regimen-monograph

DCF

Intent

Palliative

Regimen Category

Standard

Drugs Used

DOCEtaxel , CISplatin , fluorouracil

A - Regimen Name

DCF Regimen

Docetaxel-Cisplatin-Fluorouracil

Disease Site

Gastrointestinal - Gastric / Stomach

Intent

Palliative

Regimen Category

Standard : Standard therapy endorsed by the Disease Site Group or a regimen widely used by most Regional Cancer Centres in this disease site. The category is unrelated to the source or availability of funding.

Rationale and Uses

For treatment of patients with metastatic or locally recurrent gastric or esophagogastric junction adenocarcinoma, with good performance status; with no prior palliative chemotherapy. In phase III trials this regimen was superior (overall survival, time to progression and QoL) to cisplatin and fluorouracil, but associated with more GI and hematologic toxicity

B - Drug Regimen

DOCEtaxel

75 mg /m²

IV over 1 hour

Day 1

CISplatin

75 mg /m²

IV over 1 to 3 hours

Day 1

fluorouracil

750 mg /m²/day

IV as continuous infusion

Days 1 to 5

C - Cycle Frequency

REPEAT EVERY 21 DAYS

Until disease progression, or unacceptable toxicity.

D - Premedication and Supportive Measures

Antiemetic Regimen:

High (Day 1)
Minimal (5FU continuous infusion)

E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations have been adapted from clinical trials or product monographs and could be considered. See appendix 6 for general recommendations.

Dosage with toxicity

Worst Toxicity / Counts (x 10⁹/L) in previous cycle		Worst Toxicity / Counts (x 10⁹/L) in previous cycle	DOCEtaxel * (% previous dose)	CISplatin* (% previous dose)		Fluorouracil* (% previous dose or daily dose)
Febrile Neutropenia Or ANC < 0.5 for ≥ 5-7 d Or recurrent low ANC despite GCSF	Or	Thrombocytopenic bleeding Or Platelets < 25	If febrile neutropenia alone consider g-csf prior to dose modification, otherwise 80%
Grade 3 diarrhea	First occurrence		No change		No change		80%
	Second occurrence		80% #		No change		Dose reduce or discontinue
Worst Toxicity / Counts (x 10⁹/L) in previous cycle	Worst Toxicity / Counts (x 10⁹/L) in previous cycle		DOCEtaxel * (% previous dose)		CISplatin* (% previous dose)		Fluorouracil* (% previous dose or daily dose)
Grade 4 diarrhea	First occurrence		80% #		No change		80% #
Grade 3 stomatitis	1^st / 2^nd occurrence		No change		No change		80% #
	Third occurrence		80% #		No change		Discontinue^
Grade 4 stomatitis	First occurrence		No change		No change		Discontinue
	Second occurrence		80% #		No change		Discontinue^
Hand-foot syndrome or cutaneous toxicity	Grade 2		No change		No change		↓ to 700 mg/m²/d #
	Grade 3		80% #		No change		↓ to 675 mg/m²/d #
Grade 2 Neurotoxicity			No change		80% #		No change
Grade 3 neurotoxicity			80% #		Discontinue		No change
Grade 3 related organ / non-hematologic			80%* for suspect drug(s)
Grade 4 related organ / non-hematologic (includes grade 4 neurotoxicity and any grade cardiotoxicity			Discontinue

_{* Do not start new cycle until toxicities have recovered to ≤ grade 2, platelets ≥ 100 x 10⁹/L, and ANC ≥ 1.5 x 10⁹/L.}
^{# Discontinue if recurs at same grade}
^{^ If not already discontinued}

Hepatic Impairment

AST/ALT		Alk Phosp		Bilirubin	docetaxel (% previous dose)	cisplatin (% previous dose)	fluorouracil (% previous dose)
> 1.5 X ULN	AND	> 2.5 x ULN			75%	No change	No change
> 3.5 x ULN	AND	> 6 x ULN	OR	> ULN	Discontinue	No change	Caution; consider dose reduction
				> 4 x ULN	Discontinue	No change	OMIT

Renal Impairment

Creatinine clearance	Docetaxel (% previous dose)	Cisplatin (% previous dose)	Fluorouracil (% previous dose)
>45-60	No change	75%	No change
>30-45	No change	50%	No change
15-30	No change	Discontinue	Consider dose ↓
<15	No change	Discontinue	Consider dose ↓

F - Adverse Effects

Refer to DOCEtaxel, CISplatin, fluorouracil drug monograph(s) for additional details of adverse effects

Most Common Side Effects

Less Common Side Effects,
but may be Severe or Life-Threatening

Nausea and vomiting
Nephrotoxicity (may be severe)
Electrolyte abnormalities
Neurotoxicity and ototoxicity (may be severe)
Myelosuppression ± infection / bleeding (may be severe)
Hyperuricemia
Hypersensitivity reactions (may be severe)
Fluid retention
Cutaneous effects (including nails, hand-foot syndrome; may be severe)
Alopecia
GI (nausea, vomiting stomatitis, diarrhea); may be severe
Myalgia, arthralgia
↑ LFTs (may be severe)
Anorexia, fatigue

Arterial thromboembolism
Arrhythmia
Hemolytic uremic syndrome, vasculitis
Secondary malignancy
Seizures
Raynaud's
Hemolysis
Pneumonitis
GI obstruction, perforation
Venous thromboembolism
Cardiotoxicity
Leukoencephalopathy
Optic neuritis
Disseminated intravascular coagulation

G - Interactions

Refer to DOCEtaxel, CISplatin, fluorouracil drug monograph(s) for additional details

H - Drug Administration and Special Precautions

Refer to DOCEtaxel, CISplatin, fluorouracil drug monograph(s) for additional details

I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

CBC; baseline and regular
Liver function tests; baseline
Renal function tests; baseline
Electrolytes, including magnesium, phosphate and calcium; baseline and regular
Clinical toxicity assessment (infection, bleeding, stomatitis, diarrhea, neurotoxicity, fluid retention, hypersensitivity, ototoxicity , thromboembolism, nausea/vomiting, local site toxicity, skin effects (nails, rash or hand-foot-syndrome)
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Audiogram; baseline and periodic
Liver function tests; baseline and regular

J - Administrative Information

Approximate Patient Visit

4.5 to 6.5 hours

K - References

Ajani JA, Moiseyenko VM, Tjulandin S, et al. Clinical benefit with docetaxel plus fluorouracil and cisplatin compared with cisplatin and fluorouracil in a phase III trial of advanced gastric or gastroesophageal cancer adenocarcinoma: the V-325 Study Group. J Clin Oncol 2007;25(22):3205-9.

Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006;24(31):4991-7.

Ajani JA, Fodor MB, Tjulandin SA, et al. Phase II multi-institutional randomized trial of docetaxel plus cisplatin with or without fluorouracil in patients with untreated, advanced gastric, or gastroesophageal adenocarcinoma. J Clin Oncol 2005;23(24):5660-7.

PEBC Advice Documents or Guidelines

Systemic Therapy for Advanced Gastric Cancer

October 2017 Changes to dose modifications and PEBC guidelines

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.
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Last Updated: July 21, 2026

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