CapeOX Protocol for BSA 1.8 m²
For a patient with BSA 1.8 m², the recommended CapeOX protocol consists of oxaliplatin 130 mg/m² IV on day 1 (234 mg total dose) and capecitabine 1000 mg/m² twice daily orally for 14 days (1800 mg twice daily), repeated every 3 weeks. 1
Detailed Dosing
Oxaliplatin Component
- Dose: 130 mg/m² 1
- Total dose for BSA 1.8 m²: 234 mg
- Administration: IV infusion over 2 hours on day 1 1
- Frequency: Every 3 weeks (21-day cycle) 1
Capecitabine Component
- Dose: 1000 mg/m² twice daily 1
- Total dose for BSA 1.8 m²: 1800 mg twice daily
- Administration: Oral tablets taken approximately 12 hours apart for 14 days 1
- Schedule: Days 1-14, followed by 7 days rest (21-day cycle) 1
Important Considerations
Regional Dosing Differences
- North American patients may experience greater toxicity with capecitabine than European patients 1
- The recommended starting dose for North American patients is 1000 mg/m² twice daily (rather than the European standard of 1250 mg/m²) 1
- Close monitoring during the first cycle is essential with dose adjustments as needed based on toxicity 1
Duration of Therapy
- Discontinuation of oxaliplatin should be strongly considered after 3-4 months of therapy (or sooner if significant neurotoxicity ≥ grade 2 develops) 1
- Other drugs (capecitabine ± bevacizumab) may be maintained until disease progression 1
- Oxaliplatin may be reintroduced if it was discontinued previously for neurotoxicity rather than disease progression 1
Common Toxicities to Monitor
Oxaliplatin-Related
- Neurotoxicity (acute and chronic sensory neuropathy) - most common adverse event (85%) 2
- Thrombocytopenia (6.1-22%) 3, 4
- Neutropenia (7-17%) 4, 2
Capecitabine-Related
Potential Modifications
Dose Reductions for Toxicity
- For significant neurotoxicity (≥ grade 2): Consider oxaliplatin dose reduction or discontinuation 1
- For severe diarrhea or hand-foot syndrome: Consider capecitabine dose reduction 3
Bevacizumab Addition (Optional)
- If adding bevacizumab: 7.5 mg/kg IV on day 1 of each cycle 1
- Note: There is an increased risk of stroke and other arterial events, especially in patients ≥65 years 1
Monitoring Recommendations
- CT scan with contrast or MRI (not PET/CT) to monitor progress of therapy 1
- Regular assessment of neurotoxicity 1
- Complete blood count before each cycle 4
- Liver function tests and renal function monitoring 4
Common Pitfalls to Avoid
- Do not use PET/CT to monitor progress of therapy; CT with contrast or MRI is recommended 1
- Do not continue oxaliplatin beyond 3-4 months if significant neurotoxicity develops 1
- Avoid combination therapy involving cytotoxics, anti-EGFRs, and anti-VEGFs 1
- Do not isolate patients on capecitabine therapy as it does not pose a transmission risk 6
This protocol has demonstrated efficacy with response rates of 39-55% and median progression-free survival of 4.37-7.9 months in various studies 7, 2.