Example orders for mFOLFOX 6 & Bevacizumab (Avastin) 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.


mFOLFOX 6 & Bevacizumab (Avastin)

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 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 to 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
  • Calcium and magnesium are 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.
  • 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.