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Systemic Anti-Cancer Therapy Regimen Library

UGI PANC Metastatic - mFOLFOX6 [oxaliplatin, foliNIc acid and fluorouracil] [high dose foliNIc acid]

Treatment Overview

Cycle 1 (and all further cycles) - 14 days

Cycle length:
14

Cycle details

Cycle 1 (and all further cycles) - 14 days

Medication Dose Route Days Max Duration
dexamethasone * 8 mg oral administration 1, 2, 3
ondansetron 8 mg oral administration 1
oxaliplatin * 85 mg/m² intravenous 1 120 minutes
foliNIc acid * 400 mg/m² intravenous 1 120 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

Full details

Cycle 1 (and all further cycles) - 14 days

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.
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 * 400 mg/m² intravenous 120 minutes
Instructions:
To run concurrently with oxaliplatin.
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.

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 8 mg oral administration
Instructions:
ONCE daily in the morning with food.

Supportive Care Factors

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

References

Gill, S. Y. Ko, C. Cripps, et al. 2016. "Pancreox: A randomised phase III study of Fluorouracil/Leucovorin with or without Oxaliplatin for Second-Line Advanced Pancreatic Cancer in Patients who have received Gemcitabine-based Chemotherapy." J Clin Oncol 34:3914-3920, PMID: 27621395

Oettle, H., H. Riess, J. Stieler, et al. 2014. “Second-line Oxaliplatin, Folinic Acid, and Fluorouracil versus Folinic Acid and Fluorouracil alone for Gemcitabine-Refractory Pancreatic Cancer: Outcomes from the CONKO-003 Trial”. J Clin Oncol 32:2423-2429, PMID: 24982456

Yoo, C., J. Y. Hwang, J. E. Kim, et al. 2009. "A randomised phase II study of modified FOLFIRI.3 vs modified FOLFOX as second-line therapy in patients with gemcitabine-refractory advanced pancreatic cancer." Br J Cancer 101(10):1658-1663., PMID: 19826418

Pelzer, U., I. Schwaner, J. Stieler, et al. 2011. “Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: a phase III-study from the German CONKO-study group.” Eur J Cancer 47(11):1676-1681., PMID: 21565490

Tsavaris, N., C. Kosmas, H. Skopelitis, et al. 2005. "Second-line treatment with oxaliplatin, leucovorin and 5-fluorouracil in gemcitabine-pretreated advanced pancreatic cancer: A phase II study." Invest New Drugs 23(4):369-375., PMID: 16012797

Novarino, A., M. A. Satolli, I. Chiappino, et al. 2009. "Oxaliplatin, 5-fluorouracil, and leucovorin as second-line treatment for advanced pancreatic cancer." Am J Clin Oncol 32(1):44-48, PMID: 19194124

Ghosn, M., F. Farhat, J. Kattan, et al. 2007. "FOLFOX-6 combination as the first-line treatment of locally advanced and/or metastatic pancreatic cancer." Am J Clin Oncol 30(1):15-20., PMID: 17278889

Boulanger J, Boursiquot JN, Cournoyer G, et al. Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations. Curr Oncol. 2014;21(4):e630-e641. , PMID: 25089112

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/contents/infusion-reactions-to-systemic-chemotherapy (Accessed 26 March 2021).

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).

* 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.