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Home > UGI GAST AND OES Neoadjuvant/Adjuvant - DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid] followed by durvalumab

UGI GAST AND OES Neoadjuvant/Adjuvant - DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid] followed by durvalumab

Treatment Overview

This regimen consists of:

1. 4 cycles of DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid] Q4W for 2 neoadjuvant  and 2 adjuvant cycles, then

2. durvalumab Q4W monotherapy for 10 cycles.


This regimen contains a medicine where one or more biosimilars may exist. Any biosimilars used have been reviewed by the regulator (Medsafe) and relevant specialists were consulted nationally. Where regulators, in consultation with relevant specialists, have agreed that there are no clinically significant differences in either safety or effectiveness between a biosimilar and originator product, these drugs may be used interchangeably.

Cycles 1 to 4 - 28 days - DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid]

Cycle length:
28

dexamethasone: 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.


durvalumab: For those with body-weight of 30 kg or less weight-based dosing of durvalumab 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycles 5 to 14 - 28 days - durvalumab monotherapy

Cycle length:
28

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of durvalumab 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycle details

Cycles 1 to 4 - 28 days - DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid]

Medication Dose Route Days Max Duration
dexamethasone * 8 mg Twice daily oral administration 0, 1, 2,
14, 15, 16
ondansetron 8 mg oral administration 1, 15
durvalumab * 1500 mg flat dosing intravenous 1 60 minutes
DOCEtaxel * 50 mg/m² intravenous 1, 15 60 minutes
oxaliplatin * 85 mg/m² intravenous 1, 15 120 minutes
foliNIc acid (as calcium folinate) * 50 mg flat dosing intravenous 1, 15 2 minutes
fluorouracil * 2600 mg/m² intravenous 1, 15 24 hours Min: 24 hours
ondansetron 8 mg oral administration 1, 15
domperidone 10 mg Three times daily oral administration 1
loperamide 2 mg oral administration 1
pegFILGRASTIM 6 mg subcutaneous injection 3, 17

dexamethasone: 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.


durvalumab: For those with body-weight of 30 kg or less weight-based dosing of durvalumab 20 mg/kg is recommended until weight increases to greater than 30 kg.

Cycles 5 to 14 - 28 days - durvalumab monotherapy

Medication Dose Route Days Max Duration
durvalumab 1500 mg flat dosing intravenous 1 60 minutes

durvalumab: For those with body-weight of 30 kg or less weight-based dosing of durvalumab 20 mg/kg is recommended until weight increases to greater than 30 kg.

Full details

Cycles 1 to 4 - 28 days - DFLOT [durvalumab, DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid]

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.

    durvalumab * 1500 mg flat dosing intravenous 60 minutes
    Instructions:
    • Administer via a sterile, low protein binding 0.2 or 0.22 micron in-line filter.
    • For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended.
    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:
    • 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 * 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

    Day: 14

    Medication Dose Route Max duration Details
    dexamethasone * 8 mg Twice daily oral administration
    Instructions:

    Take with food.

    Day: 15

    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:
      • 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 * 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.

      Day: 16

      Medication Dose Route Max duration Details
      dexamethasone * 8 mg Twice daily oral administration
      Instructions:

      Take with food.

      Day: 17

      Medication Dose Route Max duration Details
      pegFILGRASTIM 6 mg subcutaneous injection

      Cycles 5 to 14 - 28 days - durvalumab monotherapy

      Day: 1

      Medication Dose Route Max duration Details
      durvalumab 1500 mg flat dosing intravenous 60 minutes
      Instructions:
      • Administer via a sterile, low protein binding 0.2 or 0.22 micron in-line filter.
      • For those with body-weight of 30 kg or less weight-based dosing of 20 mg/kg is recommended.

      Supportive Care Factors

      Factor Value
      Diarrhoea risk: Variable
      Emetogenicity: Variable
      Growth factor support: Variable
      Hypersensitivity / Infusion related reaction risk: Variable

      Diarrhoea: Antidiarrhoeals are usually prescribed with DFLOT.


      Emetogenicity:

      • DFLOT: MEDIUM.
      • durvalumab monotherapy: MINIMAL.

      Growth factor support: Recommended for primary prophylaxis with DFLOT.


      Hypersensitivity / Infusion related reaction risk:

      • DFLOT: HIGH - routine premedication recommended.
      • durvalumab monotherapy: LOW - routine premedication not recommended.

      References

      Janjigian YY, Al-Batran SE, Wainberg ZA, et al; MATTERHORN Investigators. Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer. N Engl J Med. 2025 Jul 17;393(3):217-230., PMID: 40454643

      AstraZeneca Limited. Imfinzi New Zealand Data Sheet 17 July 2025. https://www.medsafe.govt.nz/profs/Datasheet/i/imfinziinf.pdf (Accessed 11 September 2025).

      Pfizer New Zealand Limited. DBL Docetaxel New Zealand Data Sheet 05 February 2024. https://www.medsafe.govt.nz/profs/Datasheet/d/dbldocetaxelinj.pdf (Accessed 11 September 2025)

      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).

      Chouhan JD, Herrington JD. "Single premedication dose of dexamethasone 20 mg IV before docetaxel administration." J Oncol Pharm Pract. 2011 Sep;17(3):155-9. Doi: 10.1177/1078155210367950. Epub 2010 May 6. , PMID: 20447949

      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 (Accessed 26 March 2021)

      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.

      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.