Example orders for FLOX 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.

FLOX

FLOX: Fluorouracil, Leucovorin, OXaliplatin

Published regimens and references may be found on the colon cancer page.

Example regimen #1

• Fluorouracil (5-FU) 500 mg/m² IV bolus on days 1, 8, 15, 22, 29, 36, to be given last, 1 hour after start of leucovorin
• Leucovorin (Folinic acid) 500 mg/m² IV over 2 hours on days 1, 8, 15, 22, 29, 36, given concurrently with oxaliplatin on days when oxaliplatin is given
  • Mixed in 250 mL D5W.
• Oxaliplatin (Eloxatin) 85 mg/m² IV over 2 hours on days 1, 15, 29, given concurrently with leucovorin
  • Mixed in 500 mL D5W, and only infuse through D5W line.

8-week cycles x 3 cycles

Supportive therapy

• Ondansetron (Zofran) 8 mg IV on days 1, 15, 29; 30 minutes prior to oxaliplatin
• Dexamethasone (Decadron) 10 mg IV on days 1, 15, 29; 30 minutes prior to oxaliplatin
• Ondansetron (Zofran) 8 mg IV prn breakthrough nausea
• 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

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:

• Rather than administer drugs in the order of: 1) Oxaliplatin (Eloxatin), 2) Leucovorin (Folinic acid), 3) Fluorouracil (5-FU), my institution administers oxaliplatin and leucovorin concurrently and then 5-FU last.