Example orders for mFOLFOX6-B in colon cancer

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mFOLFOX 6 & Bevacizumab (Avastin)

Original references may be found at mFOLFOX 6 & Bevacizumab (Avastin)

Example regimen #1

• Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on days 1 & 15 after oxaliplatin and leucovorin
• Fluorouracil (5-FU) 1200 mg/m2/day (total dose 2400 mg/m2) IV continuous infusion over 46 hours on days 1-2, 15-16, given after 5-FU bolus
• Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours on days 1 & 15, given after bevacizumab, concurrently with oxaliplatin
  • Mixed in 250 mL D5W.
• Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on days 1 & 15, given after bevacizumab, concurrently with leucovorin
  • Mixed in 500 mL D5W, and only infuse through D5W line.
• Bevacizumab (Avastin) 5 mg/kg IV on days 1 & 15, given first
  • Only infuse through NS line. Infusion times for bevacizumab are 90 for cycle 1, 60 minutes for cycle 2, then 30 minutes for cycles 3 and later.

28-day cycles

Supportive medications:

• Ondansetron (Zofran) 8 mg IV 30 minutes prior to oxaliplatin
• Dexamethasone (Decadron) 10 mg IV 30 minutes prior to oxaliplatin
• Lorazepam (Ativan) 0.5-1 mg PO prn nausea/anxiety, given 30 minutes prior to chemotherapy
• 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.
• 500 ml NS at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml NS.

Monitoring:

• Hold if ANC <1500 or platelets <75 and notify physician.
• Check blood pressure during and after the first two doses of bevacizumab; for the third dose and later, check blood pressure before and after bevacizumab.
• Check urine protein every month; notify physician for urine protein >100 mg/dL.

Comments:

• My institution administers this regimen in 28-day cycles.