FOLFOX Regimen for Periampullary Carcinoma

Standard FOLFOX4 Dosing Schedule

The National Comprehensive Cancer Network recommends oxaliplatin 85 mg/m² IV over 2 hours on day 1 2
The National Comprehensive Cancer Network recommends leucovorin 200 mg/m² IV over 2 hours on days 1 and 2 (or 400 mg/m² if using racemic leucovorin instead of levoleucovorin) 5, 6
The National Comprehensive Cancer Network recommends 5-Fluorouracil 400 mg/m² IV bolus, then 600 mg/m² as 22-hour continuous infusion on days 1 and 2 2
The National Comprehensive Cancer Network recommends a cycle frequency of every 2 weeks 1, 2, 3, 4

The National Comprehensive Cancer Network recommends an alternative mFOLFOX6 regimen, which simplifies administration 1, 2, 3, 4
The National Comprehensive Cancer Network recommends oxaliplatin 85 mg/m² IV on day 1 2
The National Comprehensive Cancer Network recommends leucovorin 400 mg/m² IV on day 1 8
The National Comprehensive Cancer Network recommends 5-Fluorouracil 400 mg/m² IV bolus on day 1, then 2,400 mg/m² (1,200 mg/m²/day × 2 days) as 46-48 hour continuous infusion 8

Monitor complete blood counts, liver function, renal function, and peripheral neuropathy before each cycle, and consider discontinuing oxaliplatin after 3-4 months if grade ≥2 neurotoxicity develops while maintaining fluoropyrimidine 9
Never confuse leucovorin (400 mg/m²) with levoleucovorin (200 mg/m²)—the active isomer requires half the dose 5, 8, 10
Limit chemotherapy orders to 24-hour units (prescribe as 1,200 mg/m²/day, NOT 2,400 mg/m²/day over 46 hours) to minimize medication errors 5, 6, 8, 10

Perform response evaluation after 2-3 months using CT scan with contrast, and monitor CEA levels if initially elevated 9