Colorectal Cancer ____________________________________________________________________________
COMBINATION CHEMOTHERAPY REGIMENS USED IN THE TREATMENT OF COLON AND RECTAL CANCER
Name
Agents
Regimen
Irinotecan (100 mg/m 2 ) and leucovorin (500 mg/m 2 ) administered as two-hour infusions on day 1, followed by 5-FU (2,000 mg/m 2 ) IV bolus administered via ambulatory pump weekly over 24 hours, four times per year (52 weeks) Capecitabine (1,000 mg/m 2 ) twice daily on days 1 through 14, plus oxaliplatin (130 mg/m 2 ) on day 1 every three weeks Irinotecan (180 mg/m 2 ) and leucovorin (400 mg/m 2 ) administered as two- hour infusions on day 1, followed by a loading dose of 5-FU (400 mg/m 2 ) IV bolus administered on day 1, then 5-FU (1,200 mg/m 2 ) for two days (total 2,400 mg/m 2 over 46 to 48 hours) every two weeks Oxaliplatin (85–100 mg/m 2 ) and leucovorin (400 mg/m 2 ) administered as two-hour infusions on day 1, followed by a loading dose of 5-FU (400 mg/ m 2 ) IV bolus on day 1, then 5-FU (2,400–3,000 mg/m 2 ) administered via ambulatory pump over 46 hours every two weeks Oxaliplatin (130 mg/m 2 ) and leucovorin (400 mg/m 2 ) administered as two- hour infusions on day 1, followed by a loading dose of 5-FU (400 mg/m 2 ) IV bolus administered over 46 hours on day 1, then 5-FU (2,400 mg/m 2 ) administered via ambulatory pump over 46 hours beginning on day 1, every two weeks, for a total of eight cycles Irinotecan (165 mg/m 2 ) administered as a 60-minute infusion, then concomitant infusion of oxaliplatin (85 mg/m 2 ) and leucovorin (200 mg/ m 2 ) over 120 minutes, followed by 5-FU (3,200 mg/m 2 ) administered as a 48-hour continuous infusion.
Arbeitsgemeinschaft Internistische Onkologie (AIO) or German AIO
Folic acid (leucovorin), 5-FU, and irinotecan
CAPOX
Capecitabine and oxaliplatin
FOLFIRI
Leucovorin, 5-FU, and irinotecan
mFOLFOX6
Oxaliplatin, leucovorin, and 5-FU Oxaliplatin, leucovorin, and 5-FU
FOLFOX7
FOLFOXIRI
Irinotecan, oxaliplatin, leucovorin, and 5-FU
5-FU and leucovorin Leucovorin (200 mg/m 2 ) administered as a 2-hour infusion on days 1 and 2, followed by a loading dose of 5-FU (600 mg/m 2 ) IV bolus over 22 hours on days 1 and 2 every two weeks
FU-LV (Roswell Regimen)
Oral encorafenib (300 mg) days 1 to 28 and cetuximab IV (400 mg/m 2 ) on day 1 followed by 250 mg/m 2 days 8, 15, and 22. Oral capecitabine (1,000 mg/m 2 ) administered twice daily for 14 days plus oxaliplatin (130 mg/m 2 ) IV infusion administered over 2 hours on day 1 every 3 weeks
BRAFTOVI
Encorafenib and cetuximab Oxaliplatin and capecitabine
XELOX
Source: [229; 230; 231; 283]
Table 11
Fruquintinib Fruquintinib is a small molecule kinase inhibitor of VEGFRs. It inhibits cell proliferation, tubular formation, and tumor growth. It was approved in 2023 as treatment for patients with refractory metastatic colorectal cancer. Trifluridine-tipiracil Trifluridine-tipiracil is used to treat metastatic colorectal cancer, either as a single agent or in combination with bevaci- zumab. The triphosphate form of trifluridine is incorporated into DNA, which interferes with DNA synthesis and inhibits
cell proliferation. Tipiracil hydrochloride is a potent inhibitor of thymidine phosphorylase, which actively degrades trifluri- dine. The combination of trifluridine and tipiracil allows for adequate plasma levels of trifluridine. Combination Regimens The basis of chemotherapy for the treatment of colon and rectal cancer is combination therapy, with agents identified to work synergistically to manage unresectable lesions and minimize drug resistance. These combinations are generally known by their acronyms ( Table 11 ).
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