Systemic Anti-Cancer Therapy Regimen Library
UGI PANC Metastatic - FOLFIRINOX [oxaliplatin, irinotecan, foliNIc acid and fluorouracil] [low dose foliNIc acid]
Treatment Overview
Usual maximum of 12 cycles.
Cycle 1 (and all further cycles) - 14 days
Cycle details
Cycle 1 (and all further cycles) - 14 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration | 1 to 4 | |
| aprepitant | 125 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 12 mg | oral administration | 1 | |
| dexamethasone * | 8 mg | oral administration | 2, 3, 4 | |
| ondansetron | 8 mg | oral administration | 1 | |
| oxaliplatin * | 85 mg/m² | intravenous | 1 | 120 minutes |
| atropine sulfate * | 600 microgram | intravenous | 1 | 2 minutes |
| irinotecan * | 180 mg/m² | intravenous | 1 | 90 minutes |
| foliNIc acid * | 50 mg flat dosing | intravenous | 1 | 2 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 | |
| cycliZINE | 50 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 |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment. |
|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 12 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:
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. |
| atropine sulfate * | 600 microgram | intravenous | 2 minutes |
Instructions:
600 microgram = 0.6 mg. Some centres may wish to give a reduced dose of 300 micrograms (= 0.3 mg) in line with institutional policy. |
| irinotecan * | 180 mg/m² | intravenous | 90 minutes | |
| foliNIc acid * | 50 mg flat dosing | intravenous | 2 minutes | |
| 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. |
|
| cycliZINE | 50 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. Warning: may cause drowsiness. Consider starting dose at 25 mg and increasing as tolerated/required. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation. |
|
| 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 |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| 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: | High |
References
Lowery, Maeve A, Kenneth H. Yu, Nelly G. Adel, et al. 2012. "Activity of front-line FOLFIRINOX (FFX) in stage III/IV pancreatic adenocarcinoma (PC) at Memorial Sloan-Kettering Cancer Center (MSKCC)." ASCO Meeting Abstracts 30(15_suppl):4057.
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.