Example orders for mFOLFOX 6 in colon cancer
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.
Published regimens and references may be found on the colon cancer page.
Example regimen #1
- Fluorouracil (5-FU) 400 mg/m2 IV bolus over 10-15 minutes on day 1 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 to 2, given after 5-FU bolus
- Folinic acid (Leucovorin) 400 mg/m2 IV over 2 hours on day 1, given first, concurrently with oxaliplatin
- Mixed in 250 mL D5W.
- Oxaliplatin (Eloxatin) 85 mg/m2 IV over 2 hours on day 1, given first, concurrently with leucovorin
- Mixed in 500 mL D5W, and only infuse through D5W line.
14-day cycles x 12 cycles, to start within 10 weeks of surgery (if adjuvant); in metastatic settings, given until progression of disease or unacceptable toxicity
- 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
- 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
- 500 ml D5W at KVO rate as running IV for chemotherapy infusion. Give up to 500 ml D5W.
- Hold if ANC <1500 or platelets <75 and notify physician.