Colon Cancer Treatment Regimens

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Colon Cancer Treatment Regimens

Clinical Trials: The NCCN recommends cancer patient participation in clinical trials as the gold standard for treatment.

Cancer therapy selection, dosing, administration, and the management of related adverse events can be a complex process that should be handled by an experienced health care team. Clinicians must choose and verify treatment options based on the individual patient; drug dose modifications and supportive care interventions should be administered accordingly. The cancer treatment regimens below may include both U.S. Food and Drug Administration-approved and unapproved indications/regimens. These regimens are provided only to supplement the latest treatment strategies.

These Guidelines are a work in progress that may be refined as often as new significant data become available. The NCCN Guidelines® are a consensus statement of its authors regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult any NCCN Guidelines® is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The NCCN makes no warranties of any kind whatsoever regarding their content, use, or application and disclaims any responsibility for their application or use in any way.

Note: All recommendations are category 2A unless otherwise indicated.

Systemic Therapy for Advanced or Metastatic Disease1

REGIMEN

DOSING

Capecitabine2-4,a

Days 1–14: Capecitabine 850–1,250mg/m2 orally twice daily.

Repeat cycle every 3 weeks.a

Capecitabine + Bevacizumab2,5-7,b

Day 1: Bevacizumab 7.5mg/kg IV

Days 1–14: Capecitabine 850–1,250mg/m2 orally twice daily.

Repeat cycle every 3 weeks.

CapeOX2,8-10,a,c-e

Day 1: Oxaliplatin 130mg/m2 IV over 2 hours

Days 1–15: Capecitabine 1,000mg/m2 orally twice daily.e

Repeat cycle every 3 weeks.a

CapeOX + Bevacizumab 2,5,8,10,11,b-e

Day 1: Bevacizumab 7.5mg/kg IV, followed by:

Day 1: Oxaliplatin 130mg/m2 IV over 2 hours

Days 1–15: Capecitabine 1,000mg/m2 orally twice daily.e

Repeat cycle every 3 weeks.

Cetuximab (KRAS/NRAS/BRAF wild-type gene)12-16, f

Day 1: Cetuximab 400mg/m2 IV over 2 hours first infusion, then 250mg/m2 IV over 60 minutes weekly

OR

Day 1: Cetuximab 500mg/m2 IV.

Repeat cycle every 2 weeks.

Dabrafenib + Trametinib + Cetuximab (BRAF V600E mutation positive)12,17-21

Days 1–28: Dabrafenib 150mg orally twice daily

Days 1–28: Trametinb 2mg orally once daily

Repeat cycle every 4 weeks, with:

Day 1: Cetuximab 400mg/m2 IV over 2 hours first infusion, then 250mg/m2 IV over 60 minutes beginning with cycle 2.

Repeat cycle weekly.

Dabrafenib + Trametinib + Panitumumab (BRAF V600E mutation positive)17-22

Days 1–28: Dabrafenib 150mg orally twice daily

Days 1–28: Trametinb 2mg orally once daily

Repeat cycle every 4 weeks, with:

Day 1: Panitumumab 6mg/kg IV over 60 minutes.

Repeat cycle every 2 weeks.

Encorafenib + Binimetinib + Cetuximab (BRAF V600E mutation positive)12,23-26

Days 1–28: Encorafenib 300mg orally once daily

Days 1–28: Binimetinib 45mg orally twice daily

Repeat cycle every 4 weeks, with:

Day 1: Cetuximab 400mg/m2 IV over 2 hours first infusion, then 250mg/m2 IV over 60 minutes beginning with cycle 2.

Repeat cycle weekly.

OR

Days 1–28: Encorafenib 300mg orally once daily

Days 1–28: Binimetinib 45mg orally twice daily

Repeat cycle every 4 weeks, with:

Day 1: Cetuximab 500mg/m2 IV.

Repeat cycle every 2 weeks.

Encorafenib + Binimetinib + Panitumumab (BRAF V600E mutation positive)22-26

Days 1–28: Encorafenib 300mg orally once daily

Days 1–28: Binimetinib 45mg orally twice daily, with:

Day 1: Panitumumab 6mg/kg IV over 60 minutes.

Repeat cycle every 2 weeks.

FOLFIRI27-31,g

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 12: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

FOLFIRI + Bevacizumab5,27,30,32,b,g

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 12: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 2 weeks.

FOLFIRI + Cetuximab KRAS/NRAS/BRAF wild-type gene)12,14,27-29,31,33,g

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes, with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 12: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion

Repeat cycle every 2 weeks, with:

Day 1: Cetuximab 400mg/m2 IV over 2 hours first infusion, then 250mg/m2 IV over 60 minutes beginning with cycle 2.

Repeat cycle weekly.

OR

Day 1: Cetuximab 500mg/m2 IV, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30-90 minutes, with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 1–2: Fluorouracil 400mg/m2 IV push day 1, then 1,200,g/m2/day x 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

FOLFIRI + Panitumumab (KRAS/NRAS/BRAF wild-type gene) 22,27-29,31,33,34,g

Day 1: Panitumumab 6mg/kg IV over 60 minutes, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 12: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

FOLFIRI + Ramucirumab27-29,35,36,g

Day 1: Ramucirumab 8mg/kg IV over 60 minutes followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 1–2: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 day (total 2,400mg/m2 over 46–48 hours) IV continuous infusion

Repeat cycle every 2 weeks.

