|FDA-APPROVED COLORECTAL CANCER TREATMENTS|
|oxaliplatin||Eloxatin||5mg/mL||soln for IV infusion after dilution||Day 1: 85mg/m² + leucovorin, followed by 5−FU.
Day 2: Leucovorin followed by 5−FU.
Give by IV infusion every 2wks for a total of 6mos (12 cycles) for adjuvant use or until disease progression or unacceptable toxicity for advanced disease.
|capecitabine||Xeloda||150mg, 500mg||tabs||1250mg/m² twice daily for 2wks on and 1wk off, for a total of 8 cycles.|
|fluorouracil||—||50mg/mL||soln for IV inj||12mg/kg once daily for 4 successive days; max 800mg/day. If no toxicity, then 6mg/kg on days 6, 8, 10, 12; stop after day 12. Discontinue if toxicity occurs.|
|ANTIMETABOLITES + PHOSPHORYLASE INHIBITORS|
|trifluridine/ tipiracil||Lonsurf||15mg/6.14mg, 20mg/8.19mg||tabs||Days 1−5, 8−12: 35mg/m² twice daily; continue every 28-day cycle until disease progression or unacceptable toxicity; max 80mg/dose (based on trifluridine component).|
|CTLA-4 BLOCKING ANTIBODY|
|ipilimumab||Yervoy3||5mg/mL||soln for IV infusion||In combination with nivolumab: 1mg/kg as an IV infusion over 30mins (given after nivolumab 3mg/kg on the same day) every 3wks for 4 doses. After completing 4 doses of the combination, give nivolumab as a single agent until disease progression or unacceptable toxicity.|
|EPIDERMAL GROWTH FACTOR RECEPTOR (EGFR) INHIBITORS|
|cetuximab||Erbitux2||100mg, 200mg||soln for IV infusion||Give by IV infusion; max rate: 10mg/min. Single agent or in combination with irinotecan or FOLFIRI: Weekly regimen (initial dose): 400mg/m² once over 2hrs; (subsequent doses): 250mg/m² once weekly over 1hr. Biweekly regimen (initial and subsequent doses): 500mg/m² every 2wks over 2hrs. Complete administration 1hr prior to irinotecan or FOLFIRI. In combination with encorafenib (initial dose): 400mg/m² once over 2hrs; (subsequent doses): 250mg/m² once weekly over 1hr. All: continue until disease progression or unacceptable toxicity.|
|Vectibix4||20mg/mL||soln for IV infusion after dilution||6mg/kg as IV inf over 60min once every 14 days. Doses >1000mg: infuse over 90min.|
|Folic acid derivative|
|lyophilized pwd for IV or IM inj reconsti–
|200mg/m² by slow IV inj over a minimum of 3min followed by 5−fluorouracil (370mg/m²); or 20mg/m² IV followed by 5 fluorouracil (425mg/m²); both regimens: daily for 5 days, may be repeated at 4‑wk intervals for 2 courses and then repeated at 4−5‑wk intervals.|
|Fusilev||50mg/vial||lyophilized pwd for IV inj after reconsti–
|100mg/m² by slow IV inj over a minimum of 3min, followed by 5‑FU at 370mg/m² by IV inj; or 10mg/m² by IV inj followed by 5‑FU at 425mg/m² by IV inj. Treat daily for 5 days; may repeat 5-day course at 4wk intervals for 2 courses, then at 4–5wk intervals provided that patient recovered completely from toxic effects from prior treatment course. Administer 5-FU separately to avoid precipitate formation.|
|lyophilized pwd for IV inj after reconsti–
tution and dilution
|ziv-aflibercept||Zaltrap||25mg/mL||soln for IV infusion after dilution||4mg/kg as an IV infusion over 1hr every 2wks; continue until disease progression or unacceptable toxicity|
|encorafenib||Braftovi1||75mg||caps||In combination with cetuximab: 300mg once daily until disease progression or unacceptable toxicity. Discontinue Braftovi if cetuximab is discontinued.|
|regorafenib||Stivarga||40mg||tabs||160mg once daily for the first 21 days of each 28-day cycle; continue until disease progression or unacceptable toxicity.|
|PD-1/PD-L1 BLOCKING ANTIBODIES|
|nivolumab||Opdivo3||10mg/mL||soln for IV infusion after dilution||Give as IV infusion over 30mins. Continue until disease progression or unacceptable toxicity. Single-agent (≥40kg): 240mg every 2wks or 480mg every 4wks; (<40kg): 3mg/kg every 2wks. In combination with ipilimumab: 3mg/kg (followed by ipilimumab on the same day) every 3wks for 4 doses, then followed by 240mg every 2wks or 480mg every 4wks (≥40kg) or 3mg/kg every 2wks (<40kg) as single agent.|
|Keytruda3||25mg/mL||soln for IV infusion after dilution||Give as IV infusion over 30mins. 200mg every 3wks or 400mg every 6wks until disease progression, unacceptable toxicity, or up to 24mos in patients without disease progression.|
|irinotecan||Camptosar||20mg/mL||soln for IV infusion after dilution||Combination therapy (with 5‑FU and leucovorin): 125mg/m² on days 1, 8, 15, 22; or, 180mg/m² on days 1, 15, 29; both: give every 6wks. Monotherapy: 125mg/m² on days 1, 8, 15, 22, then 2‑week rest; or, 350mg/m² once every 3wks.|
|VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) INHIBITORS|
|bevacizumab||Avastin||100mg, 400mg||soln for IV infusion after dilution||5mg/kg (with bolus−IFL) or 10mg/kg (with FOLFOX−4) once every 2wks until disease progression or unacceptable toxicity; 5mg/kg every 2wks or 7.5mg/kg every 3wks (when used with fluoropyrimidine-irinotecan- or fluoropyrimidine-oxaliplatin-based therapy). 1st infusion over 90min, 2nd infusion over 60min, subsequent infusion over 30min.|
|ramucirumab||Cyramza||10mg/mL||soln for IV infusion after dilution||In combination with FOLFIRI: 8mg/kg as an IV infusion over 60mins every 2wks until disease progression or unacceptable toxicity. Administer prior to FOLFIRI.|
1 For BRAF V600E mutation (as detected by an FDA-approved test) colorectal cancer only.
2 For wild-type K-RAS, EGFR-expressing (as detected by an FDA-approved test) colorectal cancer only.
3 For microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR) colorectal cancer.
4 For wild-type RAS (as detected by an FDA-approved test) colorectal cancer only.
Not an inclusive list of medications, official indications and/or dosing details. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.
This article originally appeared on MPR