FOLFOX is an abbreviation for one of several chemotherapy regimens used to treat advanced-stage and metastatic colorectal cancer. It includes the drugs leucovorin calcium (calcium folinate), 5-fluorouracil and oxaliplatin. Learn more about this chemotherapy regimen.
Colorectal Cancer Spread to Body Stage 4
Image by TheVisualMD
FOLFOX Chemotherapy
What is FOLFOX Chemotherapy?
This chemotherapy combination contains the drugs leucovorin calcium (folinic acid), fluorouracil, and oxaliplatin. Combinations usually work better than single drugs because different drugs kill cancer cells in different ways.
Drugs in the FOLFOX combination:
FOL
= Leucovorin Calcium (Folinic Acid)
F
= Fluorouracil
OX
= Oxaliplatin
Each of the drugs in this combination is approved by the Food and Drug Administration (FDA) to treat cancer or conditions related to cancer.
Use in Cancer
FOLFOX is used to treat:
Colorectal cancer.
This combination may also be used with other drugs or treatments or to treat other types of cancer.
Source: National Cancer Institute (NCI)
FOL = Folinic Acid
Leucovorin Injection
Also called: Leucovorin Calcium
Leucovorin is a prescription medicine used alone or with other drugs to treat certain types of colorectal cancer and anemia and to lessen the toxic effects of the anticancer drug methotrexate or other substances that block the action of folic acid. Leucovorin is a form of folic acid.
Leucovorin Injection
Also called: Leucovorin Calcium
Leucovorin is a prescription medicine used alone or with other drugs to treat certain types of colorectal cancer and anemia and to lessen the toxic effects of the anticancer drug methotrexate or other substances that block the action of folic acid. Leucovorin is a form of folic acid.
Leucovorin calcium is a type of drug called a folic acid analog, which means it is similar to the vitamin folic acid. It is used in combination with certain chemotherapy drugs to enhance their ability to kill cancer cells (for example, fluorouracil) or to lessen their harmful side effects (for example, methotrexate). It is a type of chemoprotective agent and a type of chemosensitizing agent. Leucovorin is the active ingredient of leucovorin calcium. Also called citrovorum factor and folinic acid.
Leucovorin calcium is approved to be used alone or with other drugs to treat:
Colorectal cancer. It is used with fluorouracil as palliative treatment in patients with advanced disease.
Anemia. It is used to treat megaloblastic anemia that occurs when the body does not get enough of a vitamin called folic acid. It is used by patients who cannot take the vitamin by mouth.
Leucovorin calcium is also used to prevent and treat the toxic effects of high-dose methotrexate when used to treat osteosarcoma and other types of cancer. It is also used to treat overdoses of methotrexate or other folic acid antagonists.
The drug is also being studied in the treatment of other conditions and types of cancer.
Leucovorin Calcium - NCI. National Cancer Institute. Aug 21, 2008 [accessed on Nov 09, 2023]
Leucovorin Injection. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Leucovorin Injection. If you would like more information or have any questions, talk to your healthcare provider.
F = Fluorouracil
Fluorouracil Injection
Also called: Adrucil®, 5-Fluorouracil, 5-FU
Fluorouracil (Adrucil) is a prescription medicine used to treat cancer of the colon, rectum, breast, stomach, or pancreas. It is given as an injection into the vein (IV), or as an infusion. Fluorouracil is a type of antimetabolite.
Fluorouracil Injection
Also called: Adrucil®, 5-Fluorouracil, 5-FU
Fluorouracil (Adrucil) is a prescription medicine used to treat cancer of the colon, rectum, breast, stomach, or pancreas. It is given as an injection into the vein (IV), or as an infusion. Fluorouracil is a type of antimetabolite.
Fluorouracil is a type of chemotherapy drug called an antimetabolite. It mimics one of the building blocks of RNA and DNA, which disrupts the ability of the cells to make DNA and proteins. This slows or stops the growth of cancer cells and other rapidly dividing cells and causes them to die.
Fluorouracil injection is approved to treat:
Breast cancer.
Colorectal cancer.
Gastric (stomach) cancer.
Pancreatic cancer.
Fluorouracil is also called 5-FU. Fluorouracil is also being studied in the treatment of other conditions and types of cancer.
Fluorouracil is also available in a topical form.
Fluorouracil Injection - NCI. National Cancer Institute. Apr 13, 2007 [accessed on Nov 09, 2023]
ADRUCIL (fluorouracil) injection, solution [accessed on Aug 15, 2019]
Fluorouracil Injection. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Fluorouracil Injection. If you would like more information or have any questions, talk to your healthcare provider.
