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COLON CANCER

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Colon Cancer, Adjuvant
Colon Cancer, metastatic

***ADJUVANT COLON CANCER:

5FU + Leucovorin ---- Low-dose

5FU 425 mg/m2/d IV bolus DAYS 1-5
Leucovorin 20 mg/m2 IV bolus DAYS 1-5 immediately before 5FU

Repeat cycle at 4 weeks, 8 weeks, then Q5weeks

JCO 7:1407-1418, 1989

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Adjuvant High Dose Leucovorin + 5FU

Leucovorin 500 mg/m2 IV over 2 hours Q week X 6 weeks
5 FU 500 mg/m2 IV over 1 hour after the start of leucovorin Qweek X 6 weeks

Repeat Q8weeks X 6 cycles

Proc Am Soc Clin Oncol 15:205, 1996

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Advanced Colorectal CA: Bimonthly high-dose leucovorin & 5FU bolus plus CI (LV5FU2)

LV 200 mg/m2 as a 2-hour infusion followed by bolus 5-FU 400 mg/m2 and 22-hour infusion 5FU 600 mg/m2 for 2 consecutive days every 2 weeks

REF: JCO 15:808, 1997
LV5FU2 was superior to 5FU/LV monthly 5-day regimen in terms of RR, PFS, toxicity but not OS
RR: 32.6% vs 14.5% P = .0004
PFS: 27.6 wks vs 22 wks P = .0012
Grade 3-4: 11.1% vs 22.9% P = .0004
OS: 56.8 weeks vs 62 weeks P = .067

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***METASTATIC COLON CANCER:

5FU+Leucovorin+Irinotecan

Qweek X 4 (of 6 weeks)
IRINOTECAN 125 mg/m2
LEUCOVORIN 20 mg/m2 bolus
5FU 500 mg/m2 bolus

Proc Am Soc Clin Oncol 18:2333a, 1999

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IRINOTECAN Single agent:

IRINOTECAN 350 mg/m2 Q3weeks

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TOXICITIES:

IRIONOTECAN:
Diarrhea- use lopramide 4 mg loading dose followed by 2 mg Q2hours until diarrhea stops for at least 12 hours

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