Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.
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regimen-monograph
XELOX+ENCO+PNTM
Cancer Type
Gastrointestinal,
Colorectal,
Small bowel and appendix
Intent
Palliative
Regimen Category
Evidence-informed
Funding Program
New Drug Funding Program
Panitumumab - In Combination with Encorafenib and Chemotherapy for Previously Untreated Metastatic Colorectal Cancer
ODB - General Benefit
capecitabine
Exceptional Access Program
Encorafenib - In combination with panitumumab and chemotherapy for previously untreated metastatic colorectal cancer, according to specific criteria
Drugs Used
A - Regimen Name
XELOX+ENCO+PNTM Regimen
Capecitabine-Oxaliplatin-Encorafenib-Panitumumab
Disease Site
Gastrointestinal
Colorectal
Small bowel and appendix
Small bowel and appendix
Intent
Palliative
Regimen Category
Evidence-informed :
Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.
This Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Rationale and Uses
Treatment for patients with previously untreated BRAF-V600E mutated metastatic colorectal, small bowel, or appendiceal cancer
(Refer to the NDFP eligibility forms for detailed funding criteria.)
Supplementary Public Funding
PANitumumab
New Drug Funding Program (Panitumumab - In Combination with Encorafenib and Chemotherapy for Previously Untreated Metastatic Colorectal Cancer) (NDFP Website )
capecitabine
ODB - General Benefit (capecitabine) (ODB Formulary )
encorafenib
Exceptional Access Program (Encorafenib - In combination with panitumumab and chemotherapy for previously untreated metastatic colorectal cancer, according to specific criteria) (EAP Website )
B - Drug Regimen
|
Every 2 weeks: |
|||
| PANitumumab | 6 mg /kg | IV | Day 1 |
|
|
|||
| oxaliplatin | 130 mg /m² | IV | Day 1 |
| capecitabine
^ |
1000 mg /m² | PO | BID, Days 1 to 14 |
|
^Total dose 2000 mg/m2/day |
|||
| encorafenib | 300 mg | PO | Daily |
C - Cycle Frequency
Panitumumab: Repeat every 14 days
Oxaliplatin and capecitabine: Repeat every 21 days
Encorafenib: Continuous treatment
Until disease progression or unacceptable toxicity
If encorafenib or panitumumab is discontinued due to unacceptable toxicity, the other drug (i.e., panitumumab or encorafenib) must also be discontinued.
D - Premedication and Supportive Measures
Antiemetic Regimen:
Moderate
No routine prophylaxis (capecitabine and encorafenib)
- Also refer to CCO Antiemetic Recommendations.
Screen for hepatitis B virus in all cancer patients starting systemic treatment. Refer to the hepatitis B virus screening and management guideline.
Patients should be tested for DPD deficiency before starting treatment with capecitabine. Refer to the DPD Deficiency Guidance for Clinicians for more information.
Oxaliplatin premedication (prophylaxis for infusion reactions):
- There is insufficient evidence that routine prophylaxis with pre-medications reduces IR rates.
- Consider corticosteroids and H1-receptor antagonists ± H2-receptor antagonists in high-risk patients (i.e. ≥ cycle 6, younger age, female gender, prior platinum exposure, platinum-free interval ≥ 3 years).
Other Supportive Care:
- Topical emollients (e.g. hand creams, udder balm) therapy may ameliorate the manifestations of hand-foot syndrome in patients receiving capecitabine.
- Standard antidiarrheal agents (e.g. loperamide) should be initiated as medically appropriate, as early as possible for diarrhea, in patients receiving capecitabine.
- Patients should be counselled about cold avoidance prior to receiving oxaliplatin, since cold temperatures can precipitate or exacerbate acute neurological symptoms.
- As sun exposure may exacerbate skin reactions associated with panitumumab, patients should be advised to use sunscreen, wear a hat and limit sun exposure.