FOLFIRI + Ziv-aflibercept27-29,37,38,g

Day 1: Ziv-aflibercept 4mg/kg IV over 1 hour, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes, with:

Day 1: Leucovorin 400mg/m2 IV infusion to match duration of irinotecan infusion, followed by:

Days 1–2: Fluorouracil 400mg/m2 IV push day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

FOLFOXIRI8,27-29,39,d,g

Day 1: Irinotecan 165mg/m2 IV over 30 to 90 minutes

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours

Day 1: Leucovorin 400mg/m2 IV over 2 hours to match the infusion time of oxaliplatin, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 (2,400mg/m2 over 48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

FOLFOXIRI + Bevacizumab5,8,27-29,39,40,b,d,g

Day 1: Irinotecan 165mg/m2 IV over 30–90 minutes

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours

Day 1: Leucovorin 400mg/m2 IV to match infusion time of oxaliplatin, followed by:

Days 1–2: Fluorouracil 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 48 hours) continuous infusion starting on day 1

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 2 weeks.

FOLFOXIRI + Cetuximab (KRAS/NRAS/BRAF wild-type gene)8,12,27-29,39,41,42,d,g (Category 2B)

Day 1: Cetuximab 400mg/m2 IV over 2 hours week 1, then 250mg/m2 IV over 60 minutes starting week 2.

Repeat cycle weekly, with:

Day 1: Irinotecan 165mg/m2 IV over 30–90 minutes

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours).

Repeat cycle every 2 weeks.

OR

Day 1: Cetuximab 500mg/m2 IV, followed by:

Day 1: Irinotecan 165mg/m2 IV over 30–90 minutes

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours).

Repeat cycle every 2 weeks.

FOLFOXIRI + Panitumumab

(KRAS/NRAS/BRAF wild-type gene)8,22,27-29,39,42,43,d,g (Category 2B)

Day 1: Panitumumab 6mg/kg IV over 60 minutes, followed by:

Day 1: Irinotecan 165mg/m2 IV over 30–90 minutes

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours).

Repeat cycle every 2 weeks.

Irinotecan29,44,45,h

Days 1 and 8: Irinotecan 125mg/m2 IV over 30–90 minutes.

Repeat cycle every 3 weeks.

OR

Day 1: Irinotecan 300–350mg/m2 IV over 30–90 minutes.

Repeat cycle every 3 weeks.h

OR

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes.

Repeat cycle every 2 weeks.

Irinotecan + Bevacizumab5,29,44,46,b,h

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 2 weeks.

OR

Day 1: Irinotecan 300-350mg/m2 IV over 30–90 minutes

Day 1: Bevacizumab 7.5mg/kg IV.

Repeat cycle every 3 weeks.i

Irinotecan + Cetuximab (KRAS/NRAS/BRAFwild-type gene)12,14,16,29,44

Day 1: Cetuximab 400mg/m2 first infusion, then 250mg/m2 IV weekly OR Cetuximab 500mg/m2 IV every 2 weeks

Day 1: Irinotecan 300–350mg/m2 IV every 3 weeks.h

OR

Day 1: Irinotecan 180mg/m2 IV every 2 weeks.

OR

Days 1 and 8: Irinotecan 125mg/m2 IV every 3 weeks.

Irinotecan + Cetuximab + Vemurafenib (BRAF V600E mutation positive)12,29,47,48

Day 1: Cetuximab 500mg/m2 IV, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes

Days 1–14: Vemurafenib 960mg orally twice daily.

Repeat cycle every 2 weeks.

Irinotecan + Panitumumab (KRAS/NRAS/BRAF wild-type gene only)22,29,34,49,50

Day 1: Panitumumab 6mg/kg IV over 60 minutes, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes.

Repeat cycle every 2 weeks

Irinotecan + Panitumumab + Vemurafenib (BRAF V600E mutation positive)22,29,47,48

Day 1: Panitumumab 6mg/kg IV over 60 minutes, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes

Days 1–14: Vemurafenib 960mg orally twice daily.

Repeat cycle every 2 weeks.

Irinotecan + Ramucirumab29,35,36

Day 1: Ramucirumab 8mg/m2 over 60 minutes, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes.

Repeat cycle every 2 weeks.

Irinotecan + Ziv-aflibercept29,37,38,44

Day 1: Ziv-aflibercept 4mg/kg IV over 60 minutes, followed by:

Day 1: Irinotecan 180mg/m2 IV over 30–90 minutes.

Repeat cycle every 2 weeks.

IROX8,29,51,d

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, followed by:

Day 1: Irinotecan 200mg/m2 over 30–90 minutes.

Repeat cycle every 3 weeks.

