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FOLFIRI (Irinotecan de Gramont, Irinotecan modified de Gramont)

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This page tells you about the chemotherapy drug combination FOLFIRI. There is information about

 

What FOLFIRI is

FOLFIRI is the name of a chemotherapy combination used to treat bowel cancer. It is made up of the drugs

The links above take you to information about the individual side effects of each drug.

Folinic acid is taken with fluorouracil because it makes the chemotherapy more active against cancer cells. You are unlikely to have any side effects from it, although it occasionally causes a high temperature.

The side effects of a combination of drugs are usually a mixture of those of each drug. You may get some or most of the side effects. The combination may increase or decrease your chance of getting each side effect or it may change the severity. The side effects associated with FOLFIRI are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drug side effects section.

 

How you have FOLFIRI

You usually have this chemotherapy as cycles of treatment. Each cycle of treatment lasts 2 weeks. Depending on your needs, you may have up to 12 cycles, taking up to 6 months in total.

Fluorouracil and folinic acid are clear, colourless fluids. Irinotecan is a clear, slightly yellow coloured fluid. You have FOLFIRI 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.

For each cycle of treatment you have on the first day

  • Folinic acid and irinotecan through a drip over 2 hours (two drips at the same time)
  • An injection of fluorouracil through your cannula or central line
  • An infusion of fluorouracil through a drip or pump – some people have this for 22 hours (almost 1 day) and some people have it for 46 hours (just under 2 days)

If you have the 22 hour infusion of fluorouracil, you have no treatment from days 2 to 14. If you have the 46 hour infusion you have no treatment from days 3 to 14. You then start the cycle again.

If you have a central line you may be able to have the infusions of 5FU at home. If so, you have the infusions through a small pump. You can keep the pump in a small bag or attached to a belt. If you have the 46 hour infusion, you’ll need 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. If you have a central line or PICC line, it will stay in, but the end will be blocked off with a plastic cap until you start your next treatment cycle.

 

Common side effects

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, causing

  • 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. You should contact your doctor or nurse straight away 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

  • Increased saliva production, watery eyes, abdominal cramps and diarrhoea when you are having the drug – tell your nurse straight away if you have these effects, as you can have treatment to help
  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Diarrhoea can occasionally become severe on the day of treatment and for a day or two afterwards. You will have an anti diarrhoea medicine to take at home for 48 hours after your chemotherapy. It is important that you take this medicine exactly as prescribed. Drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days. Make sure you follow any advice you are given about coping with diarrhoea and contact your specialist if you are worried
  • Feeling or being sick is usually well controlled with anti sickness medicines
  • Sore mouth or mouth ulcers
  • Hair loss or hair thinning
 

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Muscle cramps
  • 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
  • Loss of appetite
  • Watery eyes due to increased production of tears, or gritty eyes and blurred vision
  • A skin rash which may be itchy – avoid exposing your skin to the sun as this may make the rash worse
  • Brown marking on the skin along the line of the vein where fluorouracil has been injected
  • 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
 

Rare side effects

Fewer than 1 in 100 people have these side effects after fluorouracil

  • Total hair loss
  • Darkened skin
  • Heart problems, such as angina, heart failure or a heart attack
  • Confusion or unsteadiness
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment so do talk to your doctor before starting treatment if you are planning to have a baby in the future
 

Important points to remember

You may have some of the above effects. 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

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. They can give you advice or reassure you. 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.

FOLFIRI may have a harmful effect on a developing baby. Do talk to your doctor or nurse about contraception before having treatment if there is any chance that you or your partner could become pregnant.

Breastfeeding is not advisable during this treatment because the drugs may come through in the breast milk.

 

Immunisations and chemotherapy

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.

 

More information about FOLFIRI drugs

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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Updated: 20 March 2013