Additional Materials (6)
Bowen's disease plaque
Bowen's disease typically presents as a gradually enlarging, well-demarcated red colored plaque with an irregular border and surface crusting or scaling. Bowen's disease may occur at any age in adults, but is rare before the age of 30 years; most patients are aged over 60. Any site may be affected, although involvement of palms or soles is uncommon. Bowen's disease occurs predominantly in women (70–85% of cases). About 60–85% of patients have lesions on the lower leg, usually in previously or presently sun-exposed areas of skin.
This is a persistent, progressive, unelevated, red, scaly or crusted plaque which is due to an intraepidermal carcinoma and is potentially malignant. The lesions may occur anywhere on the skin surface, including on mucosal surfaces. Freezing, cauterization, or diathermy coagulation is often effective treatment. Pathomorphologic study of tissue sampling revealed: polymorphism of spiny epithelial cells has progressed into atypism; increased mitosis; giant and multinucleate cells; acanthosis; hyperkeratosis and parakeratosis; basal membrane and basal layer are retained.
Causes Edit
Causes of Bowen's disease include solar damage, arsenic, immunosuppression (including AIDS), viral infection (human papillomavirus or HPV), chronic skin injury, and other dermatoses.[4]
Histology Edit
In Bowen's disease, atypical squamous cells proliferate through the whole thickness of the epidermis. The entire tumor is confined to the epidermis and does not invade into the dermis. The cells in Bowen's disease are often highly atypical under the microscope, and may in fact look more unusual than the cells of some invasive squamous cell carcinomas.
Bowen's disease as seen under a microscope
Bowen disease (2).jpg
Bowen disease (3).jpg
Bowen disease (4).jpg
Treatment Edit
Photodynamic therapy, cryotherapy (freezing), or local chemotherapy (with 5-fluorouracil) are favored by some clinicians over excision. Because the cells of Bowen's disease have not invaded the dermis, it has a much better prognosis than invasive squamous cell carcinoma.
Good results have been noted with the use of imiquimod for Bowen's disease, including on the penis (erythroplasia of Queyrat), although imiquimod is not (as of 2013) approved by the U.S. Food and Drug Administration for the treatment of any type of squamous cell carcinoma, and serious side effects can occur with use of imiquimod.
References Edit
^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
Image by Masryyy/Wikimedia
Severe Toxicity Under 5- Fluorouracil-Based Therapy
Video by Mayo Proceedings/YouTube
Fluorouracil and Pet Safety | How You Can Keep Your Pets Safe When Using 5-FU
Video by U.S. Food and Drug Administration/YouTube
What is FEC and Docetaxel combination chemotherapy and what are its side effects? | OncoPower
Video by OncoPower/YouTube
What is FEC chemotherapy and what are its side effects? | OncoPower
Video by OncoPower/YouTube
What is FEC and Paclitaxel combination chemotherapy and what are its side effects? | OncoPower
Video by OncoPower/YouTube
Bowen's disease plaque
Masryyy/Wikimedia
4:47
Severe Toxicity Under 5- Fluorouracil-Based Therapy
Mayo Proceedings/YouTube
4:43
Fluorouracil and Pet Safety | How You Can Keep Your Pets Safe When Using 5-FU
U.S. Food and Drug Administration/YouTube
5:57
What is FEC and Docetaxel combination chemotherapy and what are its side effects? | OncoPower
OncoPower/YouTube
6:13
What is FEC chemotherapy and what are its side effects? | OncoPower
OncoPower/YouTube
5:59
What is FEC and Paclitaxel combination chemotherapy and what are its side effects? | OncoPower
OncoPower/YouTube
OX = Oxaliplatin
Oxaliplatin Injection
Also called: Eloxatin®
Oxaliplatin injection is an anti-cancer (chemotherapy) medicine that is used in combination with other anti-cancer medicines to treat cancers of the colon and rectum, and many other cancers.
Oxaliplatin Injection
Also called: Eloxatin®
Oxaliplatin injection is an anti-cancer (chemotherapy) medicine that is used in combination with other anti-cancer medicines to treat cancers of the colon and rectum, and many other cancers.
Oxaliplatin injection can cause serious allergic reactions, including allergic reactions that can lead to death. Oxaliplatin injection is a platinum base medicine. Serious allergic reactions including death can happen in people who take oxaliplatin injection and who have had previous allergic reactions to platinum medicines. Serious allergic reactions can happen within a few minutes of your oxaliplatin injection infusion or any time during your treatment with oxaliplatin injection.
