Example orders for FLOX in colon cancer

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FLOX

FLOX: Fluorouracil, Leucovorin, OXaliplatin

Original references may be found at FLOX

Example regimen #1

• Fluorouracil (5-FU) 500 mg/m2 IV bolus on days 1, 8, 15, 22, 29, 36, to be given last, 1 hour after start of leucovorin
• Folinic acid (Leucovorin) 500 mg/m2 IV over 2 hours on days 1, 8, 15, 22, 29, 36, given concurrently with oxaliplatin on days when oxaliplatin is given
  • Mixed in 250 mL D5W.
• Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on days 1, 15, 29, given concurrently with leucovorin
  • Mixed in 500 mL D5W, and only infuse through D5W line.

8-week cycles x 3 cycles

Supportive medications:

• Ondansetron (Zofran) 8 mg IV on days 1, 15, 29; 30 minutes prior to oxaliplatin
• Dexamethasone (Decadron) 10 mg IV on days 1, 15, 29; 30 minutes prior to oxaliplatin
• Ondansetron (Zofran) 8 mg IV prn breakthrough nausea
• Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start prior to oxaliplatin to decrease likelihood of neuropathy
• Calcium gluconate 1 g & magnesium sulfate 1 g (admixed together) IV, given over 30 minutes, to start after oxaliplatin infusion is complete to decrease likelihood of neuropathy

Hydration:

• 500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.

Monitoring:

• Hold if ANC <1000 or platelets <100 and notify physician.

Comments:

• Rather than administer drugs in the order of: 1) Oxaliplatin (Eloxatin), 2) Folinic acid (Leucovorin), 3) Fluorouracil (5-FU), my institution administers oxaliplatin and leucovorin concurrently and then 5-FU last.