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regimen-monograph
CISPFU(HD-RT)
A - Regimen Name
CISPFU(HD-RT) Regimen
CISplatin (high dose)-Fluorouracil
Disease Site
Gastrointestinal - Esophagus
Intent
Curative
Palliative
(Curative - combined modality with radiotherapy; Palliative - with or without radiotherapy)
Palliative
(Curative - combined modality with radiotherapy; Palliative - with or without radiotherapy)
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
Standard regimen for use with radiation therapy as multimodality therapy for esophageal cancer
B - Drug Regimen
| fluorouracil
(Round to nearest 50mg) |
1000 mg /m²/day | IV continuous infusion over 24 hours | Days 1-4 |
|
(Maximum 2 g/ day) |
|||
| CISplatin
(Round to nearest 1mg) |
75-80 mg /m² | IV | Day 1 |
|
(or give as Cisplatin 100mg/m2 IV on Day 1 - reduce dose if necessary)
|
|||
C - Cycle Frequency
During WEEKS 1 & 5 of Radiotherapy (If Radiotherapy given concurrently);
Then REPEAT EVERY 21-28 DAYS
For a Usual Total of 4 to 6 Cycles
D - Premedication and Supportive Measures
Antiemetic Regimen:
High (Cisplatin)
Minimal (Fluorouracil infusion)
E - Dose Modifications
Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.
Dosage with toxicity
Hematologic Toxicities
See appendix 6 for general recommendations.
GI Toxicities
| Toxicity | Action |
| If Mucositis or Diarrhea ≥ Grade 3 in previous course | REDUCE to 2/3 dose of 5-FU |
| If Hand-Foot Syndrome ≥ Grade 2 | REDUCE to 2/3 dose of 5-FU |
Hepatic Impairment
If Bilirubin > 4 x ULN, OMIT 5FU dose.
Renal Impairment
| Toxicity | Action |
If renal function has not returned to normal |
DISCONTINUE Cisplatin |
F - Adverse Effects
Refer to fluorouracil, CISplatin drug monograph(s) for additional details of adverse effects
Prolonged 5FU regimens have more Hand-Foot Syndrome but less myelosuppression and GI effects compared to bolus infusions.
Most Frequently Occurring Adverse Effects
- Nausea and vomiting
- Fatigue
- Nephrotoxicity
- Neurotoxicity & ototoxicity
- Stomatitis and diarrhea
- Hand foot syndrome
H - Drug Administration and Special Precautions
Refer to fluorouracil, CISplatin drug monograph(s) for additional details
I - Recommended Clinical Monitoring
Recommended Clinical Monitoring
- Clinical toxicity assessment (including stomatitis, neurotoxicity, ototoxicity, skin).
- CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modifications necessary.
- Baseline and regular liver and renal function (including electrolytes and magnesium) tests.
- Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version
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J - Administrative Information
Approximate Patient Visit
Day 1: 3 to 4 hours; 5FU-only days: 0.5 hour
K - References
Walsh T, Noonan N, Hollywood D et al. A comparison of multimodality therapy and surgery for esophageal adenocarcinoma. N. Eng J Med 1996. 335:462-7.
Herskovic A, Martz K, Muhyi A et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992. 326:1593-8.
Wobst A, Audision R, Colleoni M, Geraghty J. Oesophageal cancer treatment – studies, strategies and facts. Ann Oncol 1998. 9(9): 951-62.
PEBC Advice Documents or Guidelines
L - Other Notes
Schedule pump teaching session BEFORE first day of infusion.
December 2011: Modified section F
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.
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Last Updated: July 21, 2026
