Treatment Name: FOLFIRI + Panitumumab (Vectibix®)
FOLFIRI + Panitumumab (Vectibix®) is a Chemotherapy Regimen for Colon Cancer
How does FOLFIRI + panitumumab work?
Each of the chemotherapy drugs in FOLFIRI are designed to kill cancer cells. Panitumumab (an immunotherapy drug) is designed to bind to Epidermal Growth Factor Receptor (EGFR) on the surface of cancer cells, which shuts down one of the signals that tell the colon cancer cells to grow.
FOL – folinic acid (leucovorin)
F - fluorouracil
Goals of therapy:
FOLFIRI + panitumumab is given to shrink tumors and decrease symptoms of 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
- Panitumumab I.V. infusion over 60 minutes on Day 1. If the first infusion is well tolerated, subsequent infusions may be given over 30 to 60 minutes. Large doses may need to be given over 90 minutes
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 + panitumumab 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 + panitumumab may be given in the hospital if someone is too sick.
FOLFIRI + panitumumab 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 common FOLFIRI + panitumumab 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 clinical studies give the best estimate of what to expect. In clinical studies, the most commonly reported serious side effects (Grade 3 to 4) of FOLFIRI + panitumumab are shown here:
- Skin rash, redness, or blistering (37%)
- Neutropenia [low white blood cells] (20%)
- Diarrhea (14%)
- Mouth sores (8%)
- Low blood potassium (7%)
- Blood clot in the lungs (5%)
- Dehydration (3%)
- Low blood magnesium (3%)
- Changes to fingernails (3%)
- Neutropenic fever (2%)
- Infusion reaction (<1%)
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), blood magnesium, plus any others your doctor may order. CEA (carcinoembryonic antigen), a 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 + panitumumab 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 is treated with atropine injections in the medical setting, both before and 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
- Panitumumab may cause low blood magnesium and potassium. You may need to receive IV infusions of potassium or magnesium which may increase your time spent at the infusion center
- Panitumumab may make your skin more sensitive to sunlight. When out in the sun during treatment and for up to 2 months after the last dose, be sure to use sunscreen and wear clothing and hats that will limit your exposure to sun as best as possible
- Panitumumab may cause changes to fingernails and toenails such as redness, swelling, oozing, bleeding, cracking, discoloration, or ridges in the nails. This is known as “paronychia”. This can first develop weeks or months after starting therapy with panitumumab and can last for months after therapy is stopped. To help prevent paronychia from developing, avoid wearing tight fitting shoes or gloves and avoid putting unnecessary pressure or friction on fingernails and toenails. If you experience symptoms of paronychia, talk with your doctor as prescription corticosteroid creams or antibiotics may be needed
- 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 + Panitumumab (Vectibix®), 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 + Panitumumab (Vectibix®). 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 + Panitumumab (Vectibix®) 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 + Panitumumab (Vectibix®)