Get emergency help right away if you:
have trouble breathing
feel like your throat is closing up
Call your doctor right away if you have any of the following signs or symptoms of an allergic reaction:
rash
flushed face
hives
itching
swelling of your lips or tongue
sudden cough
dizziness or feel faint
sweating
chest pain
See “What are the possible side effects of oxaliplatin injection?” for information about other serious side effects.
Oxaliplatin injection is an anti-cancer (chemotherapy) medicine that is used with other anti-cancer medicines called 5-fluorouracil and leucovorin to treat people with:
stage III colon cancer after surgery to remove the tumor
advanced colon or rectal cancer (colorectal cancer)
It is not known if oxaliplatin injection is effective in children.
Do not receive oxaliplatin injection if you are allergic to any of the ingredients in oxaliplatin injection or other medicines that contain platinum. See the end of this leaflet for a complete list of the ingredients in oxaliplatin injection.
Ask your doctor if you are not sure if you take a medicine that contains platinum.
Before receiving oxaliplatin injection, tell your doctor about all of your medical conditions, including if you:
have an infection
have lung, liver, or kidney problems
have or had heart problems such as an abnormal heart test called an electrocardiogram (ECG or EKG), a condition called long QT syndrome, an irregular or slow heartbeat, or a family history of heart problems.
have had changes in the level of certain blood salt (electrolytes) levels, including potassium, magnesium, and calcium.
are pregnant or plan to become pregnant. Oxaliplatin injection may harm your unborn baby. Females who are able to become pregnant should avoid becoming pregnant and should use effective birth control during treatment with oxaliplatin injection.
are breastfeeding or plan to breastfeed. It is not known if oxaliplatin injection passes into your breast milk. You and your doctor should decide if you will receive oxaliplatin injection or breastfeed. You should not do both.
Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.
Oxaliplatin injection is given to you into your vein through an intravenous (IV) tube.
Your doctor will prescribe oxaliplatin injection in a dose that is right for you.
Your doctor may change how often you receive oxaliplatin injection, your dose, or how long your infusion will take.
You and your doctor will decide how many oxaliplatin injection treatments you will receive.
It is very important that you do exactly what your doctor and nurse tell you to do.
Some medicines may be given to you before oxaliplatin injection to help prevent nausea and vomiting.
Each treatment course is given to you over 2 days. You will receive oxaliplatin injection on the first day only.
There are usually 14 days between each chemotherapy treatment course.
It is important for you to keep all of your medical appointments. Call your doctor if you miss an appointment. There may be special instructions for you.
Treatment Day 1:
Oxaliplatin injection and leucovorin will be given through a thin plastic tube into a vein (intravenous infusion or IV) and given for 2 hours. You will be watched by a healthcare provider during this time.
Right after the oxaliplatin injection and leucovorin are given, 2 doses of 5-fluorouracil will be given. The first dose is given right away into your IV tube. The second dose will be given into your IV tube over the next 22 hours, using a pump device.
Treatment Day 2:
You will not get oxaliplatin injection on Day 2. Leucovorin and 5-fluorouracil will be given the same way as on Day 1.
The 5-fluorouracil will be given through your IV with a pump. If you have any problems with the pump or the tube, call your doctor, your nurse, or the person who is responsible for your pump. Do not let anyone other than a healthcare provider touch your infusion pump or tubing.
Avoid cold temperatures and cold objects. Cover your skin if you go outdoors in cold temperatures.
Do not drink cold drinks or use ice cubes in drinks.
Do not put ice or ice packs on your body.
Oxaliplatin injection can cause dizziness, vision problems, or vision loss that can affect your ability to drive or use machines. You should not drive or operate machinery if you develop these symptoms while receiving oxaliplatin injection.
See “How can I reduce the side effects caused by cold temperatures?” for more information.
Talk with your doctor and nurse about your level of activity during treatment with oxaliplatin injection. Follow their instructions.
Oxaliplatin injection can cause serious side effects, including:
See “What is the most important information I should know about oxaliplatin injection?”
Nerve problems. Oxaliplatin injection can affect how your nerves work and make you feel. Nerve problems may happen with the first treatment or within two days after your treatment of oxaliplatin injection. Nerve problems may last a short time (acute) or may become persistent. Symptoms may improve after stopping treatment with oxaliplatin injection. Exposure to cold or cold objects may cause or worsen nerve problems. Tell your doctor right away if you get any signs of nerve problems, including:
very sensitive to cold temperatures and cold objects
trouble breathing, swallowing, or saying words, jaw tightness, odd feelings in your tongue, or chest pressure
pain, tingling, burning (pins and needles, numb feeling) in your hands, feet, or around your mouth or throat, which may cause problems walking or performing activities of daily living.
