This document summarizes the BCCA protocol for treating recurrent head and neck cancer with fluorouracil and leucovorin. Patients eligible have any recurrence or metastasis of primary head and neck cancer except lymphoma or melanoma. Tests include baseline bloodwork and monitoring bloodwork and doctor visits during treatment. Treatment involves intravenous fluorouracil and leucovorin weekly for a minimum of 6 to 8 cycles or until disease progression or toxicity. Dose modifications are specified for hematological and gastrointestinal toxicities. Precautions discussed drug interactions and rare but serious cardiac side effects.
This document summarizes the BCCA protocol for treating recurrent head and neck cancer with fluorouracil and leucovorin. Patients eligible have any recurrence or metastasis of primary head and neck cancer except lymphoma or melanoma. Tests include baseline bloodwork and monitoring bloodwork and doctor visits during treatment. Treatment involves intravenous fluorouracil and leucovorin weekly for a minimum of 6 to 8 cycles or until disease progression or toxicity. Dose modifications are specified for hematological and gastrointestinal toxicities. Precautions discussed drug interactions and rare but serious cardiac side effects.
This document summarizes the BCCA protocol for treating recurrent head and neck cancer with fluorouracil and leucovorin. Patients eligible have any recurrence or metastasis of primary head and neck cancer except lymphoma or melanoma. Tests include baseline bloodwork and monitoring bloodwork and doctor visits during treatment. Treatment involves intravenous fluorouracil and leucovorin weekly for a minimum of 6 to 8 cycles or until disease progression or toxicity. Dose modifications are specified for hematological and gastrointestinal toxicities. Precautions discussed drug interactions and rare but serious cardiac side effects.
This document summarizes the BCCA protocol for treating recurrent head and neck cancer with fluorouracil and leucovorin. Patients eligible have any recurrence or metastasis of primary head and neck cancer except lymphoma or melanoma. Tests include baseline bloodwork and monitoring bloodwork and doctor visits during treatment. Treatment involves intravenous fluorouracil and leucovorin weekly for a minimum of 6 to 8 cycles or until disease progression or toxicity. Dose modifications are specified for hematological and gastrointestinal toxicities. Precautions discussed drug interactions and rare but serious cardiac side effects.
BCCA Protocol Summary for Fluorouracil and Leucovorin for
Recurrent Head and Neck Cancer (Squamous Cell Carcinoma)
Protocol Code
HNAVFUFA
Tumour Group
Head and Neck
Dr Cheryl Ho
Contact Physician
ELIGIBILITY: All patients with recurrence or metastasis of a primary in the head and neck region and with any histology except lymphoma and melanoma Check eligibility for a research protocol or methotrexate therapy first TESTS: Baseline CBC, diff, platelets, bilirubin, AST, alkaline phosphatise CBC, diff, platelets and doctor visit initially every 2 weeks (chemotherapy to be given weekly). Bilirubin, AST, alkaline phosphatise if indicated. If tolerating treatment well and disease is stable, doctor visit can be every 4 weeks with CBC and diff every 2 weeks and treatment weekly Tests to measure treatment response to be done every 6-8 weeks TREATMENT: Fluorouracil and leucovorin: Drug
Dose
BCCA Administration Guideline
fluorouracil (5-FU)
500 mg/m
IV push
leucovorin (folinic acid)
20 mg/m
IV push prior to fluorouracil
Repeat every week x minimum 6 to 8 cycles. Each week is one cycle.
If response or stabilisation occurs, continue until disease progression or toxicity occurs. DOSE MODIFICATIONS: For fluorouracil only 1. Hematological ANC (x109/L)
Platelets (x109/L)
Dose (fluorouracil)
greater than or equal to 1.5
and
greater than or equal to
100
100%
1 to 1.49
or
50 to 99
75%
less than 1
or
less than 50
Delay
BC Cancer Agency Protocol Summary HNAVFUFA
Page 1 of 2
Warning: The information contained in these documents are a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use available at www.bccancer.bc.ca/legal.htm
2. Gastrointestinal GI toxicity
Dose adjustment (fluorouracil)
Grade 1
None
Grade 2
Discontinue for 1 week; decrease by 25%
Grade 3 to 4
Discontinue: consider other treatment
Symptom checklist at every visit
Use chemotherapy flow sheets with vertical columns
PRECAUTIONS: 1. Possible drug interactions with fluorouracil and warfarin, phenytoin and fosphenytoin have been reported and may occur at any time. Close monitoring is recommended (eg, for warfarin, monitor INR weekly during fluorouracil therapy and for 1 month after stopping fluorouracil). 2. Myocardial ischemia and angina occurs rarely in patients receiving fluorouracil or capecitabine. Development of cardiac symptoms including signs suggestive of ischemia or of cardiac arrhythmia is an indication to discontinue treatment. If there is development of cardiac symptoms patients should have urgent cardiac assessment. Generally re-challenge with either fluorouracil or capecitabine is not recommended as symptoms potentially have a high likelihood of recurrence which can be severe or even fatal. Seeking opinion from cardiologists and oncologists with expert knowledge about fluorouracil or capecitabine toxicity is strongly advised under these circumstances. The toxicity should also be noted in the patients allergy profile. Call Dr. Cheryl Ho or tumour group delegate at (604) 877-6000 or 1-800-663-3333 with any problems or questions regarding this treatment program. Date activated:
01 Nov 2010 (replacing HNFUFA)
Date revised:
1 May 2013 (cardiac toxicity updated)
References: Jacobs C. et al. Phase III randomized study comparing cisplatin and fluorouracil as single agents and in combination for advanced squamous cell carcinoma of the head and neck. J Clin Oncol 1992;10(2):25763.
BC Cancer Agency Protocol Summary HNAVFUFA
Page 2 of 2
Warning: The information contained in these documents are a statement of consensus of BC Cancer Agency professionals regarding their views of currently accepted approaches to treatment. Any clinician seeking to apply or consult these documents is expected to use independent medical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. Use of these documents is at your own risk and is subject to BC Cancer Agency's terms of use available at www.bccancer.bc.ca/legal.htm
