To see all protocols that comply with the WHO Essential Medicine List 

There are several different dosing schedules for FOLFOX regimens (FOLFOX4, FOLFOX6, FOLFOX7, FLOX). However, most clinical trials now use FOLFOX6 (Modified) as the control arm (e.g. the NSABPc08 trial and the SCOT trial).

In the adjuvant setting, both FOLFOX4 (MOSAIC) and FLOX (NSABPc07) used oxaliplatin 85 mg/m2. Further comparative analysis of these studies demonstrated that the FLOX protocol achieved similar clinical benefits despite giving only 2/3 as much oxaliplatin, and resulting in less neurotoxicity.r As a result, regimens with oxaliplatin 85 mg/m2 have been readily adopted, and for convenience, the FOLFOX6 (Modified) regimen, which avoids the day 2 bolus 5FU bolus, is used.

In advanced disease, the original FOLFOX regimens used oxaliplatin 85 mg/m2 andr although FOLFOX6 regimens were developed (using oxaliplatin 100 mg/m2 and avoiding the day 2 5FU bolus), there is little data to suggest these regimens are more effective; only one very small retrospective comparison showed a higher response rate.r There are no prospective randomised comparisons of 85 mg/m2 and 100 mg/m2 oxaliplatin regimens and these studies are never likely to be run.

The cumulative toxicity of oxaliplatin is significant ( greater than 15% grade 1 or 2 toxicities remaining at 4 years in adjuvant studies); and given that in the adjuvant setting, lower cumulative doses do not compromise efficacy, but do reduce neuropathy, and that cooperative groups in UK/Australia (SCOT) and USA (NSABP) have accepted FOLFOX6 (Modified), it is the preferred regimen of the eviQ Medical Oncology Reference Committee. On an individual patient basis, there is always an option for increasing the dose of oxaliplatin from 85 mg/m2 to 100 mg/m2 if the clinician feels that a response is inadequate.

While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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https://www.eviq.org.au/p/3064

14 Oct 2019