IROX + Bevacizumab5,8,29,51,52,b

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours

Day 1: Irinotecan 200mg/m2 IV over 30–90 minutes.

Day 1: Bevacizumab 7.5mg/kg IV.

Repeat cycle every 3 weeks.

Larotrectinib (NTRK gene fusion positive)53,54

Larotrectinib 100mg orally twice daily.

mFOLFOX68,27,28,55-58,d,g,i

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 12: Fluorouracil 400mg/m2 IV push on day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.i

mFOLFOX6 + Bevacizumab5,8,27,28,55-58,d,g

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 12: Fluorouracil 400mg/m2 IV push on day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 2 weeks.

mFOLFOX6 + Cetuximab (KRAS/NRAS/BRAF wild-type gene)8,12,27,28,61,d,g

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 1–2: Fluorouracil 400mg/m2 IV push on day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks, with

Day 1: Cetuximab 400mg/m2 IV over 2 hours for the first infusion, then 250mg/m2 IV over 60 minutes weekly.

OR

Day 1: Cetuximab 500mg/m2 IV over 2 hours every 2 weeks.

mFOLFOX6 + Panitumumab (KRAS/NRAS/BRAF wild-type gene)8,22,27,28,56,62,63,d,g

Day 1: Panitumumab 6mg/kg IV over 60 minutes, followed by:

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 12: Fluorouracil 400mg/m2 IV push on day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks.

mFOLFOX78,27,28,64,65,d,g

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours IV followed by:

Days 12: Fluorouracil 1,200mg/m2/day (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat every 2 weeks.

Nivolumab (MSI-H/dMMR tumors only)66,67

Day 1: Nivolumab 240mg IV over 30 minutes.

Repeat every 2 weeks.

OR

Day 1: Nivolumab 3mg/kg IV over 30 minutes

Repeat cycle every 2 weeks.

OR

Day 1: Nivolumab 480mg IV over 30 minutes.

Repeat cycle every 4 weeks

Nivolumab + Ipilimumab (MSI-H/dMMR tumors only)66,68,69,f

Day 1: Nivolumab 3mg/kg IV over 30 minutes, followed by:

Day 1: Ipilimumab 1mg/kg IV over 30 minutes

Repeat cycle every 3 weeks for 4 cycles, followed by:

Day 1: Nivolumab 240mg IV over 30 minutes.

Repeat cycle every 2 weeks.

OR

Day 1: Nivolumab 3mg/kg IV over 30 minutes

Day 1: Ipilimumab 1mg/kg IV over 30 minutes

Repeat cycle every 3 weeks for 4 cycles, followed by:

Day 1: Nivolumab 3mg/kg IV over 30 minutes.

Repeat cycle every 2 weeks.

Panitumumab (KRAS/NRAS/BRAF wild-type gene)22,70,f

Day 1: Panitumumab 6mg/kg IV over 60 minutes.

Repeat cycle every 2 weeks.

Pembrolizumab (MSI-H/dMMR tumors only)46,47

Day 1: Pembrolizumab 200mg IV over 30 minutes.

Repeat every 3 weeks.

OR

Day 1: Pembrolizumab 2mg/kg IV over 30 minutes.

Repeat cycle every 3 weeks.

Regorafenib73-75,j

First Cycle

Days 1–7: Regorafenib 80mg orally once daily

Days 8–14: Regorafenib 120mg orally once daily

Days 15–21: Regorafenib 160mg orally once daily.

Subsequent Cycles:

Days 1–21: Regorafenib 160mg orally once daily.

Repeat cycle every 4 weeks.

Roswell Park Fluorouracil/Leucovorin27,28,76-78,b,g,k

Days 1, 8, 15, 22, 29, and 36: Leucovorin 500mg/m2 IV over 2 hours

Days 1, 8, 15, 22, 29, and 36: Fluorouracil 500mg/m2 IV push 1 hour after start of leucovorin.

Repeat cycle every 8 weeks.l (6 weeks on- followed by 2 weeks off-treatment).k

Roswell Park Fluorouracil/Leucovorin + Bevacizumab 5,27,28,76,77,79,b,g

Days 1, 8, 15, 22, 29, and 36: Leucovorin 500mg/m2 IV over 2 hours

Days 1, 8, 15, 22, 29, and 36: Fluorouracil 500mg/m2 IV push 1 hour after start of leucovorin infusion, with:

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 8 weeks. (6 weeks on- followed by 2 weeks off-treatment)

Simplified Biweekly Infusional Fluorouracil/Leucovorin27,28,31,g,l

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Day 1: Fluorouracil 400 mg/m2 IV push, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours).

Repeat cycle every 2 weeks.l

Simplified Biweekly Infusional Fluorouracil/Leucovorin + Bevacizumab5,27,28,31,79,b,g

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Day 1: Fluorouracil 400 mg/m2 IV push, followed by:

Days 1–3: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours)

Day 1: Bevacizumab 5mg/kg IV.

Repeat cycle every 2 weeks.

Trastuzumab + Lapatinib (HER2-amplified and RAS wild-type gene) (Category 2B)80,82

Day 1: Trastuzumab 4mg/kg IV first infusion, then 2mg/kg IV beginning with cycle 2

Days 1–7: Lapatinib 1,000mg orally once daily.