- Consider pre-emptive therapy for EGFR inhibitor-related skin toxicity; the following was shown to be of benefit with panitumumab treatment, starting the day before treatment and continued until week 6. (Lacouture et al, 2010):
- Skin moisturizer applied to the face, hands, feet, neck, back and chest in the morning
- Sunscreen to exposed areas (SPF > 15, UVA and UVB) before going outdoors
- Hydrocortisone 1% cream to the face, hands, feet, neck, back and chest at bedtime
- Doxycycline (or minocycline) PO
- Refer to EGFR inhibitor-induced skin toxicity management guidelines for more information (e.g. Alberta Health Services, ESMO, NCCN, Melosky 2009).
K - References
Burtness B, Anadkat M, Basti S, et al. NCCN Task Force Report: Management of dermatologic and other toxicities associated with EGFR inhibition in patients with cancer. J Natl Compr Canc Netw. 2009;7 Suppl 1:S5-S24.
Capecitabine drug monograph. Ontario Health (Cancer Care Ontario).
Cassidy J, Clarke S, Diaz-Rubio E, et al. XELOX vs FOLFOX-4 as first-line therapy for metastatic colorectal cancer: NO16966 updated results. Br J Cancer 2011; 105: 58–64.
Elez E, Yoshino T, Shen L, et al. Encorafenib, cetuximab, and mFOLFOX6 in BRAF-mutated colorectal cancer. N Engl J Med 2025;392(24):2425-37. doi: 10.1056/NEJMoa2501912.
Encorafenib drug monograph. Ontario Health (Cancer Care Ontario).
Lacouture ME, Sibaud V, Gerber PA, et al. Prevention and management of dermatological toxicities related to anticancer agents: ESMO Clinical Practice Guidelines. Ann Oncol. 2021;32(2):157-170.
Lacouture, ME, Mitchell EP, Piperdi B et al. Skin toxicity evaluation protocol with panitumumab (STEPP), a phase II, open-label, randomized trial evaluating the impact of a pre-emptive skin treatment regimen on skin toxicities and quality of life in patients with metastatic colorectal cancer. J Clin Oncol 2010; 28: 1351-7.
Melosky B, Burkes R, Rayson D, et al. Management of skin rash during EGFR-targeted monoclonal antibody treatment for gastrointestinal malignancies: Canadian recommendations. Current Oncology 2009; 16(10): 14-24.
Oxaliplatin drug monograph. Ontario Health (Cancer Care Ontario).
Panitumumab drug monograph. Ontario Health (Cancer Care Ontario).
Prevention and Treatment of Acneiform Rash in Patients Treated with EGFR Inhibitor Therapies. Alberta Health Services. November 2020.
Reimbursement recommendation: Encorafenib. Canada's Drug Agency, March 2026.
May 2026 new ST-QBP regimen
L - Other Notes
DPD Deficiency Testing and Guidance:
Patients should be tested for DPD deficiency before starting treatment with capecitabine. Refer to the DPD Deficiency Guidance for Clinicians for more information.
In patients with unrecognized DPD deficiency, acute, life-threatening toxicity may occur; if acute grade 2-4 toxicity develops, treatment should be stopped immediately and permanent discontinuation considered based on clinical assessment of the toxicities.
Antidote for Capecitabine Overdose:
Uridine triacetate is a prodrug of uridine and is a specific antidote for treating capecitabine overdose or severe early onset toxicities. If available, consider administering as soon as possible (i.e. within 96 hours) for suspected overdose. If not available, treatment is symptomatic and supportive.
For usage approval and supply, contact Health Canada’s Special Access Program (SAP) (Phone: 613-941-2108. On-call service is available for emergencies).
The recommended dosing and administration for uridine triacetate in patients ≥18 years is:
- 10 grams (1 packet of coated granules) orally every 6 hours for 20 doses in total, without regards to meals.
- Granules should not be chewed. They should be mixed with 3 to 4 ounces of soft foods such as applesauce, pudding or yogurt.
- The dose should be ingested within 30 minutes of preparation, followed by at least 4 ounces of water.
- Refer to the prescribing information on dose preparation for NG-tube or G-tube use.
M - Disclaimer
Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.
Last Updated: July 27, 2026
