Doctors often use chemotherapy as the first line of defense against cancer. FOLFOX, a combination of chemotherapy drugs, can treat colorectal cancer.

There are various types and combinations of chemotherapy drugs, and each has its own set of benefits and drawbacks. One example is FOLFOX, a combination of folinic acid, fluorouracil, and oxaliplatin.

While doctors commonly use it for people with colorectal cancer, FOLFOX can also treat other types of cancer. A person can use it alone or in combination with other drugs.

Read more to learn about the FOLFOX regimen, its side effects, success rates, and more.

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FOLFOX is a combination of chemotherapy drugs. Doctors commonly use it to treat colorectal cancer, particularly if it has spread beyond the colon. They may also use it to treat pancreatic cancer and some other cancers.

Doctors often use FOLFOX as an adjuvant treatment. This means they administer the medication after the primary cancer treatment, such as surgery to remove a tumor. Using FOLFOX chemotherapy after the primary treatment can prevent the cancer from returning.

Usually, in people with stage 3 colon cancer, a doctor or oncologist will prescribe FOLFOX for 6 months. Alternatively, a person may receive XELOX (also called CAPOX), which is oxaliplatin combined with capecitabine.

According to a 2016 study in Springerplus, there are significant benefits for people with stage 3 colon cancer who receive at least eight cycles of FOLFOX.

In some cases, doctors may use FOLFOX and cetuximab as first-line therapy for colorectal cancer that has spread. They can also use FOLFOX for palliative treatment. It may ease symptoms and improve the quality of life in individuals with advanced colon cancer.

Chemotherapy medications such as FOLFOX are potent drugs. Although they kill harmful cancer cells, they can also damage healthy tissue and cause a range of side effects.

At least 1 in 5 individuals receiving FOLFOX treatment develop some or all of the following side effects:

  • gastrointestinal issues, such as diarrhea, nausea, and vomiting
  • neurological issues, such as headaches, loss of sensation, numbness, and tingling
  • increased risk of infection
  • skin problems, such as itchiness and rashes
  • anemia
  • fatigue
  • bruising and bleeding
  • fever
  • difficulty breathing or swallowing
  • hair loss

People who develop side effects should discuss their treatment regimen with a doctor. They can reduce their dosage or change their medication.

According to a 2018 study of 109 individuals with stage 4 colon cancer, side effects meant doctors had to reduce the dose for almost half of the participants. Despite this, the researchers found no significant difference in overall survival between the individuals receiving an adjusted lower dose and those on the higher initial dose.

This means if side effects are causing harm to an individual, a lower dose of the medication may still be effective.

Individuals typically receive FOLFOX through intravenous (IV) infusions at a chemotherapy clinic.

Alternatively, if a person has a central line, they may receive their infusions at home. A central line is a small, flexible tube placed in a large vein. It stays in for an extended period of time and allows a person to easily receive IV medication.

Each cycle of FOLFOX is 2 weeks long, and an individual may receive up to 12 cycles.

Although everyone’s treatment is different, a sample FOLFOX regimen may look like this:

Day 1

An individual receives:

  • oxaliplatin through an IV drip over 2 hours
  • a folinic acid injection
  • a fluorouracil injection and infusion over 22 hours

Day 2

An individual receives:

  • a folinic acid injection or infusion over 2 hours
  • a fluorouracil injection and infusion over 22 hours

Days 3–14

An individual will have no treatment until the start of the next cycle.

Treatment for colon cancer often involves surgery to remove the primary tumor. Doctors may then recommend chemotherapy to attack any remaining cancerous cells.

Depending on their cancer stage and grade, FOLFOX may be a good option for some people with colon cancer. Several studies have evaluated the success rates of FOLFOX chemotherapy:

  • A 2016 study looked at FOLFOX as an adjuvant treatment. Researchers found that in the 213 participants with stage 3 colon cancer, the 5-year overall survival rate was 77.9%. They noted that FOLFOX significantly increases the survival rate in people receiving at least eight cycles.
  • A 2019 study compared FOLFOX with an alternative regimen called FOLFIRI in people with stage 4 colon cancer. The researchers found no significant differences in survival rates between the two treatments. However, they noted that FOLFOX was the more common option, potentially due to lower costs and fewer side effects.
  • A 2020 study determined that FOLFOX could effectively treat aggressive pancreatic neuroendocrine tumors in people receiving capecitabine and temozolomide. However, the effects of FOLFOX were generally short-lived.
  • Another 2020 study compared the effectiveness of 3 months to 6 months of adjuvant chemotherapy using FOLFOX. The researchers found that in the 3-month group, the 5-year overall survival rate was 82.6%, while in the 6-month group, it was 83.8%.

FOLFOX is a chemotherapy regimen that doctors commonly use to treat colorectal cancer. It contains the chemotherapy drugs folinic acid, fluorouracil, and oxaliplatin.

Although FOLFOX can improve an individual’s outlook, it may cause unpleasant side effects. If an individual experiences side effects, they can discuss adjusting the dosage with a doctor.