FOLFOX is a chemotherapy regimen for treatment of colorectal cancer, made up of the drugs folinic acid (leucovorin, FOL), fluorouracil (5-FU, F), and oxaliplatin (Eloxatin, OX).[1]
Adjuvant treatment in patients with stage III colon cancer is recommended[2] for 12 cycles, every two weeks. The recommended dose schedule is as follows:
Day 1: Oxaliplatin 85 mg/m2 intravenous (IV) infusion in 250-500 mL D5W and leucovorin 200 mg/m2 IV infusion in D5W administered concurrently over 120 minutes in separate bags using a Y-line, followed by fluorouracil (5-FU) 400 mg/m2 IV bolus given over 2–4 minutes, followed by 5-FU 600 mg/m2 IV infusion in 500 mL D5W (recommended) as a 22-hour continuous infusion.
Day 2: Leucovorin 200 mg/m2 IV infusion over 120 minutes, followed by 5-FU 400 mg/m2 IV bolus given over 2–4 minutes, followed by 5-FU 600 mg/m2 IV infusion in 500 mL D5W (recommended) as a 22-hour continuous infusion.
| Drug | Dose | Administration | Time | Term | |
|---|---|---|---|---|---|
| Oxaliplatin | 85 mg/m2 | IV infusion | 2 h | day 1 | |
| Folinic acid | 200 mg/m2 | IV infusion | 2 h | day 1 + 2 | |
| Fluorouracil | 400 mg/m2 | IV bolus | 2 min | day 1 + 2 | |
| Fluorouracil | 600 mg/m2 | IV infusion | 22 h | day 1 + 2 |
Premedication with antiemetics, including 5-HT3 blockers with or without dexamethasone, is recommended.
The dose schedule given every two weeks is as follows:[3]
Day 1–2: Oxaliplatin 100 mg/m2 IV infusion, given as a 120 minutes IV infusion in 500 mL D5W, concurrent with leucovorin 400 mg/m2 (or levoleucovorin 200 mg/m2) IV infusion, followed by 5-FU 400 mg/m2 IV bolus, followed by 46-hour 5-FU infusion (2400 mg/m2 for first two cycles, and may be increased to 3000 mg/m2 if tolerated by patient (no toxicity > grade 1 during the first two cycles).
Days 3–14: Rest days
Antiemetic prophylaxis with 5-HT3 receptor antagonist.
FOLFOX is given directly into the bloodstream through an intravenous line. It can be given through a thin, short tube (a cannula) put into a vein in the arm each time one has a treatment. It may also be given 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 the chest. The tube can stay in place throughout the treatment.
Chemotherapy can be given as cycles of treatment. The number of cycles depends on the situation but may be up to 12. Each treatment cycle lasts 2 weeks.
On the first day oxaliplatin is given via IV drip over 2 hours. Folinic acid is given concurrently. This is followed by an injection of fluorouracil into the cannula or central line. An infusion of 5-FU is then started through a drip or pump, which lasts for 22 hours.
On the second day, folinic acid is given as an injection or via IV drip for 2 hours. This is followed by an injection of fluorouracil, followed by another fluorouracil infusion through a drip or pump for 22 hours.
Patient has no additional treatment for 12 days, after which, the cycle is repeated.
If the patient has a central line, the infusions of fluorouracil may be administered at home through a small pump. The patient can retain mobility during infusion by putting the pump in a pouch or bag on a belt (like a bum bag). The patient must return to the treatment center for the second day of their treatment, to have the pump changed unless a chemotherapy nurse is available to change the pump at the patient's home. In some countries (like Germany), it is common practice that patients disconnect the infusion pump themselves at home.
When the second infusion of 5-FU is finished, the nurse will disconnect the drip and take the cannula out. If a central line is present, it will be covered and protected with a plastic cap until they start their next treatment cycle.[4]
More than 10 in every 100 people have one or more of the side effects listed below.