This page tells you about the chemotherapy drug combination called FOLFOX. There are sections about
- FOL = Folinic acid (also called leucovorin, FA or calcium folinate)
- F = Fluorouracil (5FU)
- OX = Oxaliplatin
You can click on the above links to find out about the side effects of the individual chemotherapy drugs.
Folinic acid is a vitamin you take along with fluorouracil because it makes the chemotherapy more active against cancer cells. It is very unlikely you will have any side effects from it, although it occasionally causes a high temperature.
You have these drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may 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 usually have chemotherapy as cycles of treatment. The number of cycles of treatment you need depends on your situation but you may have up to 12. Each treatment cycle lasts 2 weeks.
On the first day you have folinic acid and oxaliplatin through a drip over 2 hours. You have two drips at the same time. Then you have an injection of fluorouracil into the cannula or central line. You then start an infusion of 5FU through a drip or pump, which lasts for 22 hours.
On the second day you have folinic acid through a drip for 2 hours. You then have an injection of fluorouracil, followed by another fluorouracil infusion through a drip or pump for 22 hours. You then have no treatment for 12 days. After that you start another treatment cycle.
If you have a central line you may be able to have the infusions of fluorouracil 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.
When the second infusion of 5FU is finished, your nurse will disconnect the drip and take the cannula out. If you have a central line this will stay in but it will be blocked with a plastic cap until you start your next treatment cycle.
The side effects associated with FOLFOX are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section.
More than 10 in every 100 people have one or more of the side effects listed below.
A temporary drop in the number of blood cells made by the bone marrow. This may cause
- 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, sore throat, pain passing urine or feel cold and shivery
- 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)
Some of these side effects can be life threatening, particularly infections. Contact your doctor or nurse straightaway if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.
Other common side effects include
- Fatigue (tiredness) 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 (70%) people who have oxaliplatin, 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 – 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) which 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%)
- Loss of fertility – we don’t know exactly what effect these drugs may have on your fertility. It is important to talk to your doctor before starting treatment if you plan to have a baby in the future
- 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.
- Sensitivity to the sun – cover up and stay in the shade while you are having this treatment and use a high factor sun cream on any exposed skin
- Brown marking on the skin following the line of the vein where the chemotherapy has been injected
- Hair thinning
- Brittle, chipped and ridged nails
- Gritty eyes, blurred vision or watery eyes from increased production of tears
Fewer than 1 in 100 people have these.
- Difficulty swallowing or breathing can be triggered by cold air in the first 5 days after you have oxaliplatin but usually clears up on its own – tell your doctor or nurse if you have this side effect and avoid cold drinks or ice cubes for the first few days
- Ringing in the ears (tinnitus) happens in about 1 in 100 people (1%) and usually gets better gradually after your treatment is finished
- Allergic reactions happen to about 1 in every 100 people (1%) while the oxaliplatin is going into your bloodstream – tell your nurse if your face goes red, or you have an itchy rash, or feel faint or breathless. Your nurse will watch for signs of an allergic reaction while you are having the treatment
The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on
- How many times you've had the drug before
- Your general health
- The amount of the drug you have (the dose)
- Other drugs you are having
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 other over the counter remedies – some drugs can react together.
These drugs may have a harmful effect on a developing baby. Talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant. It is important to use reliable contraception throughout the treatment.
Breastfeeding is not advisable 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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