What Is FOLFOX Chemotherapy?

FOLFOX is not one drug. NCI lists three components by name.

• FOL is leucovorin calcium, also called folinic acid.
• F is fluorouracil, often written 5-FU.
• OX is oxaliplatin.

NCI's reason for combining them is short. Combinations usually work better than single drugs. Different drugs kill cancer cells in different ways.

Knowing the three names matters. Side effects attach to one drug, not to the acronym. Ask your team which drug is causing a problem.

NCI lists colorectal cancer as the main use for FOLFOX. Its oxaliplatin page is more exact. Oxaliplatin is approved for advanced colorectal cancer. It is also approved for stage III colon cancer after surgery to remove the cancer. In both, it is used with fluorouracil and leucovorin calcium.

The phrase after surgery marks the adjuvant setting. NCI's patient summary describes stage III treatment as resection and anastomosis. That means taking out the diseased segment and rejoining the bowel. Chemotherapy may follow.

For stage IV and recurrent disease, NCI lists several chemotherapy drugs and says combinations may be used. It may also be combined with targeted drugs. Ask your team what is planned for you and why.

MedlinePlus says oxaliplatin is a liquid injected into a vein. It is usually given once every fourteen days. That two-week rhythm shapes the whole regimen.

Fluorouracil also goes into a vein. A doctor or nurse gives it in a hospital or medical facility. MedlinePlus warns that a doctor skilled in chemotherapy must oversee it. The reason is the serious effects it can cause.

Ask your team to write down three things before cycle one. Get the date of each planned infusion. Get the total number of cycles. And ask which drug is given first on infusion day.

This is the instruction that surprises people most, and it is specific to oxaliplatin.

MedlinePlus warns that cold air or cold objects can make oxaliplatin effects worse. The rule runs five days after a dose. Avoid cold drinks and cold food. Avoid cold objects, air conditioning, freezers, and cold water. In cold weather, cover your hands, feet, and face before going out.

Plan for it. Take drinks at room temperature. Use a straw. Warm the car before driving. Keep gloves near the refrigerator, and skip the ice machine. These sound small until the first mouthful of ice water tightens your throat.

MedlinePlus lists common nerve effects of oxaliplatin. They include numbness, burning, or tingling in the fingers, toes, hands, feet, mouth, or throat. Raised sensitivity is common too, above all to cold.

Call your care team right away about these symptoms. Do not wait for the next visit. MedlinePlus also says to call your doctor right away about stumbling or loss of balance, trouble with writing or fastening buttons, trouble speaking, a strange feeling in the tongue, or tightening of the jaw.

Tell the team what you cannot do, not just what you feel. "I cannot feel the car keys in my pocket" is more useful than "some tingling."

MedlinePlus notes that your doctor may run a genetic test before starting fluorouracil. The point is to see how well you will tolerate it.

Ask two questions if this applies to you. Which gene is being tested? And will the result be back before cycle one? A result that lands after treatment starts cannot protect the first dose.

MedlinePlus is blunt about oxaliplatin. It may cause severe allergic reactions. These may start within a few minutes of the dose. They may cause death.

Report these at once during or right after an infusion. Watch for rash, hives, trouble breathing, throat swelling, or dizziness. Do not wait for the nurse's next round. Say something while it is happening.

Call 911 or go to the nearest emergency department for:

• Black or tarry stool, or bright red blood in the stool.
• Vomit that is bloody or looks like coffee grounds.
• Bleeding that will not stop.
• Trouble breathing, chest pain or pressure, or a throat that feels like it is closing.
• Sudden confusion, or being hard to wake.
• Sudden inability to urinate at all.

Call your care team right away, day or night, for:

• Fever of 100.4 degrees F (38 degrees C) or higher. The CDC says to call your doctor right away. Call before taking a fever reducer, since it can hide the problem.
• Chills, sore throat, mouth or throat sores, burning or pain when you urinate, or any other sign of infection. Call even if your temperature is normal. A normal temperature is not a reason to wait.
• Pain, burning, redness, or swelling at the infusion site or catheter.
• Diarrhea. Tell your team about any diarrhea. NCI says seven or more bowel movements above your normal daily number can be life-threatening, and dehydration can be too. Count them. Call right away if you feel dizzy or lightheaded, have a fever, or see blood or mucus in the stool.
• Numbness, burning, or tingling, loss of balance, trouble speaking or writing, or trouble with vision.
• Unusual bruising, blood in the urine, a nosebleed, or swelling of the arms, hands, feet, or legs.
• Fast or severe allergic signs during an infusion. Rash, hives, trouble swallowing, dizziness, or fainting. Say something while it is happening.

If you cannot reach your team quickly, go to the emergency department and tell them you are having chemotherapy.

• How many cycles are planned, and is this adjuvant or for metastatic disease?
• Which drug gets reduced or dropped first if I have side effects?
• Was a genetic test ordered before fluorouracil, and when does it result?
• What is my anti-nausea plan, and do I take anything before I feel sick?
• Which phone number is answered overnight and on weekends?
• What exactly should I do in the first 24 hours if diarrhea starts?

For related reading, see Targeted Therapy vs Chemotherapy, Biomarker Testing and Precision Medicine, and Cancer Staging.

• National Cancer Institute — FOLFOX
• National Cancer Institute — Oxaliplatin
• National Cancer Institute — Colon Cancer Treatment (PDQ), Patient Version
• MedlinePlus — Oxaliplatin Injection
• MedlinePlus — Fluorouracil Injection
• National Cancer Institute — Diarrhea and Cancer Treatment
• National Cancer Institute — Infection and Neutropenia during Cancer Treatment
• CDC — Watch Out for Fever