How does FOLFOX chemotherapy work?
Each chemotherapy drug in FOLFOX is designed to kill colon cancer cells.
FOLFOX chemo is given to shrink tumors and help decrease symptoms for a colon cancer patient. If the disease is not metastatic, it is commonly given with the goal of cure. If the disease is advanced colorectal cancer, or metastatic, FOLFOX is not commonly given with the goal of cure but rather to prolong survival.
FOLFOX chemo is usually given in an outpatient health care infusion center, allowing the cancer patient to go home afterwards where they will continue to receive their continuous 5-FU infusion via ambulatory (home) infusion pump. FOLFOX may be given in the hospital if someone is too sick or if an ambulatory pump is not available or its use is not desired.
FOLFOX is repeated every 14 days. Each 14-day period is known as one Cycle. If the disease is not metastatic, treatment is given for a total of 12 cycles (6 months). If the disease is metastatic, each cycle may be repeated until the treatment no longer works or until unacceptable side effects occur. Duration of FOLFOX chemotherapy depends upon response, tolerability, and number of cycles prescribed.
Click here for common FOLFOX starting doses.
On average, up to 25% of colon cancer patients discontinue treatment at some point due to unacceptable side effects if FOLFOX is being given for metastatic disease. If the disease is not metastatic, most patients are able to complete all planned courses of treatment.
** Hair loss from FOLFOX is almost always mild, not obvious from a distance, and seen only on close inspection. A different hair style can help cover some hair loss, and a wig or hair piece is usually not required.
NOTE: Twelve months after treatment, the incidence of moderate to severe tingling, pain, burning, or numbness in hands or feet from FOLFOX is about 1%, and less than 1% four years after treatment. Many patients experience improvement from these effects within 28 days after treatment is stopped, however mild symptoms may persist beyond 1 year.
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. CEA (carcinoembryonic antigen) may be checked every six weeks to monitor tumor response to FOLFOX.
Imaging, such as computerized tomography (CT) scan and/or magnetic resonance imaging (MRI), is checked before treatment and may be checked every 6 weeks during treatment or at the discretion of your doctor.
Depending upon the results, your doctor may advise to continue FOLFOX as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy. The dose of oxaliplatin may be reduced if persistent (lasting more than 14 days) tingling, pain, numbness, or burning are experienced. Fluorouracil or oxaliplatin doses may be reduced for avoiding infection if the white blood cells, known as neutrophils, drop too low. Doses may also be lowered if the platelet count drops too low, or for severe side effects such as severe mouth sores or diarrhea. Other dose reductions may be recommended by your doctor.
If you have insurance and are looking for patient assistance or copay assistance for FOLFOX (Folinic acid + Fluoro­uracil + Oxali­platin), we have provided links that may help.
The clinic providing treatment will likely pre-authorize medications and immune therapies such as FOLFOX (Folinic acid + Fluoro­uracil + Oxali­platin) and are the best source to help you understand drug cost.
1) Cassidy J, Clarke S, Díaz-Rubio E, et al. Randomized phase III study of capecitabine plus oxaliplatin compared with fluorouracil/folinic acid plus oxaliplatin as first-line therapy for metastatic colorectal cancer. J Clin Oncol. 2008; 26:2006-2012.
2) André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343-2351.
3) André T, Boni T, Navarro M, et al. Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol. 2009;27:3109-3116.
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Hand-foot syndrome is a side effect of fluorouracil that can cause painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet. It is sometimes referred to as “palmar-plantar erythrodysesthesia”, or PPE.