FOLFOX Chemotherapy Regimen Components
FOLFOX is a combination chemotherapy regimen consisting of three drugs: leucovorin (folinic acid), fluorouracil (5-FU), and oxaliplatin.
Specific Drug Formulations
There are two main FOLFOX variants used in clinical practice, with slightly different dosing schedules 1, 2:
FOLFOX4
- Leucovorin (LV): 200 mg/m² IV infusion over 2 hours
- Fluorouracil (5-FU): 400 mg/m² IV bolus followed by 600 mg/m² as a 22-hour continuous infusion, given on 2 consecutive days
- Oxaliplatin: 85 mg/m² IV infusion over 2 hours on day 1, administered simultaneously with leucovorin via Y-connector
mFOLFOX6 (Modified FOLFOX6)
- Oxaliplatin: 85 mg/m² IV infusion over 2 hours
- Leucovorin: 400 mg/m² IV infusion over 2 hours (administered simultaneously with oxaliplatin via Y-connector)
- Fluorouracil: 400 mg/m² IV bolus followed by 2,400 mg/m² as a 46-hour continuous infusion
Both regimens are administered in cycles, typically every 2 weeks 1, 2.
Clinical Context
FOLFOX is primarily used for colorectal cancer treatment, both in the adjuvant setting for stage III colon cancer and as first-line therapy for metastatic disease 1, 2. The regimen can be combined with targeted biologic agents such as bevacizumab, cetuximab, or panitumumab depending on tumor characteristics 2.
Key Management Considerations
Oxaliplatin should be discontinued after 3 months of therapy (or sooner if unacceptable neurotoxicity develops) while maintaining the other drugs for the full 6-month treatment course 2. This "stop-and-go" approach significantly reduces peripheral sensory neuropathy without compromising overall survival.
The regimen requires close monitoring for electrolyte abnormalities, particularly hypokalaemia, hypocalcaemia, and hypomagnesaemia, which can occur due to oxaliplatin's effects and the use of 5% dextrose for infusion 3.