Selected Treatment Schedules: Adenocarcinoma, Small Intestine, Colon

Selected Treatment Schedules

2dd, twice daily; AUC, area under the concentration–time curve; BMI, body mass index; FU, fluorouracil; HER2, human Epidermal growth factor receptor 2; FOLFIRI, folinic acid, fluorouracil and irinotecan; 5-FU, 5-fluorouracil.

Adenocarcinoma, Small Intestine

(Neo)adjuvant Palliative
--- 3-weekly capecitabine 2dd 1250 mg/m2 d1-14
--- CapOx: 3-weekly oxaliplatin 130 mg/m2 (d1), capecitabine 2dd 1000 mg/m2 d1-14
--- FOLFOX4: oxaliplatin 85 mg/m2 d1, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 600 mg/m2/22 h, d1, 2 q14[9]
--- mFOLFOX6: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, followed by 5-FU 1200 mg/m2/48 h, d q14[10]
--- FOLFIRI: irinotecan 180 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5- FU 2400 mg/m2/48 h[11]
--- 3-weekly irinotecan 350 mg/m2 or 600 mg flat dose if BMI ≤30 kg/m2 

References

9. Colucci G, Gebbia V, Paoletti G, et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 2005; 23:4866–4875.

10. Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004; 22:229–237.

11. André T, Louvet C, Maindrault-Goebel F, et al. CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic colorectal cancer. GERCOR. Eur J Cancer 1999; 35:1343–1347.

Adenocarcinoma, Colon

(Neo)adjuvant Palliative
3-weekly capecitabine 2dd 1250 mg/m2 d1-14[12] 3-weekly capecitabine 2dd 1250 mg/m2 d1-14
CapOx: 3-weekly oxaliplatin 130 mg/m2 (d1), capecitabine 2dd 1000 mg/m2 d1-14[13] CapOx: 3-weekly oxaliplatin 130 mg/m2 (d1), capecitabine 2dd 1000 mg/m2 d1-14[13]
FOLFOX4: oxaliplatin 85 mg/m2 d1, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 600 mg/m2/22 h, d1, 2 q14[14] FOLFOX4: oxaliplatin 85 mg/m2 d1, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 600 mg/m2/22 h, d1, 2 q14[9]
mFOLFOX6: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 1200 mg/m2/48 h, d q14[15] mFOLFOX6: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, followed by 5-FU 1200 mg/m2/48 h, d q14[10]
--- FOLFIRI: irinotecan 180 mg/m2, leucovorin 200 mg/m2, 5-FU 400 mg/m2 IV bolus, 5-FU 2400 mg/m2/48 h[12]
--- 3-weekly irinotecan 350 mg/m2 or 600 mg flat dose if BMI ≤30 kg/m2[16] 
--- FOLFOXIRI: oxaliplatin 85 mg/m2, leucovorin 200 mg/m2, irinotecan 165 mg/m2, 5-FU 3200 mg/m2/48 h
--- FOLFIRI + aflibercept 4 mg/kg
--- 2-weekly panitumumab 6 mg/kg[17]
--- 3-weekly cetuximab 250 mg/m2 (400 mg loading dose)[18]
--- Regorafenib 160 mg continuously[19]

References

9. Colucci G, Gebbia V, Paoletti G, et al. Phase III randomized trial of FOLFIRI versus FOLFOX4 in the treatment of advanced colorectal cancer: a multicenter study of the Gruppo Oncologico Dell’Italia Meridionale. J Clin Oncol 2005; 23:4866–4875.

10. Tournigand C, André T, Achille E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004; 22:229–237.

12. Twelves C, Wong A, Nowacki MP, et al. Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med 2005; 352:2696–2704.

13. Hochster HS, Hart LL, Ramanathan RK, et al. Safety and efficacy of oxaliplatin and fluoropyrimidine regimens with or without bevacizumab as first-line treatment of metastatic colorectal cancer: results of the TREE Study. J Clin Oncol 2008; 26:3523–3529.

14. de Gramont A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 2000; 18:2938–2947.

15. Cheeseman SL, Joel SP, Chester JD, et al. A ‘modified de Gramont’ regimen of fluorouracil, alone and with oxaliplatin, for advanced colorectal cancer. Br J Cancer 2002; 87:393–399.

16. Cunningham D, Pyrhönen S, James RD, et al. Randomised trial of irinotecan plus supportive care versus supportive care alone after fluorouracil failure for patients with metastatic colorectal cancer. Lancet 1998; 352:1413–1438.

17. Van Cutsem E, Peeters M, Siena S, et al. Open-label phase III trial of panitumumab plus best supportive care compared with best supportive care alone in patients with chemotherapy-refractory metastatic colorectal cancer. J Clin Oncol 2007; 25:1658–1664.

18. Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351:337–345.

19. Grothey A, Van Cutsem E, Sobrero A, et al. Regorafenib monotherapy for previously treated metastatic colorectal cancer (CORRECT): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381:303–312. 

Last update: 08 July 2016