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Systemic Anti-Cancer Therapy Regimen Library

Home > UGI GAST NON-Metastatic - fluorouracil chemoradiation [modified MacDonald]

UGI GAST NON-Metastatic - fluorouracil chemoradiation [modified MacDonald]

Treatment Overview

Commence regimen in relation to radiation therapy as per institutional policy

Cycle 1 - 28 days

Cycle length:
28

Cycle 2 - 28 days

Cycle length:
28

To be given concurrently with the first four days of radiotherapy.

Cycle 3 - 28 days

Cycle length:
28

To be given concurrently with the last three days of radiotherapy.

Cycles 4 to 5 - 28 days

Cycle length:
28

Cycle details

Cycle 1 - 28 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1 to 5
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 1 to 5 2 minutes
fluorouracil * 425 mg/m² intravenous 1 to 5 15 minutes
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Cycle 2 - 28 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1 to 4
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 1 to 4 2 minutes
fluorouracil * 400 mg/m² intravenous 1 to 4 15 minutes
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

To be given concurrently with the first four days of radiotherapy.

Cycle 3 - 28 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1, 2, 3
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 1, 2, 3 2 minutes
fluorouracil * 400 mg/m² intravenous 1, 2, 3 15 minutes
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

To be given concurrently with the last three days of radiotherapy.

Cycles 4 to 5 - 28 days

Medication Dose Route Days Max Duration
ondansetron 8 mg oral administration 1 to 5
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 1 to 5 2 minutes
fluorouracil * 425 mg/m² intravenous 1 to 5 15 minutes
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1

Full details

Cycle 1 - 28 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes
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
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 3

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 4

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 5

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Cycle 2 - 28 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes
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
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes

Day: 3

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes

Day: 4

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes

Cycle 3 - 28 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes
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
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes

Day: 3

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 400 mg/m² intravenous 15 minutes

Cycles 4 to 5 - 28 days

Day: 1

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes
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
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 3

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 4

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Day: 5

Medication Dose Route Max duration Details
ondansetron 8 mg oral administration
Instructions:
ONE hour prior to chemotherapy. Alternative is dexamethasone 4 mg.
foliNIc acid (as calcium folinate) * 20 mg/m² intravenous 2 minutes
fluorouracil * 425 mg/m² intravenous 15 minutes

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Low
Hypersensitivity / Infusion related reaction risk: Low - routine premedication not recommended

References

Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, Haller DG, Ajani JA, Gunderson LL, Jessup JM, Martenson JA. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001 Sep 6;345(10):725-30., PMID: 11547741

Leong, T., D. L. Joon, D. Willis, et al. 2011. "Adjuvant chemoradiation for gastric cancer using epirubicin, cisplatin, and 5-fluorouracil before and after three-dimensional conformal radiotherapy with concurrent infusional 5-fluorouracil: a multicenter study of the Trans-Tasman Radiation Oncology Group." Int J Radiat Oncol Biol Phys 79(3):690-695., PMID: 20472363

Smalley, S. R., J. K. Benedetti, D. G. Haller, et al. 2012. "Updated Analysis of SWOG-Directed Intergroup Study 0116: A Phase III Trial of Adjuvant Radiochemotherapy Versus Observation After Curative Gastric Cancer Resection." J Clin Oncol. 30(19):2327-33., PMID: 22585691

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.