This information is about a chemotherapy treatment called oxaliplatin and 5FU (fluorouracil) that is used to treat bowel cancer. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer information nurse specialists.

The treatment involves the two chemotherapy drugs oxaliplatin and 5FU, which is also known as fluorouracil. The chemotherapy is given with a vitamin called folinic acid (leucovorin), which makes 5FU more effective.

This combination of chemotherapy is sometimes referred to as the FOLFOX regimen, named after the drugs used. There are several different FOLFOX schedules that vary in the way the 5FU is given. The different schedules are given a number, such as FOLFOX4 or FOLFOX6. Some doctors may refer to the combination of these drugs as oxaliplatin modified de Gramont (OxMdG).

Oxaliplatin and 5FU treatment can be given to you during a short stay in hospital or, more usually, as a day patient. Before starting treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

Most people are given their chemotherapy drugs through a fine plastic tube inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you. Otherwise the nurse will put a thin flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful but it should not take long.

You will be given anti-sickness (anti-emetic) drugs, usually by injection through the cannula or your central or PICC line, or they may be taken as tablets.

After the anti-sickness drugs you will be given a drip (infusion) of folinic acid (a colourless fluid) and an infusion of oxaliplatin (a colourless fluid). These are given at the same time and take about two hours.

After this you will be given 5FU. How you are given the 5FU will vary depending upon the schedule you are being given.

• FOLFOX4 You will be given an injection of 5FU (a colourless fluid) into your cannula or line, followed by an infusion of 5FU over 22 hours. The next day the folinic acid infusion and the 5FU injection are repeated. This is followed by another 22-hour infusion of 5FU.
• FOLFOX6 You will have an injection of 5FU (a colourless fluid) into your cannula or line followed by an infusion of 5FU over 46 hours.

As the 5FU infusions last for between 22 and 46 hours you will need to stay in hospital, unless you have a central or PICC line. If you have a line, this part of the treatment can be given to you through a small portable pump.

The pump is used to give a controlled amount of the drug into your bloodstream over a set period of time. It is small enough to be carried in a belt or holster. This means that once the pump is connected to your line and the treatment has started you can go home with it. There are different sorts of pumps available and some are electronic. Your nurse or pharmacist will explain how your pump works and how to look after it.

When the infusion is finished there may be some fluid left in the pump. This may be normal as some types of pump need to be overfilled to get the correct dose. You can check with your nurse or pharmacist whether you have this type of pump.

After your treatment you will be given a supply of anti-sickness drugs to take home with you. It is important to take these as directed, even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.

You may hear your doctor use the word 'regimen' (eg the FOLFOX regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular chemotherapy treatment that you are receiving.

FOLFOX4 If you are having treatment as an outpatient, you will need to come back to the hospital the following day (day two), for more chemotherapy and to have your pump changed. Your pump will be disconnected when your treatment is finished (day three).

FOLFOX6 If you are having treatment as an outpatient you will come back to the hospital on day three to have your pump disconnected.

A district nurse may be able to disconnect your pump at home, so that you don't have to go back to the hospital. The hospital staff may be able to organise this for you, but it's not available in all areas.

You will then have a rest period with no chemotherapy for the next 11 days. This completes what is called a cycle of your chemotherapy treatment.

You will start the next cycle of your treatment after the rest period, which will be a fortnight after your first injection. You could have as many as 12 cycles, but the number you have will depend on your individual situation. Your specialist will be able to discuss this with you further.

Each person's reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described in this section will not affect everyone who is having this chemotherapy regime.

We have outlined the most common side effects, so that you can be aware of them if they occur. However, we have not included those that are rare and therefore unlikely to affect you. If you do notice any effects which you think may be due to the drug, but which are not listed here, please let your nurse or doctor know.

Lowered resistance to infection 5FU and oxaliplatin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin a few days after treatment has been given. Your blood cells will then increase steadily and will usually have returned to normal levels before your next course of chemotherapy is due.

Contact your doctor or the hospital straight away if:

• your temperature goes above 38°C (100.4°F)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding 5FU and oxaliplatin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums. 

Anaemia (low number of red blood cells) You may become anaemic while having treatment with 5FU and oxaliplatin. This may make you feel tired and breathless. Sometimes a blood transfusion may be required. Your doctor or nurse can discuss this with you.

Numbness or tingling in hands or feet Oxaliplatin can have an effect on the nerve endings known as peripheral neuropathy. This may result in feelings of numbness or tingling, especially in the hands and feet. For some people these symptoms can be related to anything cold, such as cold air. If you notice that your symptoms are related to the cold, you should wrap up warmly in chilly weather. It is important to report your symptoms to your doctor, as the symptoms may be controlled by slightly lowering the dose of the drug.

Sometimes the tingling or numbness may not happen with the first treatment, but after several treatments. This is known as a cumulative effect and should improve after the treatment has finished.

Feeling sick (nausea) and being sick (vomiting) These effects may begin a few hours after the treatment is given and may last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor. They can prescribe other anti-sickness drugs that may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem. 

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as you need.

Hair loss Hair loss is rare with this treatment, but you may notice that your hair becomes thinner. If any of your hair does fall out it will start to grow again once the treatment has finished. Your nurse can give you advice about coping with hair loss.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection. Using a soft toothbrush may be helpful.

Taste changes You may notice that your food tastes different. Normal taste will usually come back after the treatment finishes.

Diarrhoea Diarrhoea can usually be controlled with medicine. Let your doctor know if it is severe or if it continues. Try to drink as much as 2–3 litres of fluid a day to replace the fluid you are losing.

Skin changes Your skin may become itchy and dry. Your doctor can prescribe treatment to help reduce this.

Your skin may darken, but this will slowly return to normal a few months after the treatment has finished. During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection-factor suncream and cover up with clothes and a hat.

Gritty eyes and blurred vision If this happens let your doctor know. They can prescribe soothing eye drops.

Laryngeal spasm The area around the voice box (larynx) can be temporarily affected by oxaliplatin, resulting in a sensation of difficulty swallowing and severe breathing problems. (This symptom may be made worse by cold. It is therefore advisable to avoid cold drinks or ice cubes for 24 hours). It is important to let the doctor know if you have this side effect.

Allergic reaction Signs of an allergic reaction from oxaliplatin include skin rashes and itching, a high temperature, shivering, redness of the face, dizziness, headache, breathlessness and anxiety. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse if you have any of these symptoms.

Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straight away if you have any of these symptoms. However, most clots can usually be successfully treated  by using drugs which thin the blood. Your doctor or nurse can give you more information. 

Other medicines Some other medicines (including those you can buy in a shop or chemist) can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Loss of periods in women Due to the effect of chemotherapy on the ovaries, you may find that your periods become irregular and they may eventually stop. In some women this may be temporary, but for others it will be permanent. If your periods stop, either temporarily or permanently,  this may result in menopausal symptoms such as hot flushes and sweats.

This section is based upon our oxaliplatin and 5FU chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2007.
• Superiority of Oxaliplatin and Fluorouracil - Leucovorin compared with either therapy alone in patients with progressive colorectal cancer after Irinotecan and Fluorouracil – Leucovorin: Interim results of a phase III trial. L Mace et al. Journal of Clinical Oncology, 2003, 21; pp. 2059–69.

For further references, please see general bibliography.