Hospital Pharmacy - May 2017 - 341

715353
research-article2017

HPXXXX10.1177/0018578717715353Hospital PharmacyGarrett et al.

Cancer Chemotherapy Update
Hospital Pharmacy
2017, Vol. 52(5) 341-347
© The Author(s) 2017
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DOI: 10.1177/0018578717715353
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Capecitabine, Oxaliplatin, and
Bevacizumab (BCapOx) Regimen
for Metastatic Colorectal Cancer
Meghan J. Garrett1, J. Aubrey Waddell1,2,
and Dominic A. Solimando Jr3

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents
used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and
the agents, both commercially available and investigational, used to treat malignant diseases. Questions or suggestions for topics
should be addressed to Dominic A. Solimando, Jr, President, Oncology Pharmacy Services, Inc, 4201 Wilson Blvd #110-545,
Arlington, VA 22203, e-mail: OncRxSvc@comcast.net; or J. Aubrey Waddell, Professor, University of Tennessee College of
Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial Hospital, 907 E. Lamar Alexander Parkway, Maryville,
TN 37804, e-mail: waddfour@charter.net. The information presented in this review is based on published data and clinical
expertise and includes information not included in the product labeling. Incorporation of such published data provides a more
robust assessment of the drugs and assists pharmacists in evaluation of orders for off-label use of these agents.
Regimen Name: BCapOx
Origin of Name: The regimen is named for the 3 drugs it contains: Bevacizumab (Avastin), Capecitabine (Xeloda), and
Oxaliplatin (Eloxatin)

Indications

3.
4.

BCapOx (see Table 1) has been studied as primary therapy for
advanced, recurrent, or metastatic colorectal cancer (mCRC)19
and primary therapy for adenocarcinoma of the small bowel
or ampulla of Vater.10 Current guidelines recommend BCapOx
as first- or second-line therapy for advanced or mCRC and
first-line neoadjuvant therapy for colon cancer with unresectable synchronous liver and/or lung metastases.11,12

Drug Preparation

C. Bevacizumab
1. Use bevacizumab 25 mg/mL injection.
2. Dilute in 100 mL 0.9% sodium chloride injection.

Drug Administration
A. Capecitabine
1. Capecitabine is administered orally (PO), usually in 2 divided doses daily.
2. Tablets should be swallowed with water within
30 minutes after a meal.
3. The dose is often prescribed as the total daily
dose, which is twice the individual dose (eg,
2000 mg/m2/day = 1000 mg/m2 twice a day).

Follow institutional policies for preparation of hazardous
medications when preparing bevacizumab and oxaliplatin
and dispensing capecitabine.
A. Capecitabine
1. Capecitabine is available as 500-mg and 150-mg
tablets.
2. Capecitabine tablets are unscored and filmcoated; breaking or cutting the tablets is difficult
and not recommended.
B. Oxaliplatin
1. Use oxaliplatin injection 5 mg/mL, or powder
for injection.
2. Reconstitute the powder to a concentration of
5 mg/mL with sterile water for injection or 5%
dextrose in water (D5W).

Dilute in 250 mL to 500 mL D5W.
Oxaliplatin is incompatible with chloride ion.
Avoid saline or dextrose/saline diluents.

1

Blount Memorial Hospital, Maryville, TN, USA
Blount Memorial Hospital, Maryville, TN, USA
3
Oncology Pharmacy Services, Inc, Arlington, VA, USA
2

Corresponding Author:
J. Aubrey Waddell, Professor, University of Tennessee College of
Pharmacy; Oncology Pharmacist, Pharmacy Department, Blount Memorial
Hospital, 907 E. Lamar Alexander Parkway, Maryville, TN 37804, USA.
Email: waddfour@charter.net


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Table of Contents for the Digital Edition of Hospital Pharmacy - May 2017

