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FOLFIRINOX for pancreatic cancer

There are different chemotherapy drugs used to treat pancreatic cancer. FOLFIRINOX is one of the main chemotherapy treatments for pancreatic cancer. It is several different chemotherapy drugs, which are:

It also includes folinic acid (leucovorin). This is a vitamin that helps fluorouracil work better.

Read about:

Each hospital may do things slightly differently, and treatment will vary depending on your cancer. Speak to your doctor or nurse about your treatment.

How is FOLFIRINOX used?

FOLFIRINOX is used in different ways:

  • If you have cancer that can be removed with surgery (such as the Whipple’s procedure), you may be offered FOLFIRINOX after surgery to try stop the cancer coming back. 
  • If you have borderline resectable cancer, you may have FOLFIRINOX to try to shrink the cancer to make surgery possible. This depends how far the cancer has grown. We need more research into this, and you may be offered chemotherapy before surgery as part of a clinical trial.
  • If you have locally advanced or advanced pancreatic cancer and surgery is not possible, you may have FOLFIRINOX to try to control the growth of the cancer.  
How is FOLFIRINOX given?

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

FOLFIRINOX is given in a two-week cycle. This is the time it takes to have your treatment and to have a break before you the next cycle. The break allows your body to recover. The number of cycles you have will depend on how the treatment is working and how chemotherapy affects you. Your chemotherapy team will talk to you about your treatment.

The FOLFIRINOX drugs are given as an injection or infusion into a vein. You may hear an infusion called a ‘drip’. You will have the infusion through a cannula, or through a central line – such as a PICC line or a portacath.

On your first day of each treatment cycle, you will have an infusion of oxaliplatin, folinic acid, fluorourcail and irinotecan. Each chemotherapy team will give FOLFIRINOX slightly differently. For example, you may have oxaliplatin and folinic acid one after the other, or you have them at the same time. Speak to your chemotherapy team about how you will be given FOLFIRINOX.

  • You will have oxaliplatin for two hours.
  • You will have folinic acid for two hours.  
  • Half an hour after the folinic acid infusion starts, you will have irinotecan for 90 minutes.
  • You will then have an injection of fluorourcail into a vein – you may hear this called a ‘bolus injection’.
  • You will be given an infusion of fluorourcil over 46 hours. This is given through a small pump that attaches to your central line. The pump also attaches to a belt, so that you can carry it around with you and have your fluorourcil infusion at home.
  • After 46 hours, the pump is disconnected at the hospital, or at home by a nurse.
  • You will then have a break from chemotherapy for the next 12 days.

Allergic reaction

Some people have an allergic reaction while FOLFIRINOX is being given. Signs of a reaction are:

  • an itchy rash
  • a high temperature
  • feeling dizzy or faint
  • feeling short of breath or faint.

You may also have runny poo (diarrhoea) or tummy pain. An allergic reaction needs treating straight away, so if you have any of these symptoms tell your chemotherapy team.

What are the side effects of FOLFIRINOX? 

FOLFIRINOX can cause side effects, but these can affect everyone differently, and you may not get all of the side effects mentioned here. Your chemotherapy team should tell you about possible side effects and how they are managed. Ask them any questions you have. You can also speak to our specialist nurses on our free Support Line. 

If you have lots of side effects, your doctor may change the dose of some of the FOLFIRINOX drugs to make it easier to deal with. This is sometimes known as mFOLFIRINOX (modified FOLFIRINOX). Your chemotherapy team can talk to you about this.

Your chemotherapy team should give you an emergency number to call if you are unwell, or if you need information about any side effects. Your nurse will explain when to use this number. If you haven’t been given a number, ask your nurse about this.

Common side effects

Infection. FOLFIRINOX can increase your risk of getting an infection. An infection is an emergency if you are having chemotherapy, and needs treating straight away. Read more about the signs of an infection, and how they are treated.

Runny poo (diarrhoea). If you have diarrhoea, make sure you drink lots of water. If you have it more than four times a day, tell your chemotherapy team. They can give you medicines to control it. Read more about diarrhoea and how it is treated.

Problems emptying your bowels (constipation). If you get constipation, drink lots of water and try to eat high fibre foods, such as fruit and vegetables. Gentle exercise such as walking can also help. Speak to your doctor about medicines that can help. 

