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Stage IV and Recurrent Rectal Cancer

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    Drug combinations described in this section include the following:

    • The Arbeitsgemeinschaft Internische Onkologie (AIO) or German AIO regimen (folic acid, 5-FU, and irinotecan):
      • Irinotecan (100 mg/m2) administered as a 2-hour infusion on day 1; LV (500 mg/m2) administered as a 2-hour infusion on day 1; followed by 5-FU (2,000 mg/m2) intravenous (IV) bolus via ambulatory pump administered for a period of 24 hours on a weekly basis four times a year (52 weeks).
    • The CAPOX regimen (capecitabine and oxaliplatin):
      • Capecitabine (1,000 mg/m2) twice a day on days 1 through 14 plus oxaliplatin (70 mg/m2) on days 1 and 8 every 3 weeks.
    • The Douillard regimen (folic acid, 5-FU, and irinotecan):
      • Irinotecan (180 mg/m2) administered as a 2-hour infusion on day 1; LV (200 mg/m2) administered as a 2-hour infusion on day 1 and day 2; followed by a loading dose of 5-FU (400 mg/m2) IV bolus, then 5-FU (600 mg/m2) via ambulatory pump administered for a period of 22 hours on day 1 and day 2 every 2 weeks.
    • The FOLFOX4 regimen (oxaliplatin, LV, and 5-FU):
      • Oxaliplatin (85 mg/m2) administered as a 2-hour infusion on day 1; LV (200 mg/m2) administered as a 2-hour infusion on day 1 and day 2; followed by a loading dose of 5-FU (400 mg/m2) IV bolus, then 5-FU (600 mg/m2) administered via ambulatory pump for a period of 22 hours on day 1 and day 2 every 2 weeks.
    • The FOLFOX6 regimen (oxaliplatin, LV, and 5-FU):
      • Oxaliplatin (85–100 mg/m2) administered as a 2-hour infusion on day 1; LV (400 mg/m2) administered as a 2-hour infusion on day 1; followed by a loading dose of 5-FU (400 mg/m2) IV bolus on day 1, then 5-FU (2,400–3,000 mg/m2) administered via ambulatory pump for a period of 46 hours every 2 weeks.
    • The FOLFIRI regimen (LV, 5-FU, and irinotecan):
      • Irinotecan (180 mg/m2) administered as a 2-hour infusion on day 1; LV (400 mg/m2) administered as a 2-hour infusion on day 1; followed by a loading dose of 5-FU (400 mg/m2) IV bolus administered on day 1, then 5-FU (2,400–3,000 mg/m2) administered via ambulatory pump for a period of 46 hours every 2 weeks.
    • The FUFOX regimen (fluorouracil, LV, and oxaliplatin):
      • Oxaliplatin (50 mg/m2) plus LV (500 mg/m2) plus 5-FU (2,000 mg/m2) as a 22-hour continuous infusion on days 1, 8, 22, and 29 every 36 days.
    • The FUOX regimen (fluorouracil plus oxaliplatin):
      • Continuous infusion 5-FU (2,250 mg/m2) during 48 hours on days 1, 8, 15, 22, 29 and 36 plus oxaliplatin (85 mg/m2) on days 1, 15, and 29 every 6 weeks.
    • IFL (or Saltz) regimen (irinotecan, 5-FU, and LV):
      • Irinotecan (125 mg/m2), 5-FU (500 mg/m2) IV bolus, and LV (20 mg/m2) IV bolus administered weekly for 4 out of 6 weeks.
    • The XELOX regimen (capecitabine plus oxaliplatin):
      • Oral capecitabine (1,000 mg/m2) twice a day for 14 days plus oxaliplatin (130 mg/m2) on day 1 every 3 weeks.
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