Editorial, For Sale: FDA Priority Review Vouchers
Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Pharmacists’ Knowledge of the Cost of Laboratory Testing
Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 317
Hospital Pharmacy - May 2017 - 318
Hospital Pharmacy - May 2017 - 319
Hospital Pharmacy - May 2017 - 320
Hospital Pharmacy - May 2017 - 321
Hospital Pharmacy - May 2017 - 322
Hospital Pharmacy - May 2017 - 323
Hospital Pharmacy - May 2017 - Editorial, For Sale: FDA Priority Review Vouchers
Hospital Pharmacy - May 2017 - 325
Hospital Pharmacy - May 2017 - Current FDA-Related Drug Information; Approvals, Submission, and Important Labeling Changes for US Marketed Pharmaceuticals
Hospital Pharmacy - May 2017 - Summaries of Safety Labeling Changes Approved by the FDA: Boxed Warnings
Hospital Pharmacy - May 2017 - 328
Hospital Pharmacy - May 2017 - 329
Hospital Pharmacy - May 2017 - ISMP Adverse Drug Reactions: Levofloxacin-Induced Neuroexcitation and Hallucinations Statin-Induced Muscle Rupture Mefloquine-Induced Rhabdomyolysis Methimazole-Induced
Hospital Pharmacy - May 2017 - 331
Hospital Pharmacy - May 2017 - 332
Hospital Pharmacy - May 2017 - 333
Hospital Pharmacy - May 2017 - Critical Care Pharmacist Market Perceptions: Comparison of Critical Care Program Directors and Directors of Pharmacy
Hospital Pharmacy - May 2017 - 335
Hospital Pharmacy - May 2017 - 336
Hospital Pharmacy - May 2017 - 337
Hospital Pharmacy - May 2017 - 338
Hospital Pharmacy - May 2017 - 339
Hospital Pharmacy - May 2017 - 340
Hospital Pharmacy - May 2017 - Capecitabine, Oxaliplatin, and Bevacizumab (BCapOx) Regimen for Metastatic Colorectal Cancer
Hospital Pharmacy - May 2017 - 342
Hospital Pharmacy - May 2017 - 343
Hospital Pharmacy - May 2017 - 344
Hospital Pharmacy - May 2017 - 345
Hospital Pharmacy - May 2017 - 346
Hospital Pharmacy - May 2017 - 347
Hospital Pharmacy - May 2017 - Clinical Pharmacy Discharge Counseling Service and the Impact on Readmission Rates in High-Risk Patients
Hospital Pharmacy - May 2017 - 349
Hospital Pharmacy - May 2017 - 350
Hospital Pharmacy - May 2017 - 351
Hospital Pharmacy - May 2017 - 352
Hospital Pharmacy - May 2017 - Mannitol Prescribing Practices With Cisplatin Before and After an Educational Newsletter Intervention
Hospital Pharmacy - May 2017 - 354
Hospital Pharmacy - May 2017 - 355
Hospital Pharmacy - May 2017 - 356
Hospital Pharmacy - May 2017 - Pharmacists’ Knowledge of the Cost of Laboratory Testing
Hospital Pharmacy - May 2017 - 358
Hospital Pharmacy - May 2017 - 359
Hospital Pharmacy - May 2017 - 360
Hospital Pharmacy - May 2017 - Adverse Drug Reaction Reporting Practices Among United Arab Emirates Pharmacists and Prescribers
Hospital Pharmacy - May 2017 - 362
Hospital Pharmacy - May 2017 - 363
Hospital Pharmacy - May 2017 - 364
Hospital Pharmacy - May 2017 - 365
Hospital Pharmacy - May 2017 - 366
Hospital Pharmacy - May 2017 - Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital
Hospital Pharmacy - May 2017 - 368
Hospital Pharmacy - May 2017 - 369
Hospital Pharmacy - May 2017 - 370
Hospital Pharmacy - May 2017 - 371
Hospital Pharmacy - May 2017 - 372
Hospital Pharmacy - May 2017 - 373
Hospital Pharmacy - May 2017 - Formulary Drug Reviews
Hospital Pharmacy - May 2017 - 375
Hospital Pharmacy - May 2017 - 376
Hospital Pharmacy - May 2017 - 377
Hospital Pharmacy - May 2017 - 378
Hospital Pharmacy - May 2017 - 379
Hospital Pharmacy - May 2017 - 380
Hospital Pharmacy - May 2017 - 381
Hospital Pharmacy - May 2017 - 382
Hospital Pharmacy - May 2017 - 383
Hospital Pharmacy - May 2017 - 384
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