Example orders for CapeOx (XELOX) in colon cancer
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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.
CapeOx (XELOX)
CapeOX: Capecitabine, OXaliplatin
XELOX: XELoda, OXaliplatin
Published regimens and references may be found on the colon cancer page.
Example regimen #1
- Capecitabine (Xeloda) 1000 mg/m2 PO twice per day on days 1 to 14
- Oxaliplatin (Eloxatin) 130 mg/m2 IV over 2 hours on day 1
- Mix in 500 mL D5W, and only infuse through D5W line.
21-day cycles x 8 cycles for adjuvant therapy; in metastatic settings, given until progression of disease or unacceptable toxicity
Supportive therapy
- Ondansetron (Zofran) 8 mg IV 30 minutes prior to chemotherapy
- Dexamethasone (Decadron) 10 mg IV 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 neuropathyCalcium 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- Calcium and magnesium no longer recommended to reduce risk of oxaliplatin-induced neuropathy: Charles L. Loprinzi, Rui Qin, Shaker R. Dakhil, Louis Fehrenbacher, Philip J. Stella, Pamela J. Atherton, Drew K. Seisler, Rubina Qamar, Grant Carlton Lewis, Axel Grothey. Phase III randomized, placebo (PL)-controlled, double-blind study of intravenous calcium/magnesium (CaMg) to prevent oxaliplatin-induced sensory neurotoxicity (sNT), N08CB: An alliance for clinical trials in oncology study. 2013 ASCO Annual Meeting abstract 3501. link to abstract
Hydration:
- 500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.
Monitoring:
- Hold if ANC less than 1000 or platelets less than 100 and notify physician.
Comments:
- My institution uses the schedule described by Haller et al. 2011.