regimen-monograph

FU(CIV-RT)

Intent

Palliative

Regimen Category

Local

Drugs Used

fluorouracil

A - Regimen Name

FU(CIV-RT) Regimen

Fluorouracil

Disease Site

Gastrointestinal - Gastric / Stomach
(Locally Advanced)

Intent

Palliative
(Combined modality with radiotherapy)

Regimen Category

Local : A regimen not widely used by Regional Cancer Centres in this disease site.

Rationale and Uses

An option for local disease control in patients who are intolerant of, or unsuitable for anthracyclines or platinum-based regimens

B - Drug Regimen

fluorouracil

(Round to nearest 25 mg)

225 mg /m²/day

IV over 24 hours as continuous infusion

Concurrent with radiotherapy

C - Cycle Frequency

During entire course of radiotherapy

D - Premedication and Supportive Measures

Antiemetic Regimen:

Minimal

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.

Dosage with toxicity

Toxicity or Counts (x10⁹/L)	During Cycle	For Next cycle
Platelets < 80 or AGC < 1.5	Hold*	May consider ↓
Bleeding, febrile neutropenia	Hold*	↓ by 25%
≥ grade 3 GI	Hold*	↓ by 25%
CNS	Hold*	↓ by 25%
Cardiac	Hold*	Consider discontinuing
* Do not retreat until AGC ≥ 1.5 x 10⁹/L , platelets ≥ 100 x 10⁹/L and organ toxicity ≤ grade 2. With severe toxicity, consider testing for DPD deficiency prior to rechallenge.

Hepatic Impairment

Suggested example:

Bilirubin		AST/ALT	Fluorouracil (% previous dose)
< 2 x ULN	and	3-5 x ULN	75 %
2-4 x ULN	or	5-10 x ULN	50-75%
≥ 4 x ULN	or	≥ 10 x ULN	Discontinue

Renal Impairment

No adjustment required, although reduction may be considered with severe renal insufficiency.

F - Adverse Effects

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

Prolonged 5FU infusion regimens have more Hand-Foot Syndrome and less myelosuppression and GI effects, compared to bolus regimens.

Most Common Side Effects	Less Common Side Effects, but may be Severe or Life-Threatening
Myelosuppression ± infection, bleeding Hand-foot syndrome Stomatitis Diarrhea	Cardiotoxicity Venous thromboembolism Leukoencephalopathy Optic neuritis Hemolysis / hemolytic uremic syndrome ↑ LFTs

G - Interactions

Refer to fluorouracil drug monograph(s) for additional details

Fluorouracil is a known radiosensitizer. Patients should be carefully monitored for gastrointestinal toxicity when they are receiving concurrent 5FU-Radiation therapy

H - Drug Administration and Special Precautions

Refer to fluorouracil drug monograph(s) for additional details

I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

Weekly CBC
Liver function tests; baseline
Regular clinical assessment and grading of stomatitis, diarrhea, bleeding, infection, local site toxicity, skin effects (rash or hand-foot syndrome)
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Renal function tests; baseline

J - Administrative Information

Approximate Patient Visit

0.5 hour

K - References

Burmeister BH, Walpole ET, Burmeister EA, et al. Feasibility of chemoradiation therapy with protracted infusion of 5-fluorouracil for esophageal cancer patients not suitable for cisplatin. Int J Clin Oncol 2005;10(4):256-61.

October 2017 Entire document revision

L - Other Notes

• Schedule pump teaching session BEFORE first day of infusion.

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.
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Last Updated: July 21, 2026

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