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.