Repeat cycle weekly.

Trastuzumab + Pertuzumab (HER2-amplified and RAS wild-type gene) (Category 2B)80,83,84

Day 1: Trastuzumab 8mg/kg IV first infusion, then 6 mg/kg IV beginning with cycle 2

Day 1: Pertuzumab 840mg IV first infusion, then 420mg IV beginning with cycle 2.

Repeat cycle every 3 weeks.

Trifluridine + Tipiracil85,86,j

Days 1–5 and 8–12: Trifluridine + Tipiracil 35mg/m2 up to a maximum dose of 80mg/dose (based on the trifluridine component) orally twice daily.

Repeat cycle every 4 weeks.

Weekly Fluorouracil/Leucovorin27,28,88,89,g,m

Day 1: Leucovorin 20mg/m2 IV over 2 hours

Day 1: Fluorouracil 500mg/m2 IV push 1 hour after the start of leucovorin infusion.

Repeat cycle every week.

OR

Day 1: Leucovorin 500mg/m2 IV over 2 hours

Day 1: Fluorouracil 2,600mg/m2 continuous infusion over 24 hours.

Repeat cycle every week.

Weekly Fluorouracil/Leucovorin + Bevacizumab5,27,28,79,88,b,g

Day 1: Leucovorin 20mg/m2 IV over 2 hours once weekly

Day 1: Fluorouracil 500mg/m2 IV administered one hour after start of leucovorin infusion once weekly

Day 1: Bevacizumab 5mg/kg IV every 2 weeks.

OR

Day 1: Leucovorin 500mg/m2 IV over 2 hours once weekly

Day 1: Fluorouracil 2,600mg/m2 IV continuous infusion over 24 hours once weekly

Day 1: Bevacizumab 5mg/kg IV every 2 weeks.

Adjuvant Chemotherapy Regimens1,m

Principles of Adjuvant Therapy1

• FOLFOX is superior to Fluorouracil/Leucovorin for patients with stage III colon cancer.

• Capecitabine/oxaliplatin is superior to bolus Fluorouracil/Leucovorin for patients with stage III colon cancer.

• Capecitabine appears to be equivalent to bolus Fluorouracil/Leucovorin in patients with stage III colon cancer.

• A survival benefit has not been demonstrated for the addition of oxaliplatin to Fluorouracil/Leucovorin in stage II colon cancer. FOLFOX is reasonable for high-risk stage II patients with multiple high-risk factors and is not indicated for good- or average-risk patients with stage II colon cancer.

• A benefit for the addition of oxaliplatin to Fluorouracil/Leucovorin in patients age 70 and older has not been proven.

• In patients staged as T1-3, N1 (low-risk stage III), 3 months of CapeOX is non-inferior to 6 months of CapeOX for disease-free survival; non-inferiority of 3 vs 6 months of FOLFOX has not been proven. In patients staged as T4, N1-2 or T any, N2 (high-risk stage III), 3 months of FOLFOX is inferior to 6 months of FOLFOX for disease-free survival, whereas non-inferiority of 3 vs 6 months of CapeOX has not been proven. Grade 3+ neurotoxicity rates are lower for patients who receive 3 months vs 6 months of treatment (3% vs 16% for FOLFOX; 3% vs 9% for CapeOX).

REGIMEN

DOSING

Capecitabine3,c

Days 1–14: Capecitabine 850–1,250mg/m2 orally twice daily.

Repeat cycle every 3 weeks for 8 cycles.

CapeOx9,c,d,c,m

Day 1: Oxaliplatin 130mg/m2 IV over 2 hours

Days 1–15: Capecitabine 1,000mg/m2 orally twice dailye

Repeat cycle every 3 weeks for 8 cycles.m

mFOLFOX655-58,d,g,m

Day 1: Oxaliplatin 85mg/m2 IV over 2 hours, with:

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Days 1–2: Fluorouracil 400mg/m2 IV push on day 1, then 1,200mg/m2/day × 2 days (total 2,400mg/m2 over 46–48 hours) IV continuous infusion.

Repeat cycle every 2 weeks for 8-12 cycles.m

Roswell Park Fluorouracil/Leucovorin78,g

Days 1, 8, 15, 22, 29, and 36: Leucovorin 500mg/m2 IV over 2 hours

Days 1, 8, 15, 22, 29, and 36: Fluorouracil 500mg/m2 IV push 1 hour after start of leucovorin infusion.

Repeat cycle every 8 weeks (6 weeks on- followed by 2 weeks off-treatment) for 4 cycles.

Simplified Biweekly Infusional Fluorouracil/Leucovorin31,g

Day 1: Leucovorin 400mg/m2 IV over 2 hours, followed by:

Day 1: Fluorouracil 400 mg/m2 IV push, followed by:

Days 1–2: Fluorouracil 1,200mg/m2 IV continuous infusion daily (2,400mg/m2 IV over 46–48 hours).

