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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 have 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

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).

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.

Numbness and tingling (peripheral neuropathy)

Numbness or tingling in fingers or toes is often temporary and can improve after you finish treatment.

Feeling sick (nausea)

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.

Pain

You might have pain in your vein when you have your treatment. Tell your nurse straight away if you have any stinging, pain, redness or swelling around the vein. This could be due to the chemotherapy leaking into the tissue around the vein. This damages the tissue and needs quick treatment. 

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.

Sore mouth

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.

Allergic reaction to oxaliplatin

A mild or severe allergic reaction to oxaliplatin, mostly happens when you are having it. Tell your nurse or doctor immediately if at any time you feel odd or strange, especially if you have difficulty breathing, a skin rash, chest pain or itchy eyes.

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:

  • soreness, redness and peeling on palms and soles of feet
  • runny nose
  • skin sensitivity to sunlight
  • a brown marking on the skin following the vein
  • hair thinning
  • brittle, chipped and ridged nails
  • watery or sore eyes
  • blood clots

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:

  • difficulty swallowing or breathing
  • ringing in your ears (tinnitus)
  • heart problems

Coping with side effects

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

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 (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.

iWantGreatCare lets patients leave feedback on their experience of taking a particular drug. The feedback is from individual patients. It is not information, or specialist medical advice, from Cancer Research UK.

Last reviewed: 
17 May 2018
  • 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 May 2018

  • 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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