Treatment Name: FOLFOX + Panitumumab (Vectibix®)
FOLFOX + Panitumumab (Vectibix®) is a Chemotherapy Regimen for Colon Cancer
How does FOLFOX + panitumumab work?
Each of the medications in FOLFOX 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 cancer cells to grow.
FOL – folinic acid (leucovorin)
F - fluorouracil
OX – Oxaliplatin
Goals of therapy:
FOLFOX + panitumumab is a combination regimen of chemotherapy and immunotherapy. It is given to shrink tumors and help alleviate symptoms of colon cancer, and is not commonly given with the goal of cure.
- Folinic acid (Leucovorin) intravenous infusion (I.V.), given over two hours before fluorouracil on Day 1
- Oxaliplatin I.V. given over two hours on Day 1. This is commonly given at the same time as folinic acid (Leucovorin)
- Fluorouracil I.V. push, usually given over 3 to 5 minutes on Day 1
- Fluorouracil continuous I.V. infusion (via home-infusion pump) over 46 hours beginning Day 1
- Panitumumab I.V. infusion over 60 minutes on Day 1
- If the first infusion is well tolerated, subsequent infusions may be given over 30 minutes
- Large doses may need to be given over 90 minutes
Estimated total infusion time for this treatment:
- Up to 4 hours for Day 1 of each cycle is spent at the infusion center
- 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
FOLFOX + panitumumab is usually given in an outpatient infusion center, allowing the person to go home afterwards where they will continue to receive their continuous infusion of fluorouracil via ambulatory pump (at home). It may be given in the hospital if someone is too sick or if an ambulatory pump is not available or want to be used.
FOLFOX + panitumumab is repeated every 14 days. Each 14-day period is known as one Cycle. Each cycle may be repeated until the treatment 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 FOLFOX + 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 (Grade 3 & 4) FOLFOX + panitumumab side effects are shown here:
- Low white blood cells [neutropenia] (42%)
- Skin rash, redness, or blistering (36%)
- Diarrhea (18%)
- Nerve pain (16%)
- Low blood potassium (10%)
- Fatigue (9%)
- Mouth sores (9%)
- Low blood magnesium (6%)
- Changes to fingernails (3%)
- Blood clots in the lungs (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 FOLFOX + panitumumab as planned, or delay or switch therapy.
- 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. line is connected at the end of the chemotherapy session by a nurse. When the 5-FU infusion is finished, 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
- Oxaliplatin can make you very sensitive to cold things such as cold drinks or cold weather for a few days after receiving treatment. It is best to wear warm clothes in cold weather and to not drink cold liquids, especially those with ice, or hold cold objects in your hands for up to 2 days after each oxaliplatin infusion
- Fluorouracil may cause painful redness, blistering, and peeling skin reaction on the palms of your hands and on the soles of your feet. This is known as Hand-Foot Syndrome. Ways to help reduce the risk of experiencing Hand-Foot Syndrome include using a non-alcoholic moisturizer daily on your hands and feet, avoid wearing gloves, avoid prolonged exposure to hot water, and avoid activities that put pressure or friction on your hands and feet such as golf or tennis while receiving fluorouracil
- 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
- 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 FOLFOX + 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 FOLFOX + 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 FOLFOX + 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 FOLFOX + Panitumumab (Vectibix®)