5-FU + Leucovorine + Bevacizumab (sLV5FU2-Bev, CCR CrCl CKD sévère <30 — oxali/cabine dangereux)
Vue déterministe de l'entité source de la LJAM. L'autorité clinique demeure avec les ID de la source cités et l'état d'approbation de l ́examinateur.
Contenu clinique provisoire : il ne s'agit pas d'une ordonnance. Un oncologue doit vérifier les sources originales, l'applicabilité et le statut de révision.
| Composantes | DRUG-5-FLUOROURACIL DRUG-LEUCOVORIN DRUG-BEVACIZUMAB |
|---|
| ID | REG-5FU-LV-BEV-CKD-MODIFIED |
|---|---|
| Type | Protocole thérapeutique |
| État | reviewed 2026-04-27 | pending_clinical_signoff |
| Maladies | Aucune déclaration |
| Sources | SRC-ESMO-COLON-2024 SRC-NCCN-COLON-2025 |
Notes
Capecitabine is contraindicated CrCl <30 (renally cleared, severe toxicity risk). Oxaliplatin is hepatically cleared but has additive nephrotoxicity in pre-existing CKD; risk-benefit unfavourable in severe CKD where neuropathy is also harder to manage. sLV5FU2-Bev (simplified bolus + 46h CIVI 5-FU + leucovorin + bev) provides a reasonable backbone for mCRC in severe CKD when chemo is still desired. 5-FU is hepatically metabolised (DPD); no dose adjustment needed for renal impairment (parent and metabolites only ~5-10% renal). Bevacizumab dose reduced to 5 mg/kg q2w (vs standard 5-7.5 mg/kg q2w) to limit proteinuria worsening; close BP + UPC monitoring. DPYD pre-screening strongly recommended (CPIC).
Utilisé par
Indication
IND-CRC-RENAL-FAILURE-MOD-FOLFOX- IND-CRC-RENAL-FAILURE-MOD-FOLFOX