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Certaines de ces informations ou toutes, dans certains cas, n’apparaissent qu’en Anglais. Vous pouvez demander la version française

A - Regimen Name

FULCVR Regimen
Fluorouracil-Leucovorin


Disease Site
Gastrointestinal - Pancreas

Intent
Adjuvant
Palliative

Regimen Category
Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.


Rationale and Uses

For treatment of patients with resectable, locally unresectable or recurrent pancreatic adenocarcinoma.

 
B - Drug Regimen

leucovorin

1

20 mg /m² IV Days 1 to 5

(1Give prior to Fluorouracil)

 

fluorouracil
400 to 425 mg /m² IV Days 1 to 5
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C - Cycle Frequency

REPEAT EVERY 28 DAYS

For a usual total of 6 cycles unless disease progression or unacceptable toxicity occurs

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Low


Febrile Neutropenia Risk:

Low

Other Supportive Care:

May advise patients to suck on ice chips during bolus injection, to reduce stomatitis
 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated.

Dosage with toxicity

Hematologic Toxicities

See Appendix for general recommendations.

 

 

 

 

Gastrointestinal Toxicities

Toxicity Dose
If Mucositis or Diarrhea ≥ Grade 3 in previous course REDUCE to 2/3 dose
If Hand-Foot Syndrome ≥ Grade 2 REDUCE to 2/3 dose

 



Hepatic Impairment

Omit if bilirubin > 4 x ULN (upper limit of normal).  Consider dose reduction with moderate to severe hepatic impairment.


Renal Impairment

Dose reduction may be considered with severe renal insufficiency.

 
F - Adverse Effects

Refer to leucovorin, fluorouracil drug monograph(s) for additional details of adverse effects


Bolus 5FU regimens have more myelosuppression and GI effects but less Hand-Foot Syndrome, compared to prolonged infusions.

Most Common Side Effects

Less Common Side Effects, but may be Severe or Life-Threatening

  • Myelosuppression ± infection, bleeding
  • Stomatitis
  • Diarrhea
  • Anorexia
  • Photosensitivity
  • Rash
  • Hand-foot syndrome
  • Increased LFTs
  • Cardiotoxicity
  • Arterial thromboembolism
  • Venous thromboembolism
  • Leukoencephalopathy
  • Optic neuritis
  • Hypersensitivity
  • Radiation recall reaction
  • Hemolysis
 
G - Interactions

Refer to leucovorin, fluorouracil drug monograph(s) for additional details

 
H - Drug Administration and Special Precautions

Refer to leucovorin, fluorouracil drug monograph(s) for additional details

 
I - Recommended Clinical Monitoring

Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

  • CBC; baseline and before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary.
  • Liver & renal function tests (if severe organ failure suspected); baseline and as clinically indicated
  • Clinical toxicity assessment (including stomatitis and diarrhea); at each visit
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version


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J - Administrative Information

Approximate Patient Visit
0.5 hour
Pharmacy Workload (average time per visit)
10.742 minutes
Nursing Workload (average time per visit)
40 minutes
 
K - References

Fluorouracil and leucovorin drug monographs, Cancer Care Ontario.

Moertel CG, Gunderson LL, Mailliard JA, et al. Early evaluation of combined fluorouracil and leucovorin as a radiation enhancer for locally unresectable, residual, or recurrent gastrointestinal carcinoma. The North Central Cancer Treatment Group. J Clin Oncol. 1994 Jan;12(1):21-7.

Neoptolemos JP, Dunn JA, Stocken DD, et al. Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomized controlled trial. Lancet. 2001; 358:1576-1585.

October 2017 removed archived PEBC guidelines link


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M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.