FOLFIRI chemotherapy is a type of chemotherapy given to treat bowl cancer. It is also used as a method of treatment for colorectal cancer. It consists of the following drugs-

• FOL - folinic acid- leucovorin that is a vitamin B derivative used to reduce side effects of fluorouracil
• F - fluorouracil (5-FU)- a pyrimidine analog and antimetabolite that penetrates into the DNA molecule and stops synthesis
• IRI - irinotecan- Camptosar that is a topoisomerase inhibitor that prevents the cancer cell DNA from duplicating

Cetuximab that is a monoclonal antibody to epidermal growth factor receptor is at times added to FOLFIRI.

Folinic acid is given along with fluorouracil because it enhances the effectiveness of the treatment. There are hardly any side effects of this drug except that rarely it causes a high temperature. Fluorouracil and folinic acid are clear, colorless fluids. Irinotecan is a slightly yellow fluid. These drugs are administered intravenously.

colorectal cancer chemotherapy is generally given in cycles. Each folfiri cycle lasts for about 2 weeks. Like this, there are up to 12 cycles in a span of 6 months. On the first day of each cycle-

Folinic acid and irinotecan are administered through a drip over 2 hours at the same time followed by an injection of fluorouracil. An infusion of fluorouracil is administered through a drip for 22-46 hours depending on the patient. In case of a 22- hour infusion there is no treatment for the next 12 and for a 46- hour infusion there is no treatment for the next 11 days till the next cycle begins.

Common Side Effects of Folfiri Chemotherapy

• Increased susceptibility to infections due to drop in the count of white blood cells, as you tend to lose immunity
• Frequent headaches, muscle pain, cough, sore throat, pain passing urine and chills
• Fatigue and breathlessness due to anemia or a lowered number of red blood cells
• Bruising or bleeding due to lowered count of platelets that could cause frequent nosebleeds, bleeding gums or tiny red spots or bruises on the arms or legs
• Increased saliva production, watery eyes, abdominal cramps and diarrhea during chemotherapy
• Fatigue during and after treatment for about 6 months to 1 year
• Diarrhea could become severe and lead to dehydration at times. It is important to take in many fluids and drink plenty of water. Prescribed anti diarrhea medication could be taken
• Nausea and vomiting that can be controlled with anti sickness drugs
• Mouth ulcers
• Hair loss or hair thinning
• FOLFIRI can damage a developing baby. Hence, it is not advisable to conceive during this treatment

Effects on the bone marrow begin about 7 days after each treatment and subside in about 21 to 28 days. Some of these side effects are life threatening, especially infections. It is important to consult your doctor. The doctor would check the functioning of the bone marrow and take the blood counts before each cycle.

Rare Side Effects of Folfiri Chemotherapy

• Muscle cramps
• Liver changes
• Loss of appetite
• Watery eyes, coarse eyes and blurred vision
• Itchy skin rash
• Brown marking on the skin where fluorouracil is injected
• Redness and peeling on the palms and soles that is called palmar - plantar syndrome which causes tingling, numbness, pain and dryness
• Heart problems

Folfiri chemotherapy is generally given in an inpatient setting, as it requires a short stay in the hospital unless the patient has a central line fitted. The patient would be given anti nausea drugs prior to the treatment to prevent chemotherapy induced nausea and vomiting. However, it is essential to consult your doctor in case nausea or any other side effects are observed.