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Folinic acid, fluorouracil and oxaliplatin (FOLFOX)

Find out what FOLFOX chemotherapy is, how you have it and other important information about taking FOLFOX.

FOLFOX is a combination of chemotherapy drugs used to treat bowel cancer. It is also known as Oxaliplatin de Gramont or OxMdG, which means modified Oxaliplatin de Gramont.

It is made up of:

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

How it works

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

How you have FOLFOX chemotherapy

You have folinic acid, 5FU and oxaliplatin into your bloodstream. If you have a central line you may be able to have the infusions of 5FU at home.

If you are at home, you have the infusions through a small pump. You can keep the pump in a small bag, or a bag on a belt (like a bum bag). You’ll need to go back to the hospital for the second day of your treatment, to have the pump changed. Or sometimes a chemotherapy nurse may be able to change the infusion at your home.

Into your bloodstream

You can have the chemotherapy through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

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

When you have treatment

You have FOLFOX chemotherapy as cycles of treatment each lasting 2 weeks. Depending on your needs, you may have up to 12 cycles. 

Day 1

  • oxaliplatin through a drip into the bloodstream over 2 hours
  • an injection of folinic acid into the bloodstream at the same time
  • an injection of 5FU into a cannula or central line into the bloodstream
  • an infusion of 5FU through a drip or pump into the bloodstream for 22 hours (or 46 hours if you have modified Oxaliplatin de Gramont)

Day 2

  • folinic acid as an injection or through a drip into the bloodstream for 2 hours
  • an injection into the bloodstream of 5FU
  • a 5FU infusion through a drip or pump into the bloodstream for 22 hours

Day 3 to 14

  • you have no treatment for 12 days

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

Other medicines

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.

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.

Breastfeeding

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

Treatment for other conditions

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

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 fluorouracil. 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 shingles vaccine (Zostavax).

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, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

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

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.

Last reviewed: 
04 Jul 2016
  • Superiority of oxaliplatin and fluorouracil-leucovorin compared with either therapy alone in patients with progressive colorectal cancer after irinotecan and fluorouracil-leucovorin: interim results of a phase III trial. 

    M Rothenberg and others. Journal of Clinical Oncology, 2003.

  • Electronic medicines compendium

    Accessed July 2016

  • Influenza vaccines in immunosuppressed adults with cancer

    N Eliakim-Raz N and others. Cochrane Database of Systematic Reviews 2013. Issue 10

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