Repeat cycle every 2 weeks for 12 cycles.

   a Repeat for 8 cycles in perioperative setting.

   b Bevacizumab may be safely given at a rate of 0.5mg/kg/min (5mg/kg over 10 minutes and 7.5mg/kg over 15 minutes).

   c The majority of safety and efficacy data for this regimen have been developed in Europe, where a capecitabine starting dose of 1,000mg/m2 twice daily for 14 days, repeated every 21 days, is standard. Evidence suggests that North American patients may experience greater toxicity with capecitabine (as well as with other fluoropyrimidines) than European patients, and may require a lower dose of capecitabine.

   d Oxaliplatin may be given either over 2 hours, or may be infused over a shorter time at a rate of 1mg/m2/min. Leucovorin infusion should match time of oxaliplatin. (Cercek A, Park V, Yaeger R, et al. Faster FOLFOX: oxaliplatin can be safety infused at a rate of 1mg/m2/min. J Oncol Pract. 2016;12:e548-553.)

   e Beginning in the evening of day 1 until the morning of day 15 (28 total doses).

   f Category 2B for patient not appropriate for intensive therapy.

   g Leucovorin 400mg/m2 is the equivalent of levoleucovorin 200mg/m2.

   h Irinotecan 300mg/m2 is recommended for patients <70 years, prior pelvic irradiation, ECOG performance status or >2.

   i Repeat for 8-12 cycles in the perioperative setting.

   j Regorafenib or trifluridine + tipiracil are treatment options for patients who have progressed through all available regimens.

   k Repeat 8 week cycle (6 weeks on- and 2 weeks off-treatment) for 4 cycles in the perioperative setting.

   l Repeat for 12 cycles in perioperative setting.

  m In patients staged as T1-3,N1 (low-risk stage III), 3 months of CapeOX is non-inferior to 6 months of CapeOX for disease-free survival; non-inferiority of 3 vs. 6 months of FOLFOX has not been proven. In patients staged as T4,N1-2 or Tany, N2 (high-risk stage III), 3 months of FOLFOX is inferior to 6 months of FOLFOX for disease-free survival, whereas non-inferiority of 3 vs. 6 months of CapeOX has not been proven. Grade 3+ neurotoxicity rates are lower for patients who receive 3 months vs. 6 months of treatment (3% vs. 16% for FOLFOX; 3% vs 9% for CapeOX).

References

  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Rectal Cancer V.2.2019. Available at: https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed July 19, 2019.

  2. Capecitabine (Xeloda) [package insert]. South San Francisco, CA: Genentech, Inc.; 2019.

  3. 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.

  4. Van Cutsem E, Twelves C, Cassidy J, et al. Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol. 2001;19:4097-4106.

  5. Bevacizumab (Avastin) [package insert]. South San Francisco, CA: Genentech, Inc.; 2019.

  6. Cunningham D Lang I, Marcuello E, et al. Bevacizumab plus capecitabine versus capecitabine alone in elderly patients with previously untreated metastatic colorectal cancer (AVEX): an open-label, randomised phase 3 trial. Lancet Oncol. 2013;14:1077-1085.

  7. Van Cutsem E, Rivera F, Berry S, et al. Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol. 2009;20:1842-1847.

  8. Oxaliplatin (Eloxatin) [package insert]. Bridgewater, NJ: sanofi-aventis U.S. LLC; 2011.

  9. Schmoll HJ, Cartwright T, Tabernero J, et al. Phase III trial of capecitabine plus oxaliplatin as adjuvant therapy for stage III colon cancer: a planned safety analysis in 1,864 patients. J Clin Oncol. 2007;25:102-109.

10. Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26:2006-2012.

11. Saltz LB, Clarke S, Díaz-Rubio E, et al. Bevacizumab in combination with oxaliplatin- based chemotherapy as first-line therapy in metastatic colorectal cancer: a randomized phase III study. J Clin Oncol. 2008;26:2013-2019.

12. Cetuximab (Erbitux) [package insert]. Branchburg, NJ; Eli Lilly and Co.; 2015.

13. Van Cutsem E, Tejpar S, Vanbeckevoort D, et al. Intrapatient cetuximab dose escalation in metastatic colorectal cancer according to the grade of early skin reactions: the randomized EVEREST study. J Clin Oncol. 2012;30:2861-2868.

14. 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.

15. Tabernero J, Ciardiello F, Rivera F, et al. Cetuximab administered once every second week to patients with metastatic colorectal cancer: a two-part pharmacokinetic/pharmacodynamic phase I dose-escalation study. Ann Oncol. 2010;21:1537-1545.

16. Martín-Martorell P, Roselló S, Rodríguez-Braun E, et al. Biweekly cetuximab and irinotecan in advanced colorectal cancer patients progressing after at least one previous line of chemotherapy: results of a phase II single institution trial. Br J Cancer. 2008;99:455-458.

17. Dabrafenib (Dafinlar) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp.; 2018.

18. Trametinib (Mekinist) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corp.; 2018.

19. Corcoran RB, Atreya CE, Falchook GS, et al. Combined BRAF and MEK inhibition with dabrafenib and trametinib in BRAF V600-mutant colorectal cancer. J Clin Oncol. 2015;33:4023-4031.

