This page tells you about the chemotherapy drug combination FOLFIRINOX. There is information about
FOLFIRINOX is the name of a combination of chemotherapy drugs used to treat advanced cancer of the pancreas. It is made up of the drugs
- FOL = Folinic acid (also called leucovorin, calcium folinate or FA)
- F = Fluorouracil (also called 5FU)
- Irin = Irinotecan
- Ox = Oxaliplatin
You usually have FOLFIRINOX chemotherapy as cycles of treatment. Each cycle of treatment lasts 2 weeks. Depending on your needs, you may have up to 12 cycles, taking 6 months in total.
You have FOLFIRINOX drugs into your bloodstream (intravenously). You have them 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 your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.
You have each cycle of treatment in the following way.
- You have oxaliplatin as a drip for 2 hours
- Immediately afterwards you have leucovorin as a drip for 2 hours
- 30 minutes after the leucovorin starts you have irinotecan for 90 minutes, alongside the leucovorin
- Then you have an injection of fluorouracil by injection into the tube in your vein
- Then you have another drip of fluorouracil for 46 hours (2 days) given by a small portable pump
- For the next 11 days you have no treatment
You then start the next treatment cycle.
The side effects of a combination of drugs are usually a mixture of those of each drug. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with FOLFIRINOX are listed below. You can use the underlined links to find out more about each one. For general information, see our side effects of cancer drugs section.
More than 10 in every 100 people have one or more of these side effects.
- 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
- 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia). Tell your doctor or nurse if you have any of these effects
- Tiredness occurs in just under a quarter of people (25%) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Feeling or being sick – severe sickness happens in about 15 out of every 100 people (15%). It is usually well controlled with anti sickness medicines
- Diarrhoea that can be severe occurs in 11 out of 100 people (11%). Drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe, or continues for more than 3 days
- Hair loss affects just over 10 in 100 people (10%) – your hair will grow back once the treatment ends
- A sore mouth and ulcers
- Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished. But you will have regular blood tests to check how well your liver is working
- Brown skin markings following the line of the vein where the chemotherapy was injected
- Gritty eyes, blurred vision, or watery eyes from increased production of tears
- Some people develop soreness, redness and peeling on the palms of the hands and soles of the feet (palmar–plantar syndrome), which may cause tingling, numbness, pain and dryness
- Skin rashes, which may be itchy
- Women may stop having periods (amenorrhoea) but this may be temporary
Between 1 and 10 in every 100 people have one or more of these effects
- Numbness or tingling in fingers and toes affects about 9 out of 100 people (9%) and can cause difficulty with fiddly things such as doing up buttons. It starts within a few days or weeks and usually goes within a few months of finishing treatment
- Brittle, chipped and ridged nails
- Sensitivity to sunlight – don’t sit out in the sun, and do cover up or use sun block on exposed skin
- Loss of appetite
- Heart problems
- Blood clots – if you have a blood clot you will have treatment to thin your blood, dissolve any clots, and stop any more developing. If you are at higher than normal risk of developing blood clots, your doctor may give you low dose aspirin to take daily to prevent clots
- Difficulty swallowing or breathing can be triggered by cold air in the first 5 days after you have oxaliplatin. This effect usually clears up on its own but tell your doctor or nurse if you have it. Avoid cold drinks or ice cubes for the first few days
Fewer than 1 in 100 people have these effects
- Ringing in the ears (tinnitus) – this usually gets better after your treatment ends
- Allergic reactions can happen in about 1 in every 200 people (0.5%) while you are having the treatment. Tell your nurse if you go red in the face, have an itchy rash, or feel faint or breathless
You may have 1 or 2 or several of the effects mentioned on this page. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may 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.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
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