FOLFOX chemotherapy consists of drugs like folinic acid (FOL) fluorouracil (F) and Oxaliplatin (OX). This is very commonly used to treat colon cancers. Fluorouracil or 5-FU is an antimetabolite used for over forty years. Folinic acid is a derivative of tetrahydrofolic acid that is converted into other reduced folic acid derivatives. Folinic acid enhances the effect of 5-FU.

FOLFOX is given intravenously through an IV drip. However, it is sometimes administered through a central line directly into a large vein in the chest. The drawback here is that it should be inserted there before the treatment and should remain there till all the treatments are completed.

FOLFOX is given in cycles with breaks in between each cycle. The dose and period of treatment depends upon factors like gender, weight and the response to the treatment. Generally, up to 12 treatments are given in 2 weeks. This could go on for about 6 months.

On the first day, the patient is given an oxaliplatin and folinic acid drip for 2 hours followed by an injection of fluorouracil and then an infusion of 5-FU through another drip. This usually takes about 20 hours. On the second day, folinic acid drip is given for 2 hours followed by an injection of fluorouracil then fluorouracil infusion in a drip. This also takes about 20 hours.

FOLFOX Drugs and their Side Effects

Like some common side effects of any other chemotherapy, there is risk of susceptibility to infections because the number of white cells reduces drastically. There is fatigue, numbness in fingers and toes and general malaise.

5-Fluorouracil (5-FU)

Fluorouracil chemotherapy is a commonly used to treat colorectal cancer and is more effective with leucovorin. Hence, these two drugs are used in combinations. Some side effects of this drug are sensitivity to sunlight, mouth sores, loss of appetite, blisters on hands and feet, nausea and diarrhea.

Leucovorin (Folinic Acid, FA, LV)

Side effects of leucovorin are relatively rare; however, but this drug tends to aggravate certain side effects of 5-FU like mouth sores and diarrhea. Some other side effects are skin rash, itching, chills, dizziness, back pain, shortness of breath, throat inflammation, etc.

Oxaliplatin (Eloxatin)

Side effects of chemotherapy oxaliplatin are nausea and vomiting, diarrhea, mouth sores, fatigue, stomach pain and shortness of breath. Peripheral neuropathy that is tingling and numbness in the feet and hands is also one of the side effects. Other side effects are sensitivity to cold temperatures, difficulty in swallowing and low white blood cell and platelet count.

FOLFOX Treatment for Colon Cancer

This is usually used as an adjuvant therapy i.e. after surgery in case of colon cancer, depending on the stage.

Stage 0

These cancers are within the inner lining of the colon and hence can be removed with surgery.

Stage I

These cancers penetrate through several layers of the colon but are within the outer walls of colon. This also can be removed by surgery.

Stage II

These cancers grow through the wall of the colon and spread in the nearby tissue. These can be removed with the surgery. However, adjuvant therapy is generally applied here with FOLFOX as there is a risk not being totally removed.

Stage III

In this stage, the cancer spreads to the nearby lymph nodes. Surgery along with FOLFOX is used in this case.

Stage IV

The cancer spreads to the distant organs and tissues. Cure is unlikely in this stage. FOLFOX is given before and after the surgery.

Recurrent colon cancer

Normally in this case, FOLFOX chemotherapy is applied both before and after the surgery.

FOLFOX chemotherapy is effectively used as a method of treatment for colon cancer and bowel cancer, normally given as an adjuvant therapy. Of course, surgery is preferred especially in the early stages. Research is going on to find drugs with reduced side effects.