FOLFIRINOX is a chemotherapy treatment used to treat pancreatic cancer that has spread, or can’t be removed by surgery.
This information is best when read with our general information about chemotherapy and the type of cancer you have.
The drugs used in FOLFIRINOXBack to top
FOLFIRINOX is named after the initials of the drugs used for treatment. The drugs are:
In this information, we call fluorouracil by its more common name, 5FU.
You might hear folinic acid being called calcium folinate or leucovorin. Folinic acid is not a chemotherapy drug, but is often given with 5FU as it’s been shown to make it work better.
How FOLFIRINOX is givenBack to top
You have FOLFIRINOX in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse gives you anti-sickness (anti-emetic) drugs as an injection into a vein or as tablets. The way you have treatment depends on whether you have a line in or not. The nurse will give you the drugs and chemotherapy through one of the following:
- a short thin tube that the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you oxaliplatin as a drip (infusion) over two hours. They usually run the drip through a pump, which gives you the chemotherapy over a set time. After this, you will have folinic acid as a drip over two hours. Some people are given folinic acid at the same time as oxaliplatin.
Irinotecan is usually given as a drip that begins 30 minutes after the folinic acid is started. Sometimes the irinotecan is not given until the folinic acid has finished. The first time you have irinotecan it will be given over 90 minutes. After this, it may be given over a shorter time of about 30 minutes.
5FU is given after the irinotecan. You’ll be given some of the drug as an injection into your line. Then the rest of the 5FU will be given to you as an infusion over 46 hours.
The infusion of 5FU is usually given through a small portable pump carried on a belt or in a holster. It gives the drug over 46 hours. You will be able to go home once the pump is connected to your line and the infusion has started.
You usually come back to the hospital to have the pump disconnected. Sometimes, a district nurse will do this for you at home. Your chemotherapy nurse will explain how to look after the pump and what to do if there’s a problem.
If you have a cannula, you will need to stay in hospital for this part of the treatment.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy:
FOLFIRINOX may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having chemotherapy, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common, but if it happens it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
Irinotecan reaction (acute cholinergic syndrome)
Some people may have side effects within 24 hours of having irinotecan. This is why irinotecan is given slowly (over 90 minutes) the first time you have it. The side effects include diarrhoea, tummy cramps, sweating more than usual or producing a lot of saliva.
This is called acute cholinergic syndrome and it can usually be prevented or controlled by a drug called atropine. Atropine is given as an injection under the skin (subcutaneously). You may be given atropine with your chemotherapy to prevent these symptoms.
Tell your doctor or nurse if you have any of these symptoms. If you have these symptoms, you will normally be given atropine before irinotecan for your next treatments.
Your course of FOLFIRINOX
You have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of FOLFIRINOX takes 14 days (two weeks).
On day one you have oxaliplatin, folinic acid, irinotecan and 5FU. You will then be connected to the 5FU for 46 hours. When you finish your 46 hour infusion of 5FU, you will have a rest period with no chemotherapy for the next 11 days.
At the end of the 14 days you start your second cycle of FOLFIRINOX. This is exactly the same as the first cycle. You can have up to 12 cycles. Your doctor or nurse will tell you the number of cycles you are likely to have.
Before you go home, the nurse or pharmacist will give you anti-sickness (anti-emetic) drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as they have been explained to you.
Possible side effects of FOLFIRINOXBack to top
We explain the most common side effects of FOLFIRINOX here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
FOLFIRINOX can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your white blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
FOLFIRINOX can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
FOLFIRINOX can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your hair will thin or you may lose all the hair from your head. The thinning usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. It is important to cover your head to protect your scalp when you are out in the sun. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
You may get a bitter or metallic taste in your mouth or find that food tastes different. This should go away when your treatment finishes. Try using herbs and spices (unless you have a sore mouth or ulcers) or strong-flavoured sauces to give your food more flavour. Sucking boiled sweets can sometimes help get rid of a bitter or metallic taste. Your nurse can give you more advice.
Numb or tingling hands or feet
These symptoms are caused by the effect of FOLFIRINOX on nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes, but in some people they may never go away. Talk to your doctor if you are worried about this.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
FOLFIRINOX may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. FOLFIRINOX can cause a rash which may be itchy.
During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Treatment with FOLFIRINOX may cause changes in the way your liver works, although it will return to normal when the treatment finishes. You're very unlikely to notice any problems, but your doctor will take regular blood samples to check your liver is working properly.
Watery or sore eyes
Your eyes may become watery. They may also become sore and inflamed (conjunctivitis). Your doctor can prescribe eye drops.
Changes in hearing
You may experience ringing in your ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with longer courses of treatment. Sometimes, your sense of balance may be affected. Any hearing loss and balance changes may be permanent. Tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Less common side effects of FOLFIRINOXBack to top
Breathing and swallowing
Oxaliplatin can affect the area around the voicebox (larynx). You might feel as if it’s difficult to swallow or to breathe. This can be very frightening but should only last a short while. Try taking long deep breaths through your nose to help your breathing get back to normal. The symptoms can be made worse by cold temperatures. Try not to have cold drinks or ice cubes for a few days after treatment.
It’s important to tell your doctor or nurse if you have this side effect. They can give you the oxaliplatin over a longer time (four to six hours) to reduce the chance of this happening.
Changes in the way the heart works
FOLFIRINOX can affect the way the heart works, but this is usually temporary. You may have tests to see how well your heart is working before chemotherapy. Some people have tests before each treatment.
If you have any pain or tightening in your chest tell your doctor straight away. These symptoms can be caused by other conditions but it’s very important to get them checked out.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about FOLFIRINOXBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines can interact with chemotherapy or be harmful when you are having chemotherapy. This includes medicines you can buy in a shop or chemist. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
FOLFIRINOX may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid.
Changes to your periods
FOLFIRINOX can sometimes stop the ovaries working. You might not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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