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Folinic acid, fluorouracil and irinotecan (FOLFIRI)

Find out what folinic acid, fluorouracil and irinotecan (FOLFIRI) chemotherapy is, how you have it and other important information about taking FOLFIRI. 

FOLFIRI is a combination of chemotherapy drugs used to treat bowel cancer. It is also known as Irinotecan de Gramont or Irinotecan modified de Gramont.

It’s made up of:

  • folinic acid (also called leucovorin, calcium folinate or FA)
  • fluorouracil (also called 5FU)
  • irinotecan (Campto)

How FOLFIRI works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You have folinic acid, 5FU and irinotecan into your bloodstream. This may be through a thin, short tube called a cannula. The nurse or doctor puts it into a vein in your arm each time you have treatment.

Or you have the drugs through a long line - a central line, a PICC line or a portacath. These are long, plastic tubes that give the drugs into a large vein in your chest. The tube stays in place throughout the course of your treatment.

If you have a central line you might be able to have the 5FU at home. You'll have it through a small pump which slowly puts the fluid into your bloodstream (infusion). You can keep the pump in a small bag or attached to a belt. When you have the infusion at home, you may have to go back to the hospital on the second day of your treatment, to have the infusion changed. Sometimes a district nurse or chemotherapy nurse may be able to change it for you at home.

When the infusion of 5FU is finished, your nurse will disconnect the drip and take out the cannula, if you have one. Or if you have a central line the nurse will block the end with a plastic cap until you start your next treatment cycle.

When you have treatment

You have FOLFIRI chemotherapy as cycles of treatment each lasting 2 weeks (14 days). Depending on your needs, you may have 12 cycles, taking up to 6 months in total.

Day 1
  • irinotecan through a drip into the bloodstream over 2 hours
  • folinic acid through another drip into the bloodstream at the same time as you have the irinotecan
  • an injection of fluorouracil into the bloodstream
  • an infusion of 5FU through a drip or pump into the bloodstream for 22 hours or 46 hours
Day 2
  • you have no treatment if your 5FU infusion is over 22 hours
  • you continue to have 5FU treatment if your infusion is over 46 hours
Day 3 to 14
  • you have no treatment

Then you start the cycle again.

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Other medicines, food drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

DPD deficiency

Around 5 out of 100 people (5%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine. It doesn’t cause symptoms so you won’t know if you have a deficiency. Contact your doctor if your side effects are severe.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. 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. Women may be able to store eggs or ovarian tissue but this is rare.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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