FOLFOX chemotherapy comprises of Folinic acid, Oxaliplatin and 5-Flurouracil treatment for advanced stomach cancer & pre-surgical neoadjuvant therapy.
It is normally given through a central or Hickman line as it can cause a condition known as phlebitis, a painful condition that causes inflammation of the vein.
A cycle of this therapy normally lasts 14 days and you can have repeated cycles for a maximum of 10 treatments.
Like any drug regimen, it is not without side effects which you can read about later.
The two cancer killing agents in FOLFOX chemotherapy are 5-Flurouracil or 5-FU and Oxaliplatin, also known as Eloxatin.
The 3rd drug, Folinic acid (also known as Leucovorin) is not a chemotherapy agent, rather it works to potentiate the effect of 5-FU on your cancer.
It does this by inhibiting the enzyme called Thymidylate Synthase, which is required to produce Thymidine Triphosphate, a substance needed in the production of your DNA or deoxyribonucleic acid.
It therefore helps in the repair of your DNA when 5-Flurouracil is causing damage to your stomach cancer cells.
It is quite time consuming to have in comparison to EOX treatment as you have to have the Oxaliplatin infusion over 2 hours and then the 5-Flurouracil over nearly 24 hours (this can sometimes be given at home).
It is FOLinic acid, Fluroracil (Adrucil, Efudex, Fluoropex) and Oxaliplatin (Eloxatin) that gives FOLFOX its name.
FOLFOX chemotherapy side effects are similar to other chemotherapy drugs. These include:
Allergy to the medicines
Neutropenia – a drop in your white blood cell count is likely to occur around day 10 to 14 with this treatment and place you at risk of severe infections
Fatigue and Tiredness
Hair loss or ‘alopecia’
Bruising – due to a drop in your platelet count as it can cause suppression of your bone marrow production of these cells
Anemia – causes tiredness, breathlessness, muscle aches, headaches and fatigue
Nausea, Vomiting and Diarrhea
Peripheral Sensory Neuropathy – causes numbness or “pins and needles” in your hands and feet particularly with the Oxaliplatin
Mucositis – ulceration and inflammation in the mouth. This can make it quite difficult to eat
Photosensitive – your skin can be sensitive to light causing sunburn. Swallowing difficulty and sensitivity to cold drinks
FOLFOX chemotherapy has a 45% response rate and complete regression in about 4.6% of people that have this form of treatment.
It is best as a neoadjuvant chemotherapy option before surgery in those amenable or have only local invasion of their stomach cancer.
It is better tolerated better than EOX chemo, but not quite so effective although it does take longer to give and is also more frequent (every two weeks instead of three).