Most of us love cocktails. . .Manhattan, gin and tonic etc. We know, depending on what we use and how they are mixed, they may taste different.
Well, for the treatment of colon cancer patients we have different cocktails to choose from such as FOLFOX and FOLFIRI. Both are combinations of 5-FU and leucovorin and either irinotecan or oxaliplatin. Both regimens have similar efficacy and similar extent of side effects, with oxaliplatin having more neurotoxicity and irinotecan more diarrhea.
However, depending how you mix and deliver the three drugs you may have significant differences in toxicity. It is amazing what differences exist among oncologists in how they mix up their chemotherapeutic cocktails. Not only the doses but also the timing of administration can differ dramatically, which can result in differences in toxicities for patients.
I have seen many patients with severe diarrhea and nausea and low blood counts using FOLFOX being labeled allergic to 5-FU. Taking the 5-FU bolus infusion away (when they inject 5-FU quickly into your bloodstream), can reduce the side effects dramatically without jeopardizing the efficacy. Similarly adjusting the dose of leucovorin to 20mg/m2 and not 200mg/m2 makes no difference in efficacy but can reduce diarrhea.
When you give 5-FU as a bolus (quick infusion) we know you can develop nausea, vomiting, diarrhea and low white blood cells. When you give 5-FU over time with a slow infusion over 46 hours you don’t see the same amount of these side effects. More likely, you will see dry skin and mouth sores. It is very well established why this is the case based on how 5-FU interferes with the normal cells DNA and RNA.
If you develop significant side effects please discuss modifying the schedule and dose of 5-FU and leucovorin with your oncologist.
Last week, I saw a woman who was receiving bolus 5-FU and leucovorin weekly with a weekly infusion of irinotecan for colon cancer, which is an outdated regimen and should not be given. We have learned a lot over the years to optimize administering drugs.
February 13, 2009 at 2:45 pm, Lance Doty said:
I received bolus treatment of 5FU and Leucovorin here in Canada. I believe this treatment is when an injection of these drugs is given through an intravenous line. The benefit for me was that it allowed me to have my treatment and then go into work. I received the injections for 5 days in a row and then was off for 3 weeks. Then repeated for 6 months. They had to adjust the amount given to me after the first week due to bad side effects. Once this was done it was not too bad, but did suffer from fatique and diarrhea as treatment went on. I was stage 3, 2 nodes involved. I had Hodgkins years ago and was treated with chemo and radiation, plus developed neuropathy in the feet so the oncologist did not want to give me oxypilatin. Do you think in this case that I should have received an infusion over 48 hours instead of the injections and are the injections as effective? Thank you for these postings by the way. They are very informative.
February 13, 2009 at 3:19 pm, Heinz-Josef Lenz said:
you are very welcome, we prefer contin infusion such as 46 hours infusion compare to bolus weekly, they show less toxicity and higher efficacy (a little), you may want to discuss xeloda as a replacement for bolus 5-FU xeloda is a pill which would only require to follow up every 3-6 weeks. HJL
March 03, 2009 at 1:48 pm, karen gee said:
Hi, I have Stage IIIB colon cancer, 1 positive lymphnode. I have had 2 cycles of folfox and developed a rash on my arms and legs during the second day of the second cycle. It went away after 2 days. Is this a side-effect of 5FU or an allergic reaction? Thank you for your time.
March 03, 2009 at 1:57 pm, Heinz-Josef Lenz said:
Karen difficult to make any significant associations without seeing it, but in general 5-FU or oxaliplatin does not cause rash, it could be also from one of the premeds you are getting would close check if this happens again and try different premeds discuss with your oncologists
March 03, 2009 at 2:01 pm, karen gee said:
Thank you for your prompt response. I appreciate it.
March 17, 2009 at 5:14 pm, kerri fales said:
HI, my dad just started chemo a day ago- supposed to be folfox, but no leucovorin because of the shortage-unbelievable. Does this make the 5fu less effective, would it be better to take xeloda since he can’t get the leucovorin? Do you have any idea when leucovorin will be available???
March 17, 2009 at 5:41 pm, Heinz-Josef Lenz said:
very good question if the 5-FU is given in 46 hours infusion probably not a problem but if short term infusion LV is important. in other words the longer we give 5-FU as infusion the less important LV is. but the shortage should have been addressed since we have plenty right now HJL
May 31, 2009 at 5:06 pm, Linda Stout said:
My oncologist is suggesting I return to 5FU, leucovorin,and avastin. Oxaliplatin is optional. He states that there is little difference in effectiveness between studies including oxaliplaten. Because I do have some side effects with neuropathy he suggests one dose of oxaliplaten to see if neuropathy pain returns. Can you please state the difference in treatment effectiveness with or without oxaliplaten?
Thank you