20. Ursem C, Atreya CE, Van Loon K. Emerging treatment options for BRAF-mutant colorectal cancer. Gastrointest Cancer. 2018;8:13-23.

21. Atreya CE, Van Cutsem E, Bendell JC, et al. Phase 1/2 study of the MEK inhibitor trametinib, BRAF inhibitor dabrafenib, and anti-EGFR antibody panitumumab in patients with BRAF V600E-mutated metastatic colorectal cancer. J Clin Oncol. 2015:33 (suppl; abstr 103).

22. Panitumumab (Vectibix) [package insert]. Thousand Oaks, CA: Amgen Inc.; 2017.

23. Encorafenib (Braftovi) [package insert]. Boulder, CO: Array BioPharma Inc.; 2019.

24. Binimetinib (Mektovi) [package insert]. Boulder, CO: Array Biopharma, Inc.; 2019.

25. Van Cutsem E, Cuyle P, Huijberts S, et al. BEACON CRC study safety lead-in: assessment of the BRAF inhibitor encorafenib + MEK inhibitor binimetinib + anti- epidermal growth factor receptor antibody cetuximab for BRAF V600E metastatic colorectal cancer. Ann Oncol. 2018;29(suppl 5; abstr O-027).

26. Van Cutsem E, Huijberts S, Grothey A, et al. Binimetinib, Encorafenib, and Cetuximab Triplet Therapy for Patients With BRAF V600E-Mutant Metastatic Colorectal Cancer: Safety Lead-In Results From the Phase III BEACON Colorectal Cancer Study. J Clin Oncol. 2019;37:1460-1469.

27. Leucovorin (Leucovorin calcium injection) [package insert]. Bedford, OH: Bedford Laboratories; 2011.

28.5-Fluorouracil (Fluorouracil injection) [package insert]. Irvine, CA: Spectrum Pharmaceuticals; 2016.

29. Irinotecan (Camptosar) [package insert]. New York, NY: Pfizer, Inc.; 2015.

30. Fuchs CS, Marshall J, Mitchell E, et al. Randomized, controlled trial of irinotecan plus infusional, bolus, or oral fluoropyrimidines in first-line treatment of metastatic colorectal cancer: results from the BICC-C Study. J Clin Oncol. 2007;25:4779-4786.

31. 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.

32. Heinemann V, von Weikersthal LF, Decker T, et al. FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol. 2014;15:1065-1075.

33. Venook AP, Niedzwiecki D, Lenz HJ, et al. Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: A randomized clinical trial. JAMA. 2017;317:2392-2401.

34. Peeters M, Price TJ, Cervantes A, et al. Randomized phase III study of panitumumab with fluorouracil, leucovorin, and irinotecan (FOLFIRI) compared with FOLFIRI alone as second-line treatment in patients with metastatic colorectal cancer. J Clin Oncol. 2010;28:4706-4713.

35. Ramucirumab (Cyramza) [package insert]. Indianapolis, IN: Eli Lilly and Co.; 2019.

36. Tabernero J, Yoshino T, Cohn AL, et al. Ramucirumab versus placebo in combination with second-line FOLFIRI in patients with metastatic colorectal carcinoma that progressed during or after first-line therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine (RAISE): a randomised, double-blind, multicentre, phase 3 study. Lancet Oncol. 2015;16:499-508.

37. Ziv-aflibercept (Zaltrap) [package insert]. Bridgewater, NJ: sanofi-aventis U.S. LLC: 2012.

38. Van Cutsem E, Tabernero J, Lakomy R, et al. Addition of aflibercept to fluorouracil, leucovorin, and irinotecan improves survival in a phase III randomized trial in patients with metastatic colorectal cancer previously treated with an oxaliplatin- based regimen. J Clin Oncol. 2012;30:3499-3506.

39. Falcone A, Ricci S, Brunetti I, et al. Phase III trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) compared with infusional fluorouracil, leucovorin, and irinotecan (FOLFIRI) as first-line treatment for metastatic colorectal cancer: the Gruppo Oncologico Nord Ovest. J Clin Oncol. 2007;25:1670-1676.

40. Cremolini C, Loupakis F, Antoniotti C, et al. FOLFOXIRI plus bevacizumab versus FOLFIRI plus bevacizumab as first-line treatment of patients with metastatic colorectal cancer: updated overall survival and molecular subgroup analyses of the open-label, phase 3 TRIBE study. Lancet Oncol. 2015;16:1306-1315.

41. Bokemeyer C, Van Cutsem E, Rougier P, et al. Addition of cetuximab to chemotherapy as first-line treatment for KRAS wild-type metastatic colorectal cancer: pooled analysis of the CRYSTAL and OPUS randomised clinical trials. Eur J Cancer. 2012;48:1466-1475.

42. Cremolini C, Antoniotti C, Lonardi S, et al. Activity and safety of cetuximab plus modified FOLFOXIRI followed by maintenance with cetuximab or bevacizumab for RAS and BRAF wild-type metastatic colorectal cancer: A randomized phase 2 clinical trial. JAMA Oncol. 2018;4:529-536.

