CASES

COLORECTAL CANCER
Dr. Soha Said Mohamed, PHD
Supervisor of the oncology clinical pharmacy
Alexandria Main University Hospital
CASE I

AS is 49 old female patient , she was

diagnosed as Stage III metastatic colon
cancer, the oncologist decided to start
FOLFIRI regimen for 4 cycles and then re
asses.
Her wt :113 kg, Ht: 155cm.
1.According to the previously mentioned protocol, the
dose of irinotecan would be………………….over…………hrs
Ca-leucovorin …………..over…………hrs
5-fu IVP…………………
5-fu continuous infusion……………..over………………hrs
BSA=√(113 X 155/3600) = 2
Irinotecan= 2 X 180 =360 mg over 1.5 hours
Leucovorin= 2 X 400 = 800 mg over 1.5 hours
5-FU IVP= 2 X 400 = 800 mg
5-FU infusion= 2 X 2400 = 4800 mg over 46 hours
After 3 cycles the patient come to the chemotherapy
clinic c/o diarrhea , her CBC; Hb:11.8, PLT:163,
ANC:0.85, Bilirubin:0.8, SGPT, SGOT:22,32 respectively.
2.As a clinical pharmacist, what would be your
recommendation for;
A.management of late onset diarrhea, and preventive
measures
B. this cycle and the next one??
A- Irinotecan diarrhea
Early onset
Timing During or within 24 hours of
administration
Associated Symptoms rhinitis, hypersalivation, miosis,
lacrimation, diaphoresis,
flushing, and abdominal
cramping
Mechanism cholinergic syndrome mediated
by increased anticholinesterase
activity of the irinotecan parent
compound
Management 1- Infusion time not less than 90
minutes (peak plasma conc.)
2- Atropine 0.3 – 0.6 mg IV or
SC as needed, repeated up to a
maximum dose of 1.2 mg
Late onset
> 24 hours of administration,
median onset of 5 days after
cycle
Risk of dehydration and
electrolyte imbalance if not
properly managed
abnormal ion transport in the
injured intestinal mucosa,
leading to increased secretion
of water and electrolytes into
the intestinal lumen
Loperamide 4 mg immediately,
then 2 mg after each loose
stool until diarrhea-free for 12
hours, maximum 16 mg/ day for
a total of 48 hours
B- Cycle decision
(Pt CBC and protocol requirement)
3.dose of irinotecan would be………………….
Ca-leucovorin ………….. 5-fu IVP…………………
5-fu continuous infusion……………..

Irinotecan= 2 X 150 = 300 mg

Leucovorin= 2 X 400 = 800 mg
5-FU IVP= 2 X 320 = 640 mg
5-FU infusion = 2X 2000 = 4000 mg
• 4.After the forth cycle the patient came to the consultant clinic for re
assessment, and after doing PET CT, the decision was to continue
more two cycles
Case II
AA is a 45 years old male patient diagnosed with
metastatic rectal cancer, the oncologist decided to give
him XELOX regimen.
Wt:82 kg, Ht:170 cm
1.According to the protocol , the oxaliplatin dose
……………over….hrs
2.Capcitabine dose…………………….BID , from Day…to
Day………, and what is your patient education tips???
After two cycles , the patient was c/o of sever
neuropathy grade IV.
So he was shifted to another regimen FOLFIRI+
3.Bevacizumab, was it a right decision???/
4.The dose would be of Bevacizumab…………….mg
5.The most characteristic side effects of bevacizumab
are………………………..
6.According to the previously mentioned protocol, the
dose of irinotecan would be………………….over…………hrs,
Ca-leucovorin …………..over…………hrs
5-fu IVP…………………
5-fu continuous infusion……………..over………………hrs
7.The …………………….enzyme is responsible for
fluorouracil metabolism
8.This regimen should be repeated every………………..
Case III

A 50 years old female was diagnosed with metastatic colon

cancer(moderately differentiated adenocarcinoma), and she
would start FOLFORINOX protocol on 28/11/2022. her weight
:88kg. Hieght:166cm
1.What would be the doses for each drug ??
Oxaliplatin
Irinotecan
Ca leucovorin and 5-fu
After two cycles the patient was re- assessed, showing
poor tolerance, abdominal colic and persistent nausea
and vomiting so she was shifted to FOLFOX-
PANITUMAB regimen
2.What would be the doses of the previous regimen??

3.The most characteristic side effects of vectibex??

4.The most important patient education tips for
vectibex are……………

5.After two cycles the patient come with peripheral

tingling and numbness sensation ,what is the cause of
such adverse effect and how to manage???
6.What is the preventive measures of skin toxicity of
panitumab???
7.This protocol repeated every………….days , for
maximum……………cycles.

8.After three cycles , CBC of the patient was Hb:12,

WBC:2.6, ANC:0.43, what would be the dose of this
patient for current and next cycle, if you know that her
weight was decreased by 15kg???