Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

Nivolumab with CAPOX or FOLFOX in gastric cancer (CheckMate 649)

First line in advanced HER2-negative gastric, junctional and oesophageal adenocarcinoma

Updated: 28 October 20261 min read5 references

Summary for doctors

  • First line in advanced HER2-negative gastric, GEJ and oesophageal adenocarcinoma [1].
  • Greatest benefit with CPS 5 or more [1].
  • Nivolumab for up to 2 years.

Dose and schedule

Nivolumab + CAPOX

Advanced HER2-negative gastric cancerCycle length: Every 21 days

Nivolumab + FOLFOX

The same useCycle length: Every 14 days

The same use

DrugDoseRouteSchedule
Nivolumab240 mgIVDay 1
mFOLFOX6As in the FOLFOX regimenIVDay 1
Cycle length
Every 14 days
Duration
Until progression; nivolumab up to 2 years

As in CheckMate 649 [1]; FOLFOX doses are on the FOLFOX page.

Dose source: [3, 5].

Evidence: CheckMate 649 (2021)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Moderate antiemetics; DPYD: consider testing before the fluoropyrimidine [2].
  • HER2, MMR, PD-L1 (CPS) and claudin 18.2 testing before starting (checklist).

Monitoring and dose adjustment

Main evidence

Show detailsHide

CheckMate 649: with CPS 5 or more, median survival 14.4 vs 11.1 months; the benefit with CPS below 1 was small or uncertain [1].

Related cancer types

Stomach cancerOesophageal cancer

Treatment regimens (physicians)

FOLFOX (mFOLFOX6): dose, schedule and side effectsCAPOX (XELOX): dose, schedule and side effectsFOLFIRI regimen: dose, schedule and side effectsFLOT regimen: dose and schedule in gastric and oesophageal cancerCROSS regimen: chemoradiotherapy before oesophageal surgeryTrastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoring

Physician tools and lessons

Khorana Score (Cancer-Associated Thrombosis Risk)10 cheap steps that save patients' lives

References

5 references
Show all references, 3 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trialJanjigian YY, Shitara K, Moehler M, et al · Lancet · 2021;398:27-40
    Study cardDOIPubMed Back to text: 1 2 3 4 5
  2. 2
    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 UpdateAmstutz U, Henricks LM, Offer SM, et al · Clin Pharmacol Ther · 2018;103:210-216
    Study cardDOIPubMed Back to text
  3. 3
    OPDIVO (NIVOLUMAB) — Prescribing InformationE.R. Squibb & Sons, L.L.C · FDA label · 2026
    Source Back to text: 1 2
  4. 4
    Capecitabine plus oxaliplatin compared with fluorouracil and folinic acid as adjuvant therapy for stage III colon cancerHaller DG, Tabernero J, Maroun J, et al · J Clin Oncol · 2011;29:1465-71
    Study cardDOIPubMed Back to text
  5. 5
    A phase II study of perioperative pembrolizumab plus mFOLFOX in patients with potentially resectable esophagus, gastroesophageal junction (GEJ), and stomach adenocarcinomaSun W, Veeramachaneni N, Al-Rajabi R, et al · Cancer Med · 2023;12:16098-16107
    DOIPubMed Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/nivolumab-chemotherapy-gastric/

Related pages

27 October 2026 FOLFOX (mFOLFOX6): dose, schedule and side effects Dose and schedule of mFOLFOX6 (oxaliplatin 85, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), length of adjuvant treatment, premedication, neuropathy and dose adjustment. 27 October 2026 CAPOX (XELOX): dose, schedule and side effects Dose and schedule of CAPOX or XELOX (oxaliplatin 130 and capecitabine 1000 twice daily, days 1 to 14), length of adjuvant treatment, renal adjustment and side effects. 27 October 2026 FOLFIRI regimen: dose, schedule and side effects Dose and schedule of FOLFIRI (irinotecan 180, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), diarrhoea control, UGT1A1 and dose adjustment.