mFOLFOX: A Standard Chemotherapy Regimen for Colorectal Cancer
Yes, mFOLFOX is definitively a chemotherapy regimen consisting of oxaliplatin, leucovorin (folinic acid), and fluorouracil (5-FU) used primarily in the treatment of colorectal cancer. 1
Components and Administration of mFOLFOX6
mFOLFOX6 is administered as follows:
- Oxaliplatin: 85 mg/m² intravenous infusion over 2 hours on day 1
- Leucovorin: 400 mg/m² intravenous infusion for 2 hours on day 1
- 5-FU: 400 mg/m² intravenous bolus on day 1, followed by 1,200 mg/m²/day continuous intravenous infusion over 2 days (total dose 2,400 mg/m², infusion for 46-48 hours)
- Treatment cycle repeats every 2 weeks for typically 12 cycles 1
Clinical Applications of mFOLFOX
mFOLFOX is used in several clinical scenarios:
- Adjuvant therapy: For stage III and high-risk stage II colon cancer after surgical resection 1
- First-line treatment: For metastatic colorectal cancer 1
- Second-line treatment: For patients who have failed irinotecan-based regimens 2
- Conversion therapy: For potentially resectable metastatic disease 1
Efficacy and Outcomes
- In metastatic colorectal cancer, FOLFOX regimens achieve response rates of approximately 50% as first-line therapy 3
- Median survival times of approximately 17.4 months have been reported in first-line treatment 3
- As second-line therapy after irinotecan failure, response rates of about 16% with median progression-free survival of 2 months have been observed 2
Toxicity Profile
Common adverse effects include:
Hematologic toxicities:
Non-hematologic toxicities:
Variants of FOLFOX
Several FOLFOX variants exist:
- FOLFOX4: Similar to mFOLFOX6 but with slightly different 5-FU dosing schedule
- CAPEOX/XELOX: Substitutes oral capecitabine for infusional 5-FU, with oxaliplatin 130 mg/m² every 3 weeks 1
Important Considerations
- MMR (mismatch repair) testing should be performed before initiating therapy in stage II patients, as those with dMMR or MSI-H may not benefit from fluoropyrimidine-based adjuvant chemotherapy 1
- For elderly patients (≥70 years), there is no evidence that adding oxaliplatin to 5-FU/LV improves outcomes 1
- Duration of adjuvant therapy may be shortened to 3 months for low-risk stage III patients (T1-3N1) using CAPEOX based on the IDEA study 1
- Bevacizumab, cetuximab, panitumumab, or irinotecan should not be used in the adjuvant setting outside clinical trials 1
Special Precautions
- Avoid cold temperatures and cold objects during treatment due to oxaliplatin-induced acute neuropathy 4
- Monitor electrolytes regularly, particularly potassium, calcium, and magnesium 5
- Assess for signs of peripheral neuropathy at each visit, as this is a cumulative toxicity that may require dose modification 4
- Consider diabetes management modifications for patients on concurrent antidiabetic therapy 6
mFOLFOX remains one of the cornerstone chemotherapy regimens in colorectal cancer treatment, with established efficacy in both the adjuvant and metastatic settings.