Professional Documents
Culture Documents
Indications
Regimen details
Administration
Controlled document
Day
1
1-14
Document Number
ASWCS11 GI022
Version Number
1.1.a
Page 1 of 6
Body Surface
Dose (mg) to be given TWICE DAILY for 14
Area (m2)
days followed by a 7 day break each cycle
Frequency
Extravasation
Premedication
Emetogenicity
Additional
recommended
supportive
medication
Pre-treatment
evaluation
Regular
investigations
Controlled document
1.24 1.38
1300
1.39 1.47
1450
1.48 1.57
1500
1.58 1.72
1650
1.73 1.89
1800
1.90 2.07
2000
2.08 2.22
2150
2.23
2300
Every 21 days
Maximum 8 cycles
Oxaliplatin is an exfoliant (Group 4)
Capecitabine is an oral agent.
None usually required.
Patients who have previously experienced Grade 1 or 2 platinum
hypersensitivity should be pre-medicated with as follows:
45 minutes prior to Oxaliplatin: Dexamethasone 20mg IV bolus
30 minutes prior to Oxaliplatin: Chlorphenamine 10mg IV bolus
and Ranitidine 50 mg IV bolus diluted in at least 20ml Sodium
Chloride 0.9% and given over at least 2 minutes.
Patients who develop peripheral neuropathy may be considered for
calcium gluconate 1g and magnesium sulphate 1g given together in
250mL 5% Glucose IV over 20 minutes pre- and post-oxaliplatin
infusion. Caution is required in giving this treatment to patients with
known hypercalcemia or those receiving digoxin or thiazide diuretics.
This regimen has moderate-high emetogenic potential refer to local
protocol
Document Number
ASWCS11 GI022
Version Number
1.1.a
Page 2 of 6
Dose modifications
Haematological
toxicity
Renal impairment
Hepatic
impairment
NCI Common
toxicity criteria
Controlled document
Neutrophil
count
1.0
0.5-0.9
Platelet
count
75
50-74
<0.5
25-49
<0.5
<25
Action
Dose modification
once count recovery
Full dose
Restart capecitabine at
full dose and oxaliplatin
at 100mg/m2
Go ahead
Stop capecitabine
and delay next
cycle until count
recovery
Stop capecitabine
and delay next
cycle until count
recovery
Stop capecitabine
and delay next
cycle until count
recovery
Restart capecitabine at
full dose and oxaliplatin
at 100mg/m2
Restart capecitabine at
full dose and oxaliplatin
at 65mg/m2.
Toxicity
Neurotoxicity
(Oxaliplatin)
Document Number
ASWCS11 GI022
Definition
Grade 1 paraesthesia
Grade 2 paraesthesia
persisting until next cycle
Grade 3 paraesthesia >7
days but resolved before
next cycle
Grade 3 paraesthesia
persisting until next cycle
or Grade 4 of any
duration
Version Number
1.1.a
Dose adjustment
100%
Reduce dose to 100mg/m2
Reduce dose to 100mg/m2
Discontinue oxaliplatin
Page 3 of 6
Grade 1:Minimal
skin changes or
dermatitis (e.g.,
erythema, edema,
or hyperkeratosis)
without pain
Grade 2: Skin
changes (e.g.,
peeling, blisters,
bleeding, edema,
or hyperkeratosis)
with pain; limiting
instrumental ADL
100%
Controlled document
Document Number
ASWCS11 GI022
Version Number
Page 4 of 6
Adverse effects
Myelosuppression (common)
Cardiomyopathy / toxicity
Secondary malignancy
Ovarian failure/infertility
Nephrotoxicity
Significant drug
interactions For
full details consult
product
literature/reference texts
Comments
Cumulative Doses
References
Peripheral Neuropathy
Diarrhoea
Palmar-plantar erythrodyaesthesia
Alopecia (complete)
Stomatitis/ Mucositis
Nausea and vomiting
Fatigue
Other
dysgeusia, headache, dizziness
Warfarin/courmarin anticoagulants Avoid use switch patients to low
molecular weight heparin during treatment elevations in INR
Oxaliplatin:
Aminoglycosides: increased risk of nephrotoxicity and possibly of ototoxicityavoid concomitant use
Diuretics: increased risk of nephrotoxicity and ototoxicity when platinum
compounds given with diuretics
Capecitabine:
Phenytoin toxicity has occurred during concomitant capecitabine therapy
monitor levels regularly.
Sorivudine and its analogues co-administration causes increased
fluoropyrimidine toxicity which may be fatal
Allopurinol A decrease in capecitabine activity as been shown when taken
in combination of allopurinol. Avoid if possible.
Folinates Avoid concomitant use of folinic and folic acid enhanced toxicity
of capecitabine
Antacids the use of antacids with capecitabine can decrease absorption
avoid.
Dihydropyrimidine dehydrogenase (DPD) deficiency can result in severe
toxicity secondary to reduced fluorouracil metabolism avoid use of
capecitabine in patients with known DPD deficiency
Cardiotoxicity has been associated with fluoropyrimidine therapy, with adverse
events being more common in patients with a prior history of coronary artery
disease. Caution must be taken in patients with a history of significant cardiac
disease, arrhythmias or angina pectoris.
N/A
Controlled document
Document Number
ASWCS11 GI022
Version Number
1.1.a
Page 5 of 6
Document title
Document number
Approval date
Written by
Checked by
Authorised by
Review date
Document reviewed by
Version number
Summary of changes
Controlled document
Steve Falk
James Carr
1.1.a
Version
Document Number
ASWCS11 GI022
Version Number
1.1.a
Page 6 of 6