FOLFOX vs FOLFIRI: How to Compare

FOLFOX and FOLFIRI both use fluorouracil-based treatment. They differ in the partner drug. The comparison often turns on prior treatment, side effects, and cancer goals.

Regimen names can look like alphabet soup. They usually combine drug initials, timing, and sometimes the order of treatment. Use a regimen page this way: understand what the name means, then ask how your team's version applies to you.

It may come up in colorectal cancer, other gastrointestinal cancers, or planning for metastatic disease.

The same regimen name can be used in different situations. Doses or schedules can vary too. Do not use this page to work out doses, change medicines, or compare yourself with someone else's plan.

Before a regimen begins, the team may confirm pathology, stage, biomarkers, organ function, blood counts, and infection risk. They may also review medicines, allergies, and fertility concerns. They will decide whether a port or PICC line would help. Some regimens also call for anti-nausea medicines, steroid instructions, hydration plans, heart tests, or neuropathy checks.

• What are the names of each drug in my regimen?
• How many cycles are planned, and what would change that plan?
• Which side effects are common, and which are urgent?
• Will I need growth-factor shots, transfusions, or infection precautions?
• How will we know whether it is working?
• What happens if side effects force a delay or dose change?

Ask about nerve damage, called neuropathy, with oxaliplatin. Ask about diarrhea with irinotecan. Ask too about infusion-pump logistics, blood counts, and sequence.

Your care team can tell you which side effects matter most for your exact regimen, doses, and health history. Ask for the after-hours number and the fever rules before the first infusion.

Two problems drive most urgent calls on these regimens. Irinotecan can cause severe diarrhea, which quickly leads to dehydration. Chemotherapy also lowers your white blood cells, so a fever can mean a serious infection.

• Call 911 or go to an emergency department if you have trouble breathing, chest pain, shaking chills you cannot control, or you faint.
• Call your care team right away, at any hour, if your temperature reaches 100.4°F (38°C) or higher. CDC treats a fever during chemotherapy as a medical emergency, so go to an emergency department if you cannot reach your team at once.
• Call your care team the same day if you notice redness, swelling or pain around your port or infusion pump line.
• Call your care team the same day if you have seven or more loose stools above your normal number in a day, blood or mucus in your stool, or you cannot keep fluids down. Severe diarrhea can become life threatening.
• Call your care team within a day or two if you feel dizzy when you stand, your mouth is very dry, you are passing little urine, or numbness and tingling in your hands or feet is new or getting worse.

Do not take an anti-diarrhea medicine or a fever medicine on your own. Ask your team first, because both can hide a problem they need to see.

Sometimes regimen choices offer similar benefits with different tradeoffs. Ask what the alternatives are, and why this plan is preferred. Ask whether a clinical trial is relevant. Ask whether a second opinion should happen first.

Start with Chemotherapy, How Chemotherapy Is Given, What to Bring to Chemotherapy, and Low White Blood Cells During Chemotherapy.

• National Cancer Institute — Colon Cancer Treatment (PDQ) Patient Version
• National Cancer Institute — Diarrhea and Cancer Treatment
• National Cancer Institute — Nerve Problems (Peripheral Neuropathy) and Cancer Treatment
• CDC — Fever During Chemotherapy Is an Emergency