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FOLFOX is an abbreviation for a type of chemotherapy regimen typically used to treat colorectal cancer. Its name comes from the three types of chemotherapy drugs used during treatment:

  • FOLinic acid
  • Fluorouracil
  • OXaliplatin

Like other types of chemotherapy, FOLFOX involves taking medications that stop cancer cells from replicating. Using a combination of medications helps target cancer cells in different ways.

In this article, we break down everything you need to know about FOLFOX chemotherapy, including when it’s typically used, what it usually involves, and the most common side effects.

FOLFOX chemotherapy, also called Oxaliplatin de Gramont (OxMdG), is a type of cancer therapy that involves taking drugs containing anticancer chemicals. These chemicals target rapidly dividing cells such as cancer cells. They may also kill other healthy cells in your body that rapidly divide such as cells in your hair follicles, gastrointestinal tract, and skin cells.

FOLFOX uses the drugs folinic acid, fluorouracil, and oxaliplatin. FOLFOX can be broken down into other subtypes such as FOLFOX-4, FOLFOX-6, and FOLFOX-7 depending on how these three drugs are administered.

Researchers have found that taking these three drugs together is more effective than taking them alone. According to a 2019 study published in Clinical Colorectal Cancer,the medication oxaliplatin only has a response rate of around 10 percent, but when taken with leucovorin and fluorouracil, the response rate improves to about 53 percent.

FOLFOX is usually used to treat colorectal cancer. It may also be used to treat pancreatic cancer and certain other cancers.

According to the National Cancer Institute, FOLFOX is typically used as an adjuvant treatment (meaning in addition to the primary therapy) and for advanced cancers that have spread beyond your colon.

The National Comprehensive Cancer Network guidelines recommend that patients with metastatic colon cancer receive FOLFOX or one of two other chemotherapy regimens called XELOX or FOLFIRI. Metastatic colon cancer is when cancer spreads beyond the original site to other tissues and lymph nodes.

Clinical trials have found comparable results with all three types of treatment.

FOLFOX as first-line treatment

FOLFOX may also be used as first-line therapy for colorectal adenocarcinoma that’s spread to tissues beyond your colon and isn’t curable with surgery or radiation. Colorectal adenocarcinoma is the most common type of colon cancer.

FOLFOX as an adjuvant treatment

Adjuvant therapy is a cancer treatment administered after the primary treatment to help prevent relapse. For example, the primary treatment for colon cancer is often surgery. Chemotherapy is often used as adjuvant therapy after surgery to destroy remaining cancer cells.

FOLFOX or XELOX for 6 months is a standard adjuvant treatment for people with stage 3 colon cancer in good health.

Research has found that FOLFOX may offer benefits for people with stage 3 colon cancer when they receive at least eight cycles of treatment. Each cycle of FOLFOX lasts 2 weeks.

FOLFOX as a palliative treatment

FOLFOX is considered a standard palliative treatment for late-stage colon cancer that’s not considered treatable. Palliative treatment aims to prolong life and improve overall well-being.

FOLFOX is usually delivered intravenously directly into your bloodstream. It may be administered through a short tube called a cannula that connects to a vein in your arm.

It’s also possible to receive treatment through a peripherally inserted central catheter (PICC). A PICC is a long tube that inserts into your arm and releases the drug in the large central veins near your heart.

FOLFOX is delivered in 2-week cycles. The number of cycles you receive can vary, but might be as many as 12.

The exact treatment you receive can vary depending on the type of FOLFOX you receive, but here’s one example of what FOLFOX treatment may look like:

Day 1

On the first day, you’ll receive:

  • oxaliplatin administered into your bloodstream over 2 hours from a drip
  • folinic acid injected into your bloodstream at the same time as the oxaliplatin
  • fluorouracil injected through your cannula or PICC
  • fluorouracil infusion over 22 hours through a drip or pump

Day 2

  • folinic acid injected or administered through a drip for 2 hours
  • fluorouracil injected into your bloodstream
  • fluorouracil infusion over 22 hours through a drip or pump

Days 3 to 14

You’ll receive no treatment from days 3 to 14 until your next cycle starts.

The drugs used during FOLFOX and other types of chemotherapy can kill healthy cells in your body and lead to a variety of side effects.

According to the National Cancer Institute, more than 20 percent of people undergoing FOLFOX develop the following side effects:

GastrointestinalNeurologicalSkin and hairOther
diarrheaheadacherashincreased risk of infection
nauseatingling or loss of feeling in hands, feet, nosehair lossfever
vomitingnumbness or tingling in limbsredness, pain, or peeling on your palms and soles difficulty swallowing or breathing
constipationincreased risk of sunburnanemia
loss of appetiteitchinessbruising and bleeding
mouth sorespain
tightness in throat or jawcough

If you develop side effects, it’s a good idea to talk with your doctor about potentially adjusting your dosage.

A 2018 study found that in 109 patients with stage 4 colon cancer, 46 percent required a dose reduction due to side effects. There was no significant difference in overall survival between people who received an adjusted dose or the original dose.

Treating colorectal cancer usually involves surgically removing part of your colon. Chemotherapy is often administered after surgery to kill remaining cancer cells that may have spread. Research supports the use of FOLFOX in some situations, but its effectiveness depends on the stage and grade of your cancer.

A 2016 study examined how many cycles of adjuvant FOLFOX are needed to lead to a survival benefit in people with stage 3 colon cancer. The researchers found that the 213 patients in the study had a 5-year overall survival rate of 77.9 percent. They found FOLFOX significantly increased the overall survival rate in patients who received at least eight cycles.

A 2019 study compared the use of FOLFOX to another chemotherapy regimen called FOLFIRI in patients with stage 4 colon cancer. They concluded that there was no difference in survival benefit between the two regimens but that FOLFOX was more commonly used, possibly due to fewer side effects, lower cost, and its effectiveness in treating stage 3 cancer.

A 2020 study found that FOLFOX may be effective for treating aggressive pancreatic neuroendocrine tumors after people receive the medications capecitabine and temozolomide. However, the duration of FOLFOX response is short and the researchers concluded that new treatments are urgently needed.

FOLFOX is a chemotherapy regimen that involves taking three medications: folinic acid, fluorouracil, and oxaliplatin. It’s most often used in combination with other cancer treatments to treat late-stage colorectal cancer.

Although FOLFOX may improve the outlook of your cancer, it can also cause side effects. If you develop side effects while undergoing FOLFOX or any other chemotherapy, you should discuss them with your doctor. It’s often possible to adjust the dosage of your treatment to minimize side effects.