructions:
Continuous infusion via pump over 24 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 Twice daily | oral administration |
Instructions:
Take with food. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| pegFILGRASTIM | 6 mg | subcutaneous injection |
Supportive Care Factors
| Factor | Value |
|---|---|
| Diarrhoea risk: | Anti-diarrhoeals are usually prescribed with this treatment |
| Emetogenicity: | Medium |
| Growth factor support: | Recommended for primary prophylaxis |
| Hypersensitivity / Infusion related reaction risk: | High - routine premedication recommended |
References
2. Pfizer New Zealand Limited. DBL Docetaxel New Zealand Data Sheet 07 August 2020. https://www.medsafe.govt.nz/profs/Datasheet/d/dbldocetaxelinj.pdf (Accessed 26 November 2020).
3. 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).
6. 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)
7. E.S. Rogers, E. Witton, J. Stewart, D. Porter, 1542P - Efficacy and Safety of a Single Dose of Dexamethasone Pre Docetaxel Treatment: the Auckland Experience. Annals of Oncology, Volume 25, Supplement 4, 2014, Page iv537. https://doi.org/10.1093/annonc/mdu356.62.
* 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.