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FOLFIRINOX for pancreatic cancer is a combination of drugs – leucovorin (folinic acid) and three chemotherapy drugs – fluorouracil (5-FU), irinotecan and oxaliplatin.

It is used to treat pancreatic cancer that has spread or can’t be removed by surgery. It is also sometimes used before surgery to try to shrink the cancer to make surgery possible.

FOLFIRINOX is only suitable for people who are fit and well enough to cope with several different drugs. This is because it can cause a lot of side effects that can be difficult to cope with.

Sometimes you may start with a version of the treatment called mFOLFIRINOX (modified FOLFIRINOX). This has slightly lower doses of 5-FU and irinotecan and can be easier to cope with.

How is FOLFIRINOX given?

You will have your chemotherapy as an outpatient in the chemotherapy unit at the hospital, which means you will go in for treatment, but won’t need to stay overnight.

FOLFIRINOX is given through a central line, such as a PICC line, Hickmann line or a portacath. These are tubes that deliver drugs directly into a large vein in your chest, and stay in place for as long as your chemotherapy lasts.

FOLFIRINOX is given in a two-week cycle. The exact number of cycles you have will depend on your treatment plan and how well you respond to it. Your nurse or doctor will tell you more about this.

On your first day of treatment, your nurse will give you oxaliplatin and leucovorin as a drip (infusion) over two hours.

Half an hour after the leucovorin starts you will have irinotecan. The first time you have irinotecan it will be given over 90 minutes. After this it may take about 30 minutes to give it, if you didn’t have any problems with the first infusion. You will then have an injection of 5-FU into the line in your vein.

This is followed by an infusion of 5-FU, lasting 46 hours. This is given through a small portable pump attached to a belt, so that you can go home. When it’s finished the pump is usually disconnected at the hospital, or at home by a nurse. You will then have a break from chemotherapy for the next 12 days.

FOLFIRINOX chemotherapy cycle

Folfirinox Chemotherapy Cycle

What are the side effects of FOLFIRINOX? 

FOLFIRINOX can cause side effects but these can affect everyone differently. Your doctor or nurse should give you information about side effects. Make sure you read this, and ask them any questions you may have about the possible side effects, and how to manage them. Knowing what to expect can help you to deal with any side effects.

Common side effects

  • Increased risk of infection. FOLFIRINOX can increase your risk of getting an infection, because it can cause a drop in the number of your white blood cells. This means your body is less able to fight infection. Signs of an infection include a high temperature, headaches, aching muscles, a cough, sore throat, or feeling shivery and cold.
  • Bruising and bleeding. FOLFIRINOX can lower the number of platelets in your blood. Platelets are cells that help blood to clot. You may bruise more easily than normal, have nosebleeds, bleeding gums or tiny red spots on your skin. You may have blood in your urine but this is less common. Speak to your doctor or nurse straight away about any of these side effects, as your dose may need to be reduced.
  • Tingling and numbness in your fingertips and toes (peripheral neuropathy). This is caused by the effect of one of the chemotherapy drugs, oxaliplatin, on your nerves. It usually improves after treatment finishes, but for some people it may never go away. Talk to your nurse or doctor if you have these symptoms, as the dose of the chemotherapy drug may be reduced or stopped.
  • Feeling or being sick (nausea or vomiting). This is a common side effect of FOLFIRINOX but can be controlled with anti-sickness medication. You will usually be given medication before your chemotherapy starts to help control or prevent sickness. If it doesn’t work, tell your doctor or nurse – you should be able to change the medication. Read more about coping with feeling and being sick.
  • Loose watery poo (diarrhoea). If you have diarrhoea, make sure you drink plenty of fluids. If you have diarrhoea more than four times a day, tell your doctor or nurse. They may give you medication to control it, or reduce the dose of the chemotherapy drug in future cycles.
  • Fatigue (extreme tiredness). Fatigue is a common side effect of FOLFIRINOX. People can feel tired or exhausted for much of the time during treatment. There are ways to deal with fatigue. You might want to keep a fatigue diary, so you can see when you have more energy to do things. This may help you to plan activities on the days that you are feeling better, and rest on days when you’re more tired.
  • Hair loss. FOLFIRINOX may cause your hair to thin or you may lose it altogether. It should grow back gradually once treatment stops. Talk to your nurse about dealing with hair loss.
  • Taste changes. FOLFIRINOX may cause a funny taste in your mouth that some people describe as a metallic or cardboard taste. Taste changes usually improve with time. You might find our tips for coping with taste changes helpful.
  • Sore mouth and mouth ulcers. This can be mild or severe, making eating and drinking difficult. Try to drink lots of fluids, clean your teeth regularly with a soft toothbrush and avoid spicy or citrus foods that might sting your mouth. Your doctor or nurse can give you an anti-bacterial mouthwash which should help. Using painkillers such as paracetamol or ibiprofen can also help. 
  • Liver problems. FOLFIRINOX may affect how well your liver works. You will have regular blood tests to check for this.
  • Eye problems. FOLFIRINOX may cause sore or watery eyes. Tell your nurse or doctor if this happens, as you may need antibiotic eye drops.
  • Sore hands and mouth. FOLFIRINOX can cause soreness, redness and peeling on the palms of the hands and soles of the feet. Or your skin might look shiny, feel tight and crack around the fingertips. Your doctor or nurse may prescribe a vitamin or creams before starting chemotherapy to help with this. Keeping your hands and feet cool can also help. The soreness usually gets better after your chemotherapy ends.
  • Skin changes. Your skin may darken or be more sensitive to the sun. Use a high factor sun cream if you’re going outside. Let your doctor or nurse know about any skin changes.
  • Allergic reactions. FOLFIRINOX may cause an allergic reaction while it’s being given.  Signs include an itchy rash, or feeling dizzy, breathless or faint. Or you may have diarrhoea, tummy pain, or produce a lot of saliva. If you have any of these symptoms tell your nurse or doctor immediately as any reaction will need to be treated straight away.
  • Heart problems. One of the chemotherapy drugs, 5-FU, can cause chest pain, breathlessness, palpitations or a fluttering heart. If you have any of these symptoms let the medical team know immediately on the emergency number you should have been given. They may prescribe medication. These symptoms usually end after treatment.
  • Problems swallowing and breathing (laryngeal spasm). Oxaliplatin can affect your throat, which can cause swallowing and breathing problems. This can happen in the first few hours of having oxaliplatin. Cold temperatures can make this worse so try to avoid ice-cold drinks or foods, and wrap up warm if you go out in the cold.

Less common side effects

  • Risk of a blood clot. FOLFIRINOX can increase the risk of a blood clot forming in a vein (thrombosis). If you have pain or swelling in one of your legs or arms, or are very short of breath, phone an ambulance or the emergency contact number you will have been given immediately. A blood clot needs to be treated straight away.
  • Anaemia (low level of red blood cells). FOLFIRINOX can lower the number of red blood cells in your blood (anaemia). This can make you feel tired, faint and short of breath. If you are very anaemic, you may need to be given extra red blood cells through a drip (blood transfusion).
  • Ringing in your ears (tinnitus). FOLFIRINOX may cause ringing in your ears, or affect your hearing. This usually improves after treatment ends. Tell your medical team if you get this, as they may change your dosage.

We haven’t listed every possible side effect of FOLFIRINOX. Speak to your doctor or nurse for more information if you experience anything unusual. If you are unable to contact your doctor or nurse contact the medical team on the emergency number that you should have been given.

If you have any questions about FOLFIRINOX or side effects, you can also call our specialist nurses free on our Support Line.

More chemotherapy information

Published May 2017

Review date May 2019

Information Standard