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)
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 treatment 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.
- 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)
- 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.
You have blood tests before 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.
We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.
When to contact your team
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line 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.
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 a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.
Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.
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 petechiae).
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. Tell your doctor if you're finding it difficult to walk or complete fiddly tasks such as doing up buttons.
Feeling sick (nausea)
Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques can all help.
It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.
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.
Contact your advice line if you have diarrhoea, such as if you've had 4 or more 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 to replace the fluid lost.
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.
What else should I know?
Other medicines, food 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.
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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Contraception and pregnancy
This treatment 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 at least 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
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.
Between 2 and 8 out of 100 people (2 to 8%) 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 capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency.
Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
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.
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