FOLFOX

FOLFOX is a chemotherapy regimen for treatment of colorectal cancer, made up of the drugs

• FOL– Folinic acid (leucovorin)
• F – Fluorouracil (5-FU)
• OX – Oxaliplatin (Eloxatin)

FOLFOX4

Adjuvant treatment in patients with stage III colon cancer is recommended for 12 cycles, every 2 weeks. The recommended dose schedule given every two weeks is as follows:

Day 1: Oxaliplatin 85 mg/m² IV infusion in 250-500 mL D5W and leucovorin 200 mg/m² IV infusion in D5W both given over 120 minutes at the same time in separate bags using a Y-line, followed by 5-FU 400 mg/m² IV bolus given over 2–4 minutes, followed by 5-FU 600 mg/m² IV infusion in 500 mL D5W (recommended) as a 22-hour continuous infusion.

Day 2: Leucovorin 200 mg/m² IV infusion over 120 minutes, followed by 5-FU 400 mg/m² IV bolus given over 2–4 minutes, followed by 5-FU 600 mg/m² IV infusion in 500 mL D5W (recommended) as a 22-hour continuous infusion.

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FOLFOX4 regime

FOLFOX4
drug	dose	administration	time	term
Oxaliplatin	85 mg/m²	IV infusion	2 h	day 1
Folinic acid	200 mg/m²	IV infusion	2 h	day 1 + 2
Fluorouracil	400 mg/m²	IV bolus	2 min	day 1 + 2
Fluorouracil	600 mg/m²	IV infusion	22 h	day 1 + 2

Premedication with antiemetics, including 5-HT3 blockers with or without dexamethasone, is recommended.

FOLFOX6

The dose schedule given every two weeks is as follows:

Day 1–2: Oxaliplatin 100 mg/m² IV infusion, given as a 120 minutes IV infusion in 500 mL D5W, concurrent with leucovorin 400 mg/m² (or levoleucovorin 200 mg/m²) IV infusion, followed by 5-FU 400 mg/m² IV bolus, followed by 46-hour 5-FU infusion (2400 mg/m² for first two cycles, increased to 3000 mg/m² in case of no toxicity > grade 1 during the first two cycles).

Days 3–14: Rest days

Antiemetic prophylaxis with 5-HT3-receptor antagonist.

Administration of FOLFOX

FOLFOX is given directly into the bloodstream through an intravenous line. It can given through a thin, short tube (a cannula) put into a vein in the arm each time one has a treatment. It may also be given through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in the chest. The tube can stay in place throughout the treatment.

Chemotherapy can be given as cycles of treatment. The number of cycles depends on the situation but may be up to 12. Each treatment cycle lasts 2 weeks.

On the first day oxaliplatin is given through a drip over 2 hours. Folinic acid is given concurrently. This followed by an injection of fluorouracil into the cannula or central line. An infusion of 5FU is then started through a drip or pump, which lasts for 22 hours.

On the second day folinic acid is given as an injection or through a drip for 2 hours. This is followed by an injection of fluorouracil, followed by another fluorouracil infusion through a drip or pump for 22 hours.

Patient then has no treatment for 12 days. After that they start another treatment cycle.

If they have a central line they may be able to have the infusions of fluorouracil at home. If they are at home, they have the infusions through a small pump. They can keep the pump in a small bag, or a bag on a belt (like a bum bag). They’ll need to go back to the hospital for the second day of their treatment, to have the pump changed. Sometimes a chemotherapy nurse may be able to change the infusion at their home.

When the second infusion of 5FU is finished, the nurse will disconnect the drip and take the cannula out. If they have a central line this will stay in but it will be blocked with a plastic cap until they start your next treatment cycle.

Common complications

More than 10 in every 100 people have one or more of the side effects listed below.

• An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life-threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38 °C. You will have regular blood tests to check your blood cell levels
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
• Bruising more easily due to a drop in platelets – you may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
• Tiredness and weakness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Numbness or tingling in the fingers and toes happens to nearly everyone having oxaliplatin and is usually worse if you are cold. You may have trouble with fiddly tasks such as doing up buttons. This can start a few days or weeks after treatment and usually goes away within a few months of the treatment finishing
• Feeling or being sick happens to about 7 out of every 10 people (70%) but is usually well controlled with anti sickness drugs. If the sickness is not controlled, let your nurse know as there are other anti sickness medicines that may work better for you
• Pain in the vein during the infusion of oxaliplatin or folinic acid – tell your nurse if this happens. Sometimes the drugs may need to be given more slowly
• Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (plantar palmar syndrome). This may cause tingling, numbness, pain and dryness
• Diarrhoea happens to 6 out of 10 people (60%) – tell your doctor or nurse if it becomes severe, if you can't drink to replace the lost fluid, or if it carries on for more than 3 days.Your nurse may give you anti diarrhoea medicine to take home with you after chemotherapy
• A sore mouth happens to 4 out of 10 people (40%)
• Women may stop having periods (amenorrhoea) but this may be temporary
• Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

See also

• FOLFIRI
• FOLFIRINOX
• IFL