Fatigue (extreme tiredness). Fatigue is a common side effect of FOLFIRINOX. It isn’t the same as feeling tired. Fatigue can make you feel weak and have problems concentrating. Some people find that the fatigue starts a few hours to a few days after having chemotherapy, and starts to get better after a few days. There are things that you can do to help with fatigue. Read our tips on coping with it.

Oxaliplatin may also cause dizziness. Feeling tired and dizzy can affect your ability to drive. If you have these side effects, speak to your doctor about driving.

Feeling or being sick (nausea or vomiting). This is a common side effect of FOLFIRINOX. You will normally be given anti-sickness medicines before your chemotherapy starts. If these medicines don’t help, speak to your chemotherapy team about changing to a different medicine. We have tips for coping with feeling and being sick.

Tingling and numbness in your fingertips and toes. FOLFIRINOX can affect the nerves in your hands and feet, which can cause tingling and numbness (peripheral neuropathy). This normally gets better after your treatment, but for some people it may never go away. Talk to your chemotherapy team if you have this side effect.

Problems swallowing and breathing (laryngeal spasm). Oxaliplatin can affect your throat, which can make it hard to swallow or breathe. If this happens when you are being given oxaliplatin, tell your nurse straight away. They may stop the infusion of oxaliplatin while they give you medicine to help. You may also get this side effect in the first few hours after having oxaliplatin – but this is normally only if you are out in the cold, or having a cold drink. It should stop a few days after your treatment.

Anaemia (feeling tired or dizzy). FOLFIRINOX can lower the number of red blood cells in your blood. This is called anaemia, and can make you feel tired, dizzy or short of breath.

Bruising and bleeding. FOLFIRINOX can lower the number of platelets in your blood – this is called thrombocytopenia. This can cause you to bruise more easily than normal, and you may be more likely to have nosebleeds or bleeding gums.

Hair loss. FOLFIRINOX may cause your hair to thin, or you may lose some hair – but it should grow back once your treatment stops.

Taste changes. FOLFIRINOX may cause a funny taste in your mouth. Some people say this tastes like metal or cardboard. You might find our tips for coping with taste changes helpful.

Loss of appetite. During your treatment you may not feel like eating, and you may start to lose weight. Try eating small meals often. If your appetite doesn’t get better after a few days, tell your doctor or dietitian. We have tips on dealing with a loss of appetite.

Sore mouth and mouth ulcers. FOLFIRINOX can make your mouth sore, or cause mouth ulcers which can be uncomfortable. Tell your chemotherapy team about any problems you have with your mouth. They can make sure you don’t have a mouth infection.

Sore hands and feet. FOLFIRINOX can make the palms of your hands and the soles of your feet red and sore, and your skin may start to peel or blister. Your skin might also look shiny, feel tight and crack around the fingertips. Your doctor or nurse may give you a vitamin or creams to help. This normally gets better when your chemotherapy finishes.

Joint and bone pain. Oxaliplatin can cause problems with your joints, such as swelling or pain. Your doctor or nurse can give you painkillers to help. Read about taking painkillers when having chemotherapy.

Skin changes. FOLFIRINOX can make your skin darken or become more sensitive to the sun. Use a high factor sun cream if you are going outside. These changes normally get better when your treatment finishes.

Eye problems. FOLFIRINOX can cause sore, itchy or watery eyes. Tell your doctor or nurse if this happens, as they may need to give you some eye drops. Some people get blurred vision, but this is less common.

Less common side effects

  • Heart problems. Fluorouracil can cause chest pain. It can also make you feel short of breath, dizzy, or cause an irregular heartbeat. It is important to call your chemotherapy team straight away if you have any of these symptoms, or go to A&E and tell them that you are having chemotherapy.
  • Risk of a blood clot in a vein. Chemotherapy can increase the risk of a blood clot in a vein. If you have any pain or swelling in one of your arms or legs, or you feel very short of breath, call your chemotherapy team straight away. Or phone an ambulance and tell them you are having chemotherapy. A blood clot is serious if it isn’t treated.

Speak to your chemotherapy team if you experience anything unusual, or would like more information. You can also speak to our specialist nurses on our Support Line.

Read about how chemotherapy is given.

Read about managing the side effects of chemotherapy.

Read about coping with chemotherapy.

Updated August 2019

Review date August 2021