Treatment protocols for small and large bowel cancer

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with small bowel and colorectal cancer, both in the adjuvant setting and for advanced disease. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with bowel cancer. Additional regimens may be added over time, particularly as treatment for colorectal cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with colorectal cancer. Clinicians should refer to the individual disease-oriented topic reviews that discuss the use of these protocols in appropriate clinical situations:

●(See "Systemic therapy for metastatic colorectal cancer: General principles".)

●(See "Systemic therapy for nonoperable metastatic colorectal cancer: Selecting the initial therapeutic approach".)

●(See "Therapy for metastatic colorectal cancer in older adult patients and those with a poor performance status".)

●(See "Potentially resectable colorectal cancer liver metastases: Integration of surgery and chemotherapy".)

●(See "Adjuvant therapy for resected stage III (node-positive) colon cancer".)

●(See "Adjuvant therapy for resected stage II colon cancer".)

●(See "Adjuvant therapy for resected rectal adenocarcinoma in patients not receiving neoadjuvant therapy".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

Treatment regimens for anal cancer are discussed separately. (See "Treatment protocols for anal cancer".)

REGIMENS

Chemotherapy

Short-term infusional fluorouracil and leucovorin (modified de Gramont schedule) —  (table 1)

Weekly bolus fluorouracil plus high-dose leucovorin (Roswell Park Memorial Institute [RPMI] regimen) —  (table 2)

Capecitabine plus bevacizumab —  (table 3)

Modified FOLFOX6 (fluorouracil plus leucovorin and oxaliplatin) —  (table 4)

Modified FOLFOX6 plus bevacizumab —  (table 5)

Modified FOLFOX7 —  (table 6)

Modified FOLFOX7 plus bevacizumab —  (table 7)

Capecitabine plus oxaliplatin for small intestinal adenocarcinoma —  (table 8)

Capecitabine plus oxaliplatin (XELOX, CAPOX) for colorectal cancer —  (table 9)

XELOX/CAPOX plus bevacizumab for colorectal cancer —  (table 10)

FOLFIRI (fluorouracil plus leucovorin and irinotecan) —  (table 11)

FOLFIRI plus bevacizumab —  (table 12)

FOLFOXIRI (FOLFOX plus irinotecan) —  (table 13)

FOLFOXIRI plus bevacizumab for metastatic colorectal cancer —  (table 14)

Modified FOLFOXIRI plus panitumumab for colorectal cancer —  (table 15)

Neoadjuvant FOLFIRINOX (FOLFIRI plus oxaliplatin) for rectal cancer —  (table 16)

Single-agent cetuximab —  (table 17)

Single-agent panitumumab —  (table 18)

Cetuximab plus irinotecan —  (table 19)

FOLFIRI plus cetuximab —  (table 20)

FOLFIRI plus panitumumab —  (table 21)

FLOX for adjuvant treatment of colon cancer —  (table 22)

Immunotherapy

Nivolumab monotherapy for microsatellite-unstable (mismatch repair-deficient) advanced cancer —  (table 23)

Pembrolizumab monotherapy for microsatellite-unstable (mismatch repair-deficient) advanced cancer —  (table 24)

Nivolumab plus ipilimumab for microsatellite-unstable (mismatch repair-deficient) metastatic colorectal cancer —  (table 25)

Concomitant chemoradiotherapy for rectal cancer

Concomitant chemoradiotherapy with capecitabine for rectal cancer in both the adjuvant and neoadjuvant setting —  (table 26)

Concomitant chemoradiotherapy with infusional fluorouracil for rectal cancer in both the adjuvant and neoadjuvant setting —  (table 27)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.