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This information is about a chemotherapy| treatment for bowel cancer| that uses oxaliplatin|, fluorouracil| (5FU) and folinic acid|.
The treatment involves the two chemotherapy drugs oxaliplatin and fluorouracil, which is also known as 5FU. Throughout this section we will refer to fluorouracil by its more common name 5FU. The chemotherapy is given with a drug called folinic acid (leucovorin), which makes 5FU more effective.
This combination of chemotherapy is sometimes referred to as the FOLFOX regimen, named after the drugs used.
There are several different FOLFOX schedules that vary in the way the 5FU is given. The different schedules are given a number, such as FOLFOX4 or FOLFOX6. Some doctors may refer to the combination of these drugs as oxaliplatin modified de Gramont (OxMdG).
Oxaliplatin and 5FU treatment can be given to you during a short stay in hospital or, more usually, as a day patient. Before starting treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
Most people are given their chemotherapy drugs through a fine, plastic tube inserted under the skin into a vein near their collarbone (central line|), or passed through a vein in the crook of their arm (PICC line|). Your doctor or nurse will explain this to you. Otherwise the nurse will put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it shouldn't take long.
Before the chemotherapy you will be given anti-sickness (anti-emetic)| drugs, usually by injection through the cannula or your central or PICC line, or they may be taken as tablets.
After the anti-sickness drugs you will be given a drip (infusion) of folinic acid (a colourless fluid) and an infusion of oxaliplatin (a colourless fluid). These are given at the same time and take about two hours.
After this you will be given 5FU. How you are given the 5FU will vary depending on the schedule you are being given:
You will be given an injection of 5FU (a colourless fluid) into your cannula or line, followed by an infusion of 5FU over 22 hours. The next day the folinic acid infusion and the 5FU injection are repeated. This is followed by another 22-hour infusion of 5FU.
You will have an injection of 5FU into your cannula or line followed by an infusion of 5FU over 46 hours.
As the 5FU infusions last 22-46 hours, you will need to stay in hospital unless you have a central or PICC line. If you have a line, this part of the treatment can be given to you through a small portable pump. The pump is used to give a controlled amount of the drug into your bloodstream over a set period of time. It is small enough to be carried on a belt or in a holster. This means that once the pump is connected to your line and the treatment has started, you can go home. There are different types of pumps available and some are electronic. Your nurse or pharmacist will explain how your pump works and how to look after it.
When the infusion is finished there may be some fluid left in the pump. This may be normal as some pumps need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.
If you have a cannula rather than a line, you will be able to go home after the 5FU infusion has finished. The cannula will be removed before you go. If you havea central or PICC line, it will usually stay in place, ready for your next cycle of chemotherapy.
Before you go home you will be given a supply of anti-sickness drugs to take with you. It's important to take these as directed, even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
You may hear your doctor use the word 'regimen' (eg the FOLFOX regimen) when talking about your chemotherapy. This is the whole plan or schedule of the particular chemotherapy treatment that you are receiving.
If you are having treatment as an outpatient, you will need to come back to the hospital the following day (day two) for more chemotherapy and to have your pump changed. Your pump will be disconnected when your treatment is finished (day three).
If you are having treatment as an outpatient you will come back to the hospital on day three to have your pump disconnected. A district nurse may be able to disconnect your pump at home so that you don't have to go back to the hospital. The hospital staff may be able to organise this for you, but it's not available in all areas.
You will then have a rest period with no chemotherapy for the next 11 days. This completes what is called a cycle of your chemotherapy treatment.
You will start the next cycle of your treatment after the rest period, which will be a fortnight after your first injection. You could have as many as 12 cycles, but the number you have will depend on your individual situation. Your specialist will be able to discuss this with you further.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described below won't affect everyone who is having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you.
If you do notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Oxaliplatin and 5FU can reduce the number of white blood cells, which help to fight infection|. White blood cells are produced by the bone marrow|. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins a few days after treatment. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Oxaliplatin and 5FU can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion| if your platelet count is low.
Oxaliplatin and 5FU can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
Oxaliplatin can have an effect on the nerve endings, which is known as peripheral neuropathy|. This may result in feelings of numbness or tingling, especially in the hands or feet. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
For some people, these symptoms can be triggered by anything cold, such as iced drinks and cold air. If you notice that your symptoms are related to the cold, you should avoid cold drinks and wrap up warmly in the cold weather. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
Sometimes the tingling or numbness may not happen with the first treatment, but after several treatments. This is known as a ‘cumulative effect’ and should improve after the treatment has finished. However, for some people, the tingling and numbness can last for several months or persist; tell your doctor if this is the case for you.
This may begin soon after the treatment is given and can last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting|. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Feeling tired| is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with taking some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3-4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished.
Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss|.
Your mouth may become sore| or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different|. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Oxaliplatin and 5FU can cause diarrhoea|. This can usually be easily controlled with medicine but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Oxaliplatin and 5FU can cause a rash or dry skin, which may be itchy|. Your doctor can prescribe medicine to help with this.
Rarely, your skin may darken. If it does, it usually goes back to normal a few months after the treatment has finished. During treatment and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but should wear a suncream with a high sun protection factor (SPF) and cover up with clothing and a hat. You might find our section about taking care in the sun| helpful.
Sometimes areas of skin that have been treated with radiotherapy may become red and sore. Tell your doctor if this happens.
Oxaliplatin and 5FU may cause an inflammation of the lining of the eyelids (conjunctiva) that makes your eyes feel sore, red and itchy. Let your doctor know so they can prescribe soothing eye drops if necessary.
Oxaliplatin can affect the area around the voicebox (larynx|), causing a sensation of difficulty swallowing and severe breathing difficulties.
This symptom may be made worse by cold temperatures, so it’s advisable to avoid cold drinks and ice cubes for a few days after treatment.
This side effect can be very frightening although it should only be temporary. If you have breathing difficulties, take long deep breaths through your nose. This will have a calming effect and help your breathing return to normal. You might find our section about breathing more easily| helpful.
It’s important to let your doctor know if you have this side effect. They may increase the time of your oxaliplatin infusion to 4-6 hours in future cycles to reduce the chance of this happening.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
5FU may affect the way your heart works. Some people can experience chest pain and tightening across the centre of the chest while taking it. Chest pain can be caused by many different things other than chemotherapy. If you develop any of these symptoms, contact your doctor immediately.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having FOLFOX chemotherapy, as it may harm the developing baby. It’s important to use effective contraception while having this chemotherapy, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
Due to the effect of chemotherapy on the ovaries, women may find that their periods become irregular and they may eventually stop.
In some women this may be temporary, but for others it will be permanent. This will result in menopausal symptoms| such as hot flushes, sweats and vaginal dryness.
There is a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our oxaliplatin and 5FU chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
Content last reviewed: 1 December 2011
Next planned review: 2013
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Watch our slideshow with tips for coping with a poor appetite
Watch our slideshow with tips for coping with a sore mouth
Watch our video about coping with fatigue
Watch our slideshow about avoiding infection when you have reduced immunity
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