Treatment Name: FOLFIRI (Folinic acid + Fluorouracil + Irinotecan)
FOLFIRI (Folinic acid + Fluorouracil + Irinotecan) is a Chemotherapy Regimen for Colon Cancer
How does FOLFIRI work?
Each of the chemotherapy drugs in this combination therapy are designed to kill cancer cells.
FOL – folinic acid (leucovorin)
F - fluorouracil
Goals of therapy:
FOLFIRI is given to shrink tumors and decrease symptoms of metastatic colon cancer and is not commonly given with the goal of cure.
- Folinic acid (Leucovorin) intravenous infusion (I.V.) over two hours before fluorouracil on Day 1
- Fluorouracil (5-FU) I.V. push given over 3 to 5 minutes on Day 1
- Irinotecan I.V. infusion given over 90 minutes on Day 1
- Fluorouracil (5-FU) continuous I.V. infusion via home-infusion pump over 46 hours beginning Day 1 and ending on Day 3
Estimated total infusion time for this treatment:
- Up to 5 hours are spent at the infusion center for each cycle
- Infusion times are based on clinical studies, but may vary depending on doctor preference or patient tolerability. Pre-medications and intravenous (I.V.) fluids, such as hydration, may add more time
FOLFIRI is usually given in an outpatient infusion center, allowing the person to go home with an infusion pump, and then return to the infusion center in two days to get the pump disconnected. On occasion, FOLFIRI may be given in the hospital if someone is too sick for outpatient treatment.
FOLFIRI is repeated every 14 days. This is known as one Cycle. Each cycle may be repeated until the regimen no longer works or until unacceptable side effects occur. Duration of therapy depends upon response, tolerability, and number of cycles prescribed.
Click here for the FOLFIRI common starting doses.
In a multi-drug regimen, each medication has unique side effects. When these medicines are given together, drug-related side effects reported in FOLFIRI clinical studies give the best estimate of what to expect. Side effects sometimes have percentage ranges [example: 70 – 71%] because they differed between clinical studies:
- Nausea/vomiting (70-71%)
- Diarrhea (57-63%)
- Neutropenia [low white blood cells] (45-51%)
- Mucositis [sores in the mouth and throat] (35-51%)
- Hair loss (42-45%)
- Anemia [low red blood cells] (24-39%)
- Blister, redness, and peeling on palms of hands and soles of feet (36%)
- Thrombocytopenia [low blood platelets] (16-33%)
- Weakness (16%)
- Fever (16%)
*Due to the current use of newer anti-nausea medications, the nausea/vomiting percentages with this regimen may be much lower now.
How often is monitoring needed?
Labs (blood tests) may be checked before each treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order. CEA (carcinoembryonic antigen), a colon cancer tumor marker, may be checked periodically.
How often is imaging needed? Imaging may be checked before treatment and periodically during treatment. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment? Depending upon the results, your doctor may advise to continue FOLFIRI as planned, reduce the dose of future treatments, delay the next dose until the side effect goes away, or switch to an alternative therapy.
- Colorectal cancer patients will have an infusion pump strapped to their body for 2 days to allow fluorouracil (5-FU) to continuously infuse into a vein. The I.V. pump is connected at the end of the chemotherapy session by a nurse. When the infusion is finished (two days later) the patient will have to go back to the infusion center or hospital to have it disconnected, unless a home health nurse comes to the patient’s home to do this
- Diarrhea caused by irinotecan may be treated with atropine injections in the medical setting, both before and/or after the infusion. Diarrhea at home can affect quality of life and is commonly treated with loperamide (Imodium) purchased over-the-counter at a pharmacy. You may receive special instructions on how to use loperamide for diarrhea caused by irinotecan. Tell your doctor immediately of you have severe diarrhea at home or go to an emergency department immediately
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for colon cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for FOLFIRI (Folinic acid + Fluorouracil + Irinotecan), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for FOLFIRI (Folinic acid + Fluorouracil + Irinotecan). Depending upon your income, they may be able to help cover the cost of:
- Folinic acid
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as FOLFIRI (Folinic acid + Fluorouracil + Irinotecan) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with FOLFIRI (Folinic acid + Fluorouracil + Irinotecan)