Example orders for FOLFIRI in colon cancer
Carboplatin & Paclitaxel (CP)
CP: Carboplatin & Paclitaxel
Regimen
Study | Dates of enrollment | Evidence | Comparator | Comparative Efficacy |
---|---|---|---|---|
Forde et al. 2022 (CheckMate 816) | 2017-2019 | Phase 3 (C) | 1a. CP & Nivolumab 1b. CVb & Nivolumab 1c. DC & Nivolumab |
Inferior EFS |
Note: there were additional comparator options depending on histology; see the respective histology-specific pages for more details. This study was conducted in the United States. The reason for the study was that an unanswered question at the time was whether adding an immune checkpoint inhibitor would improve outcomes.
Biomarker eligibility criteria
- CheckMate 816: No sensitizing EGFR or ALK mutations
Chemotherapy
- Carboplatin (Paraplatin) AUC 5 or 6 IV once on day 1
- Paclitaxel (Taxol) 175 or 200 mg/m2 IV once on day 1
21-day cycle for 3 cycles
Subsequent treatment
References
- CheckMate 816: Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, Felip E, Broderick SR, Brahmer JR, Swanson SJ, Kerr K, Wang C, Ciuleanu TE, Saylors GB, Tanaka F, Ito H, Chen KN, Liberman M, Vokes EE, Taube JM, Dorange C, Cai J, Fiore J, Jarkowski A, Balli D, Sausen M, Pandya D, Calvet CY, Girard N; CheckMate 816 Investigators. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022 May 26;386(21):1973-1985. Epub 2022 Apr 11. link to original article contains dosing details in manuscript PubMed NCT02998528
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Remember that example order sets that may contain additional information about supportive medications, suggestions for monitoring, hydration, and pre-treatment screening information for chemotherapy regimens are purely anecdotal, provided only as examples of what some other providers may be using, and are typically not based on references in the primary literature.
FOLFIRI
FOLFIRI: FOLinic acid, Fluorouracil, IRInotecan
Original references may be found at FOLFIRI
Example regimen #1
- Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours on day 1, given during irinotecan infusion
- Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on day 1, given after irinotecan and leucovorin
- Fluorouracil (5-FU) 1200 mg/m2/day IV continuous infusion over 46 hours on days 1 to 2, given last after bolus 5-FU
- Irinotecan (Camptosar) 180 mg/m2 IV over 90 minutes on day 1, given first together with leucovorin
14-day cycles
Supportive medications
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
- Dexamethasone (Decadron) 10 mg IV 30 minutes prior to chemotherapy
- Lorazepam (Ativan) 0.5-1 mg PO/IV prn nausea/anxiety
- Atropine 0.4 mg IV prn diaphoresis, visual changes, abdominal cramping, or diarrhea during or after irinotecan infusion
Monitoring:
- Hold if ANC <1000 or platelets <100 and notify physician.
Outpatient medications:
- Loperamide (Imodium) 4 mg PO x1 for each day's first episode of diarrhea; 2 mg PO prn each loose stool thereafter, up to a maximum of 16 mg per day