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FOLFIRINOX

FOLFIRINOX is the name of a combination of cancer drugs that includes:

  • FOL – folinic acid (also called leucovorin, calcium folinate or FA)
  • F – fluorouracil (also called 5FU)
  • Irin – irinotecan
  • Ox – oxaliplatin

It is a treatment for advanced pancreatic cancer. 

How it works

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

How you have FOLFIRINOX

You have all drugs as a drip into your bloodstream (intravenously). 

Drugs into your bloodstream

You have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

  • central line
  • PICC line
  • portacath

You might be able to have the infusion of 5FU at home 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 after the second day of treatment, to have the pump disconnected. Or sometimes a chemotherapy nurse may be able to do this at your home.

When you have FOLFIRINOX

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 each cycle of treatment in the following way:

Day 1
  • You have oxaliplatin as a drip into your vein over 2 hours
  • You have folinic acid as a drip into your vein over 2 hours at the same time you have oxaliplatin
  • You have irinotecan as a drip into your vein for 60 to 90 minutes
  • You have fluorouracil as a injection into your vein for 5 minutes
  • You start fluorouracil as an infusion over 46 hours given by a small portable pump
Day 2
  • You continue to have fluorouracil as an infusion given by a small portable pump
Day 3 to 14
  • You have no treatment

You then start a new cycle of treatment. 

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

We haven't listed all the side effects. Your doctor or nurse will talk to you about the possible side effects. Tell your doctor or nurse if you notice anything unusual or different during and after treatment.

When to contact your team

Your doctor and nurse will monitor you closely for any side effects. Let your doctor or nurse know as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include headaches, aching muscles, cough, sore throat, pain passing urine, feeling cold and shivery or tooth ache. Infections can sometimes be life threatening. You should contact your team urgently if you think you have an infection. 

Breathlessness 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding 

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia).

Tiredness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoid eating fatty or fried foods, eat small meals and snacks, drink plenty of water and relaxation techniques all can help.

Diarrhoea

Tell your doctor or nurse if you have diarrhoea, that is 4 loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid, or if it carries on for more than 3 days. Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty of liquid to replace the fluid lost.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will grow back once treatment has finished. But it is likely to be softer. And it may grow back a different colour or be curlier than before. 

Mouth sores and ulcers 

Mouth sores and ulcers can be painful. Keep your mouth and teeth clean, drink plenty of fluids, avoid acidic foods such as oranges, lemons and grapefruits, chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.

Liver changes 

You might have liver changes that are very mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in levels of chemicals produced by the liver.

Skin problems

Skin problems include a skin rash, dry skin and itching. This usually goes back to normal when your treatment finishes.

Eye changes 

You might have eye problems including blurred vision, sore, red, itchy, dry eyes (conjunctivitis) or an infection. Tell your doctor or nurse if you have this. They can give you eye drops or other medication to help. 

Soreness, redness and peeling on palms or soles of the feet 

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • numbness or tingling in fingers and toes that can start within a few days or weeks and last for a few months
  • brittle, chipped and ridged nails
  • skin sensitivity to sunlight
  • loss of appetite
  • blood clots
  • difficulty swallowing or breathing that can be triggered by cold air in the first 5 days after you have oxaliplatin

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • a ringing sound in your ears (tinnitus) that often gets better on its own once the treatment ends
  • an allergic reaction usually during the first or second treatment
  • heart problems such as high or low blood pressure, heart palpitations or an irregular heartbeat

Coping with side effects

We have more information about side effects and tips on how to cope with them.

Important information

Other medicines, foods and 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 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.

Loss of 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.

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 drugs 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.

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 (as an injection)
  • be in contact with other people who've had live vaccines as injections

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could 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 should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

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: 
20 Aug 2018
  • Electronic Medicines Compendium
    Accessed August 2018

  • FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer
    T Conroy and others
    The New England Journal of Medicine, 2011. Vol 364, Pages 1817-18225

  • FOLFIRINOX
    South East London NHS Cancer Network, 2014

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott Williams and Wilkins, 2012

  • PATIENT AGREEMENT TO SYSTEMIC ANTICANCER THERAPY: FOLFIRINOX
    Consent forms for SACT (Systemic Anti-Cancer Therapy) from Cancer Research UK. Accessed August 2018

Information and help

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