From the Research
Neoadjuvant FOLFOX should be administered for 3-4 months (6-8 cycles) before surgery in patients with locally advanced rectal cancer or resectable liver metastases from colorectal cancer. The most recent and highest quality study, 1, supports the use of FOLFOX regimens with different doses of 5-FU for the adjuvant treatment of colorectal cancer, with similar efficiency and manageable toxicity. Key points to consider when administering neoadjuvant FOLFOX include:
- Each cycle is given every 2 weeks, with each cycle consisting of oxaliplatin 85 mg/m² IV on day 1, leucovorin 400 mg/m² IV on day 1,5-FU 400 mg/m² IV bolus on day 1, followed by 5-FU 2400 mg/m² continuous IV infusion over 46 hours.
- For patients with rectal cancer, this is often combined with radiation therapy.
- Treatment duration may be adjusted based on tumor response, which is typically assessed with imaging after 2-3 months of therapy.
- Patients should be monitored for common side effects including neuropathy, neutropenia, diarrhea, and fatigue.
- Oxaliplatin may need to be dose-reduced or discontinued if significant neuropathy develops, while continuing the 5-FU/leucovorin components.
- The timing of surgery following completion of neoadjuvant therapy is generally 4-8 weeks after the last chemotherapy dose, allowing for maximal tumor response while giving time for recovery from treatment-related toxicities.