FOLFOX regimen

Hepatic and renal function. Patients with advanced cancer may have impaired liver function due to the presence of liver metastases. In this case drug doses may need to be adjusted. In the case of the FOLFOX regimen, 5-fluorouracil dose may need to be reduced if the impairment is moderate or severe. Mrs KT s baseline liver function tests indicate a normal liver function, but these parameters should be monitored carefully throughout treatment. Reduced renal function may also necessitate a decrease in drug dosage. In the case of the FOLFOX regimen, oxaliplatin is contraindicated in patients with severe renal impairment (creatinine clearance <30 mL/min). 

Mrs KT s consultant oncologist decides to commence her on the FOLFOX chemotherapy regimen as follows ... 

This can be controlled with the co-administration of standard antidiarrhoeal agents such as loperamide. All patients on FOLFOX chemotherapy (or any 5-fluorouracil-containing regimen) should be co-prescribed an antidiarrhoeal medication to use on an as required basis. The onset of diarrhoea should also indicate to the patient that they must increase their fluid intake to prevent dehydration. Patients must be warned that if the diarrhoea is not controlled (for example, within 48 hours of onset) then dehydration is a danger and they should be advised to contact their treating hospital or GP for advice. Severe manifestations may have to be managed by delay and/or dose modification of the patient s next cycle of chemotherapy. 

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