43. Fornaro L, Lonardi S, Masi G, et al. FOLFOXIRI in combination with panitumumab as first-line treatment in quadruple wild-type (KRAS, NRAS, HRAS, BRAF) metastatic colorectal cancer patients: a phase II trial by the Gruppo Oncologico Nord Ovest (GONO). Ann Oncol. 2013;24:2062-2067.

44. Fuchs CS, Moore MR, Harker G, et al. Phase III comparison of two irinotecan dosing regimens in second-line therapy of metastatic colorectal cancer. J Clin Oncol. 2003;21:807-814.

45. 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;352:1413-1418.

46. Yildiz R, Buyukberber S, Uner A, et al. Bevacizumab plus irinotecan-based therapy in metastatic colorectal cancer patients previously treated with oxaliplatin-based regimens. Cancer Invest. 2010;28:33-37.

47. Vemurafenib (Zelboraf) [package insert]. South San Francisco, CA: Genentech, Inc.; 2017.

48. Kopetz S, McDonough SL, Lenz, H-J, et al. Randomized trial of irinotecan and cetuximab with or without vemurafenib in BRAF-mutant metastatic colorectal cancer (SWOG S1406). J Clin Oncol. 2017;35(suppl; abstr 3505).

49. André T, Blons H, Mabro M, et al. Panitumumab combined with irinotecan for patients with KRAS wild-type metastatic colorectal cancer refractory to standard chemotherapy: a GERCOR efficacy, tolerance, and translational molecular study. Ann Oncol. 2013;24:412-419.

50. Seymour MT, Brown SR, Middleton G, et al. Panitumumab and irinotecan versus irinotecan alone for patients with KRAS wild-type, fluorouracil-resistant advanced colorectal cancer (PICCOLO): a prospectively stratified randomised trial. Lancet Oncol. 2013;14:749-759.

51. Haller DG, Rothenberg ML, Wong AO, et al. Oxaliplatin plus irinotecan compared with irinotecan alone as second-line treatment after single-agent fluoropyrimidine therapy for metastatic colorectal carcinoma. J Clin Oncol. 2008;26:4544-4550.

52. Sanoff HK, Sargent DJ, Campbell ME, et al. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. J Clin Oncol. 2008;26:5721-5727.

53. Larotrectinib (Vitrakvi) [package insert]. Stamford, CT: Loxo Oncology, Inc.; 2018.

54. Drilon A, Laetsch TW, Kummar S, et al. Efficacy of larotrectinib in TRK fusion- positive cancers in adults and children. N Engl J Med. 2018;378:731-739.

55. 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.

56. 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.

57. Maindrault-Goebel F, de Gramont A, Louvet C, et al. Evaluation of oxaliplatin dose intensity in bimonthly leucovorin and 48-hour 5-fluorouracil continuous infusion regimens (FOLFOX) in pretreated metastatic colorectal cancer. Oncology Multidisciplinary Research Group (GERCOR). Ann Oncol. 2000;11:1477-1483.

58. André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343-2351.

59. Emmanouilides C, Sfakiotaki G, Androulakis N, et al. Front-line bevacizumab in combination with oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) in patients with metastatic colorectal cancer: a multicenter phase II study. BMC Cancer. 2007;7:91.

60. Venook AP, Niedzwiecki D, Lenz H-J, et al. CALGB/SWOG 80405: Phase III trial of irinotecan/5- FU/leucovorin (FOLFIRI) or oxaliplatin/5-FU/leucovorin (mFOLFOX6) with bevacizumab or cetuximab for patients with KRAS wild-type untreated metastatic adenocarcinoma of the colon or rectum [abstract]. J Clin Oncol. 2014;32(suppl; abstr LBA3).

61. Venook AP, Niedzwiecki D, Lenz HJ, et al. Effect of first-line chemotherapy combined with cetuximab or bevacizumab on overall survival in patients with KRAS wild-type advanced or metastatic colorectal cancer: A randomized clinical trial. JAMA. 2017;317:2392-2401.

62. Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008;26:2006-2012.

63. Douillard JY, Siena S, Cassidy J, et al. Randomized, phase III trial of panitumumab with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX4) versus FOLFOX4 alone as first-line treatment in patients with previously untreated metastatic colorectal cancer: the PRIME study. J Clin Oncol. 2010;28:4697-4705.

64. Maindrault-Goebel F, de Gramont A, Louvet C, et al. High-dose intensity oxaliplatin added to the simplified bimonthly leucovorin and 5-fluorouracil regimen as second-line therapy for metastatic colorectal cancer (FOLFOX 7). Eur J Cancer. 2001;37:1000-1005.

65. Hochster HS, Grothey A, Hart L, et al. Improved time to treatment failure with an intermittent oxaliplatin strategy: results of CONcePT. Ann Oncol. 2014;25:1172-1178.

