NOTE: FOR TRASTUZUMAB, THE USE OF A BIOSIMILAR OR THE REFERENCE PRODUCT IS ON PATHWAY
| Evolent Pathways | Febrile Neutropenic Risk | Emetogenic Risk | References | ||
|---|---|---|---|---|---|
| NON-METASTATIC | |||||
Neoadjuvant |
carboplatin and paclitaxel *if unresectable disease* |
Low | High |
|
|
Perioperative Chemotherapy |
FLOT (5FU, leucovorin, oxaliplatin, docetaxel) |
Low | Moderate |
|
|
Postoperative (Adjuvant) Chemotherapy |
CAPEOX or XELOX (capecitabine, oxaliplatin) |
Low | Moderate |
|
|
5FU (fluorouracil) and leucovorin |
Low | Low |
|
||
| METASTATIC DISEASE | |||||
Initial Therapy |
capecitabine and oxaliplatin |
Low | Moderate |
|
|
5FU (fluorouracil) and oxaliplatin |
Low | Moderate |
|
||
capecitabine, oxaliplatin and trastuzumab |
Low | Moderate |
|
||
5FU (fluorouracil), leucovorin, oxaliplatin and trastuzumab *HER2 positive* |
Intermediate | Moderate |
|
||
5FU (fluorouracil), leucovorin and irinotecan |
Low | Moderate |
|
||
nivolumab and CAPEOX (capecitabine, oxaliplatin) *CPS ≥5* |
Low | Moderate |
|
||
nivolumab and FOLFOX (leucovorin, fluorouracil, and oxaliplatin) *CPS ≥5* |
Intermediate | Moderate |
|
||
fluorouracil or capecitabine, oxaliplatin, trastuzumab and pembrolizumab (PD-L1 CPS ≥1) *HER2 positive* |
Low | High |
|
||
fluorouracil or capecitabine, cisplatin, trastuzumab and pembrolizumab (PD-L1 CPS ≥1) *HER2 positive* |
Low | High |
|
||
tislelizumab, oxaliplatin or cisplatin and fluorouracil or capecitabine *CPS ≥5* |
Intermediate | Moderate |
|
||
Subsequent Therapy |
paclitaxel |
Low | Low |
|
|
docetaxel |
Low | Low |
|
||
irinotecan |
Low | Moderate |
|
||
fam-trastuzumab deruxtecan-nxki *HER2 positive* |
Low | Moderate |
|
||
Best Supportive Care or Clinical Trial |
Not Applicable | Not applicable |
|
||
Neoadjuvant
carboplatin and paclitaxel *if unresectable disease*
Perioperative Chemotherapy
FLOT (5FU, leucovorin, oxaliplatin, docetaxel)
Postoperative (Adjuvant) Chemotherapy
CAPEOX or XELOX (capecitabine, oxaliplatin)
5FU (fluorouracil) and leucovorin
Initial Therapy
capecitabine and oxaliplatin
5FU (fluorouracil) and oxaliplatin
capecitabine, oxaliplatin and trastuzumab
*HER2 positive*
5FU (fluorouracil), leucovorin, oxaliplatin and trastuzumab *HER2 positive*
5FU (fluorouracil), leucovorin and irinotecan
nivolumab and CAPEOX (capecitabine, oxaliplatin) *CPS ≥5*
nivolumab and FOLFOX (leucovorin, fluorouracil, and oxaliplatin) *CPS ≥5*
fluorouracil or capecitabine, oxaliplatin, trastuzumab and pembrolizumab (PD-L1 CPS ≥1) *HER2 positive*
fluorouracil or capecitabine, cisplatin, trastuzumab and pembrolizumab (PD-L1 CPS ≥1) *HER2 positive*
tislelizumab, oxaliplatin or cisplatin and fluorouracil or capecitabine *CPS ≥5*
Subsequent Therapy
paclitaxel
docetaxel
irinotecan
fam-trastuzumab deruxtecan-nxki *HER2 positive*
Best Supportive Care or Clinical Trial