Appendix cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Systemic chemotherapy for metastatic appendiceal adenocarcinoma has not been studied appropriately.

• FOLFOX6 has been recommended in patients with adenocarcinoma specially gablet cell tumors.

• oxaliplatin, 5-FU and leucovorin or capecitabine areactive agents of the FOLFOX regime. please see below for the details<math>\blacktriangledown</math>

• Current colon cancer chemotherapy agents

• 5-fluorouracil (5-FU) : Traditional active agent
• Irinotecan
• Oxaliplatin
• Vascular endothelial growth factor receptor inhibitors (bevacizumab)
• Epidermal growth factor receptor inhibitors (cetuximab and panitumumab),
• Aflibercept
• Regorafenib: inhibitor of angiogenic tyrosine kinases (including the VEGF receptors 1,2, and 3),
• Capecitabine or 5-FU with or without a platinum drug

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR   The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Medical Therapy

• Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
• Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
• Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
• Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Modified FOLFOX6 : Cycle length 14 days

• • • • • • Oxaliplatin 85 mg/m ² IV
          • Dilute with 250 mL 5 percent dextrose in water (D5W)
          • Administer over 2 hrs
          • Avoid extravasation: May cause significant tissue damage
          • Leucovorin 400 mg/m ² IV (d,l-racemic mixture) / 200 mg/m ² IV (l-leucovorin)
          • Dilute with 250 mL D5W
          • Administer over 2 hrs concurrent with oxaliplatin.
          • Fluorouracil (FU) 400 mg/m ² IV bolus
          • Slow IV push over 5 mins (administer immediately after leucovorin)
          • Fluorouracil (FU) 2400 mg/m ² IV
          • Administer immediately after FU IV bolus
          • Dilute with 500 to 1000 mL D5W
          • Administer over 46 hours
      • Doses should be recalculated if there is a 10 percent or more change in body weight.
      • Prior to each treatment<math>\blacktriangledown</math>
      • Assess changes in neurologic function
      • Assess electrolytes and liver and renal function
      • CBC with differential and platelet count
    • Diarrhea:
    • Grade 2 or worse diarrhea <math>\blacktriangledown</math>
    • Withhold treatment
    • Restart at a lower dose of FU after complete resolution
    • Severe diarrhea, mucositis, and myelosuppression after FU <math>\blacktriangledown</math>
    • Evaluate for dihydropyrimidine dehydrogenase deficiency

• • • Neurologic toxicity
    • In order to decrease chance of developing Oxaliplatin induced neuropathy recommend patients to avoid exposure to cold up to 48 hours after each infusion.
    • Transient grade 3 paresthesias/dysesthesias / grade 2 symptoms lasting longer than 1 week<math>\blacktriangledown</math>
    • Decrease oxaliplatin dose by 25 percent.
    • Grade 4 or persistent grade 3 paresthesia/dysesthesia<math>\blacktriangledown</math>
    • Discontinue oxaliplatin

• • Myelotoxicity
  • Total white blood cell count <3000 cells/mm ³ , absolute neutrophil count <1500 cells/mm ³ , or platelets <100,000 /mm ³ on the day of treatment<math>\blacktriangledown</math>
  • Delay treatment cycle by one week
  • If treatment is delayed for two weeks or delayed for one week on two separate occasions, eliminate FU bolus
  • If occurred again<math>\blacktriangledown</math>
  • Reduce infusional FU by 20 percent and
  • Reduce oxaliplatin dose from 65 mg/m ² .