66. Nivolumab (Opdivo) [package insert]. Princeton, NJ: Bristol-Myers Squibb, Inc; 2019.

67. Overman MJ, McDermott R, Leach JL, et al. Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study. Lancet Oncol. 2017;18:1182-1191.

68. Ipilimumab (Yervoy) [package insert]. Princeton, NJ: Bristol-Myers Squibb, Inc; 2019.

69. Overman MJ, Lonardi S, Wong KYM, et al. Durable clinical benefit with nivolumab plus ipilimumab in DNA mismatch repair-deficient/microsatellite instability-high metastatic colorectal cancer. J Clin Oncol. 2018;36:773-779.

70. 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.

71. Pembrolizumab (Keytruda) [package insert]. Whitehouse Station, NJ: Merck & Co, Inc.; 2019.

72. Le DT, Uram JN, Wang H, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372:2509-2520.

73. Regorafenib (Stivarga) [package insert]. Wayne, NJ: Bayer HealthCare Pharmaceuticals Inc.; 2017.

74. Bekaii-Saab, TS, Ou F-S, Anderson DM, et al. Regorafenib dose optimization study (ReDOS): Randomized phase II trial to evaluate dosing strategies for regorafenib in refractory metastatic colorectal cancer (mCRC)—An ACCRU Network study. J Clin Oncol. 2018;36(suppl 4S;abstr 611).

75. 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

76. Wolmark N, Rockette H, Fisher B, et al. The benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol. 1993;11:1879-1887.

77. Petrelli N, Douglass HO Jr, Herrera L, et al. The modulation of fluorouracil with leucovorin in metastatic colorectal carcinoma: a prospective randomized phase III trial. Gastrointestinal Tumor Study Group. J Clin Oncol. 1989;7:1419-1426.

78. Haller DG, Catalano PJ, Macdonald JS, et al. Phase III study of fluorouracil, leucovorin, and levamisole in high-risk stage II and III colon cancer: final report of Intergroup 0089. J Clin Oncol. 2005;23:8671-8678.

79. Hurwitz HI, Fehrenbacher L, Hainsworth JD, et al. Bevacizumab in combination with fluorouracil and leucovorin: an active regimen for first-line metastatic colorectal cancer. J Clin Oncol. 2005;23:3502-3508.

80. Trastuzumab (Herceptin) [package insert]. South San Francisco, CA: Genentech, Inc.; 2018.

81. Lapatinib (Tykerb) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2018.

82. Sartore-Biachi A, Trusolino L, Martino C, et al. Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES): a proof-of-concept, multicenter, open-label, phase 2 trial. Lancet Oncol. 2016;17:738-746.

83. Pertuzumab (Perjeta) [package insert]. South San Francisco, CA: Genentech, Inc.; 2018.

84. Meric-Bernstam F, Hurwitz H, Raghav KPS, et al. Pertuzumab plus trastuzumab for HER2-amplified metastatic colorectal cancer (MYPathway): an updated report from a multicenter, open-label, phase 2a, multiple basket study. Lancet Oncol. 2019;20:518-530.

85. Trifluridine and tipiracil (Lonsurf) [package insert]. Princeton, NJ: Taiho Pharmaceutical Co.; 2019.

86. Mayer RJ, Van Cutsem E, Falcone A, et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372:1909-1919

87. Van Cutsem E, Falcone A, et al. Randomized trial of TAS-102 for refractory metastatic colorectal cancer. N Engl J Med. 2015;372:1909-1919.

88. Jäger E, Heike M, Bernhard H, et al. Weekly high-dose leucovorin versus low-dose leucovorin combined with fluorouracil in advanced colorectal cancer: results of a randomized multicenter trial. Study Group for Palliative Treatment of Metastatic Colorectal Cancer Study Protocol 1. J Clin Oncol. 1996;14:2274-2279.

89. Wolmark N, Wieand HS, Hyams DM, et al. Randomized trial of postoperative adjuvant chemotherapy with or without radiotherapy for carcinoma of the rectum: National Surgical Adjuvant Breast and Bowel Project Protocol R-02. J Natl Cancer Inst. 2000;92:388-396.

(Revised 8/2019) © 2019 by Haymarket Media, Inc.

Gastrointestinal Cancer Drug Monographs

Colorectal and Other GI Cancers

AVASTIN CAMPTOSAR CYRAMZA
Doxorubicin HCl Doxorubicin HCl Solution ELOXATIN
ERBITUX Floxuridine Fluorouracil
FUSILEV GLEEVEC HERCEPTIN
Leucovorin LONSURF Mitomycin
NEXAVAR PHOTOFRIN STIVARGA
SUTENT TAXOTERE VECTIBIX
XELODA ZALTRAP

Pancreatic, Thyroid, And Other Endocrine Cancers

ABRAXANE AFINITOR CAPRELSA
COMETRIQ Doxorubicin HCl Doxorubicin HCl Solution
Fluorouracil GEMZAR LENVIMA
LYSODREN Mitomycin NEXAVAR
ONIVYDE SOMATULINE DEPOT SUTENT
TARCEVA THYROGEN ZANOSAR
Data provided by MPR.

This article originally appeared on Cancer Therapy Advisor