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Systemic Anti-Cancer Therapy Regimen Library

Home > UGI GAST AND OES Locally advanced/Metastatic - TFOX [DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid]

UGI GAST AND OES Locally advanced/Metastatic - TFOX [DOCEtaxel, oxaliplatin, foliNIc acid and fluorouracil] [low dose foliNIc acid]

Treatment Overview

Cycle 1 (and all further cycles) - 14 days

Cycle length:
14

Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg (10 mg if aprepitant is used as part of antiemetic regimen) prior to docetaxel infusion.

Cycle details

Cycle 1 (and all further cycles) - 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) * 50 mg flat dosing intravenous 1 2 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

Some centres may wish to replace the three oral doses of dexamethasone 8 mg premedication with a single intravenous dose of dexamethasone 20 mg (10 mg if aprepitant is used as part of antiemetic regimen) prior to docetaxel infusion.

Full details

Cycle 1 (and all further cycles) - 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:
  • 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 * 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 Twice daily oral administration
Instructions:

Take with food.

Supportive Care Factors

Factor Value
Diarrhoea risk: Anti-diarrhoeals are usually prescribed with this treatment
Emetogenicity: Medium
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended

Emetogenicity:

  • Women 50 years and under should be considered high risk for oxaliplatin-induced nausea and vomiting, so antiemetic prophylaxis regimen should include an NK1 (e.g. aprepitant 125 mg day 1 and 80 mg days 2 and 3) based on trial evidence.
  • Aprepitant is expected to increase dexamethasone exposure; dexamethasone dose should be reduced by approximately 50% (e.g. to 8 mg ONCE daily) on days of concomitant administration.

References

Zaanan A, Bouché O, de la Fouchardière C, et al. TFOX versus FOLFOX in first-line treatment of patients with advanced HER2-negative gastric or gastro-oesophageal junction adenocarcinoma (PRODIGE 51- FFCD-GASTFOX): an open-label, multicentre, randomised, phase 3 trial. Lancet Oncol. 2025 Jun;26(6):732-744., PMID: 40286809

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

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.

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 4 February 2025. https://www.medsafe.govt.nz/profs/Datasheet/o/oxaliccordinf.pdf (Accessed 5 March 2026).

Pharmacy Retailing (NZ) limited t/a Healthcare Logistics. Docetaxel Accord New Zealand Medicine Data Sheet 14 November 2023. https://www.medsafe.govt.nz/profs/datasheet/d/docetaxelaccordinj.pdf (Accessed 5 March 2026).

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.