For information on ways to lessen or help with the nerve problems, see the end of this leaflet, “How can I reduce the side effects caused by cold temperatures?”
Reversible Posterior Leukoencephalopathy (RPLS). RPLS is a rare condition that affects the brain. Tell your doctor right away if you have any of the following signs and symptoms of RPLS:
headache
confusion or a change in the way you think
seizures
vision problems, such as blurriness or vision loss
Low white blood cell counts (neutropenia). Oxaliplatin injection can cause low white blood cells counts. Low blood cell counts are common with oxaliplatin injection and can lead to serious infection and death. Tell your doctor right away if you have a fever greater than 100.9°F (38.3°C) or a prolonged fever greater than 100.4°F (38°C) for more than one hour (febrile neutropenia). Call your doctor right away if you get any of the following signs of infection:
chills or shivering
pain on swallowing
sore throat
cough that brings up mucus
burning or pain on urination
redness or swelling at intravenous site
persistent diarrhea
Lung problems (interstitial fibrosis). Oxaliplatin injection can cause lung problems that may lead to death. Tell your doctor right away if you get a dry cough and have trouble breathing (shortness of breath) before your next treatment. These may be signs of a serious lung disease.
Liver problems (hepatotoxicity). Your doctor will do blood tests to check your liver.
Heart problems. Oxaliplatin injection can cause heart problems that have led to death. Your doctor may do blood and heart tests during treatment with oxaliplatin injection if you have certain heart problem. If you faint (lose consciousness) or have an irregular heartbeat or chest pain during treatment with oxaliplatin injection, tell your doctor right away as this may be a sign of a serious heart condition.
Muscle problems. Oxaliplatin injection can cause muscle damage (rhabdomyolysis) which can lead to death. Tell your doctor right away if you have muscle pain and swelling, along with weakness, fever, or red-brown urine.
Harm to an unborn baby. See “What should I tell my doctor before receiving oxaliplatin injection?”
The most common side effects of oxaliplatin injection include:
Numbness, pain, tingling, and/or burning along the nerves
Low white blood cells (neutropenia)
Low platelet count (important for clotting and to control bleeding)
Low red blood cells (blood cells that carry oxygen to the tissues)
Nausea
Changes in liver function tests
Diarrhea
Vomiting
Tiredness
Mouth sores
Tell your doctor if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of oxaliplatin injection. For more information, ask your doctor or pharmacist.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Cover yourself with a blanket while you are getting your oxaliplatin injection infusion.
Do not breathe deeply when exposed to cold air.
Wear warm clothing in cold weather at all times. Cover your mouth and nose with a scarf or a pull-down cap (ski cap) to warm the air that goes to your lungs.
Wear gloves when taking things from the freezer or refrigerator.
Drink fluids warm or at room temperature.
Always drink through a straw.
Do not use ice chips if you have nausea or mouth sores. Ask your doctor about what you can use.
Be aware that most metals are cold to touch, especially in the winter. These include your car door and mailbox. Wear gloves to touch cold objects.
Do not run the air-conditioning at high levels in the house or in the car in hot weather.
If your body gets cold, warm-up the affected part. If your hands get cold, wash them with warm water.
Always let your doctor know before your next treatment how well you did since your last visit.
Your doctor may have other useful tips for helping you with side effects.
Medicines are sometimes prescribed for purposes other than those listed in the patient information.
This patient information summarizes the most important information about oxaliplatin injection. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about oxaliplatin injection that is written for health professionals.
OXALIPLATIN- oxaliplatin injection, solution [accessed on Nov 08, 2018]
Oxaliplatin Injection. U.S. Department of Veterans Affairs. [accessed on Nov 08, 2018]
Oxaliplatin Injection. MedlinePlus/AHFS® Drug Information. [accessed on Oct 29, 2018]
These FAQs provide a summary of the most important information about Oxaliplatin Injection. If you would like more information or have any questions, talk to your healthcare provider.
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FOLFOX Chemotherapy for Colorectal Cancer
FOLFOX is an abbreviation for one of several chemotherapy regimens used to treat advanced-stage and metastatic colorectal cancer. It includes the drugs leucovorin calcium (calcium folinate), 5-fluorouracil and oxaliplatin. Learn more about this chemotherapy regimen.