Hospital Pharmacy - May 2017 - 342

342

Hospital Pharmacy 52(5)

Table 1. Capecitabine, Oxaliplatin, and Bevacizumab Regimen.1-5,10
Drug

Dose

Route of administration

2

Administered on day(s)

Capecitabine
1000 mg/m twice daily
PO
1 through 14
Oxaliplatin
130 mg/m2
IV
1
Bevacizumab
7.5 mg/kg
IV
1
Cycle repeats: every 21 days
Variations
1. Capecitabine 1500 mg/m2/day days 1-14; oxaliplatin 85 mg/m2 day 1, bevacizumab 5 mg/kg day 1, every 14 days.6
2. Capecitabine 1700 mg/m2/day days 1-14; oxaliplatin 130 mg/m2 day 1, bevacizumab 7.5 mg/kg day 1, every 14 days.7
3. Capecitabine 2000 mg/m2/day days 1-14; oxaliplatin 85 mg/m2 day 1, bevacizumab 10 mg/kg day 1, every 14 days.8
4. Capecitabine 1500 mg/m2/day days 1-14; oxaliplatin 130 mg/m2 day 1, bevacizumab 7.5 mg/kg day 1, every 21 days.9

Total dose/cycle
28 000 mg/m2
130 mg/m2
7.5 mg/kg

Note. IV = intravenous; PO = oral.

4.

Care should be taken to ensure the intended daily
dose is not taken twice a day.

B. Oxaliplatin is administered as an intravenous (IV) infusion over 2 hours on day 1.
C. Bevacizumab
1. Infuse the first dose over 90 minutes.
2. If the first dose is tolerated well, infuse the second dose over 60 minutes.
3. If the second dose is tolerated well, all subsequent doses may be infused over 30 minutes.
4. Should not be administered within 28 days of
major surgery or until the surgical wound is fully
healed.

Supportive Care
A. Acute and Delayed Emesis Prophylaxis: The
BCapOx regimen is predicted to cause acute emesis
in 30% to 90% of patients.13-16 The studies reviewed
reported nausea from 1% to 59% and vomiting from
3% to 32%, with grade 3 or 4 nausea in 1% to 2% of
patients and grade 3 or 4 vomiting in 3% to 7%.1-4
Prophylactic antiemetic therapy with a steroid and
serotonin antagonist is recommended.13-16 One group
suggests addition of a neurokinin (NK1) antagonist
may be appropriate in some patients.13 One of the following regimens given 30 minutes prior to therapy is
recommended:
1. Ondansetron 8 mg to 16 mg PO, dexamethasone
20 mg PO, given 30 minutes before oxaliplatin.
2. Granisetron 1 mg to 2 mg PO, dexamethasone 20
mg PO, given 30 minutes before oxaliplatin.
3. Dolasetron 100 mg PO, dexamethasone 20 mg
PO, given 30 minutes before oxaliplatin.
4. Palonosetron 0.25 mg IV on day 1 only and
dexamethasone 20 mg PO, given 30 minutes
before oxaliplatin.
If a neurokinin antagonist is used, one of the following
regimens is recommended:

1.
2.
3.
4.

Netupitant 300 mg/palonosetron 0.5 mg PO, dexamethasone 12 mg PO.
Aprepitant 125 mg PO day 1 and 80 mg PO on days
2 and 3, combined with one of the regimens above
(decrease dexamethasone to 12 mg).
Fosaprepitant 150 mg IV, combined with one of the
regimens above (decrease dexamethasone to 12 mg).
Rolapitant 180 mg PO, combined with one of the
regimens above.

All given 30 minutes before chemotherapy, except rolapitant which is given 1 to 2 hours before chemotherapy.
The antiemetic therapy should continue for at least 3 days.
A meta-analysis of several trials of serotonin antagonists recommends against prolonged (>24 hours) use of these agents,
making a steroid or steroid and dopamine antagonist combination most appropriate for follow-up therapy.17 One of the
following regimens is recommended:
1.

2.

3.

Dexamethasone 4 mg PO twice a day for 3 days,
±metoclopramide 0.5 to 2 mg/kg PO every 4 to 6
hours, ±diphenhydramine 25 to 50 mg PO every 6
hours if needed, starting on day 2 of BCapOx.
Dexamethasone 4 mg PO twice a day for 3 days,
±prochlorperazine 10 mg PO every 4 to 6 hours,
±diphenhydramine 25 to 50 mg PO every 6 hours if
needed, starting on day 2 of BCapOx.
Dexamethasone 4 mg PO twice a day for 3 days,
±promethazine 25 to 50 mg PO every 4 to 6 hours,
±diphenhydramine 25 to 50 mg PO every 6 hours if
needed, starting on day 2 of BCapOx.

Patients who experience significant nausea or vomiting
with one of these regimens should receive an agent from a
different pharmacologic category.13-16 There is no evidence
that substituting granisetron for ondansetron in subsequent
treatment cycles, or increasing the dose, even to very high
doses, is effective. This approach is not recommended.17-22
B. Breakthrough Nausea and Vomiting13-16: Patients
should receive a prescription for an antiemetic to



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
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