For the Patient: GIFOLFOX

Other Names: Palliative combination chemotherapy for

metastatic cancer of the colon or rectum using Oxaliplatin, 5-
Fluorouracil and Folinic Acid (Leucovorin)

GI = GastroIntestinal
FOLFOX = FOLinic Acid, Fluorouracil, OXaliplatin

ABOUT THIS MEDICATION

What are these drugs used for?

• Fluorouracil (5FU), folinic acid (leucovorin) and oxaliplatin are drugs given to treat cancer of
the colon or rectum.

How do these drugs work?

• Fluorouracil and oxaliplatin work by interfering with dividing cells and preventing an increase
in the number of cancer cells.
• Leucovorin works by enhancing the effect of fluorouracil and strengthening fluorouracil’s
ability to reduce the number of cancer cells.

INTENDED BENEFITS
• This therapy is being given to destroy and/or limit the growth of cancer cells in your body.
This treatment may improve your current symptoms, and delay the onset of new symptoms.
• It may take several treatments before your doctor can judge whether or not this treatment is
helping.

TREATMENT SUMMARY
How are these drugs given?
• Fluorouracil, leucovorin and oxaliplatin are given directly into the vein (IV).
• The oxaliplatin and leucovorin will be given first. These drugs are mixed separately into two
IV bags, which are then given to you at the same time. You will then receive a dose of
fluorouracil given directly into the vein through a syringe. You will then be given an
additional dose of fluorouracil over 46 hours, or 2 days, using a disposable infusion device
called an INFUSOR® or “baby bottle”. The infusion device delivers the fluorouracil slowly
and continuously to your body over the 46 hour time period. . Please see a copy of “Your
INFUSOR® - A Guide for Patients”, available through your chemotherapy nurse.
• The infusion device is connected to your veins by either a peripherally inserted central
catheter (PICC Line) or a PORT-A-CATH®. If using a PICC line, this is inserted in your
upper arm. If using a PORT-A-CATH®, this is inserted under the skin of the chest using
local freezing. The insertion would be done several days before your treatment starts and
would be removed once the treatment program is finished.
• The chemotherapy nurse will connect the infusion device to your IV site at the clinic and
then you can go home while your treatment is delivered over the 2 days. You may return to
the clinic after 2 days for the nurse to disconnect the infusion device, or you will be
instructed how to disconnect yourself at home. Some people may be instructed to go to
their local hospital to be disconnected, or may have a home care nurse provide this service,
if available. You will then have a two week rest period.

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• This two week period of time is called a “cycle”.
• Each treatment will take about 3 1/2 hours. This includes a dressing change if you have a
PICC line. If you have a PORT-A-CATH®, a dressing change is not needed, so your
treatment will take less time. Your first treatment will probably take longer, as the nurse will
review information on the chemotherapy drugs and infusion device with you.

The calendar below outlines your overall treatment plan.

C
Y DATE TREATMENT PLAN
C
L ▶ Week 1  oxaliplatin, leucovorin and fluorouracil IV x 1 day
E  fluorouracil infusion x 46 hours, starting on day 1
1 Week 2  no treatment

C
Y DATE TREATMENT PLAN
C
L ▶ Week 1  oxaliplatin, leucovorin and fluorouracil IV x 1 day
E  fluorouracil infusion x 46 hours, starting on day 1
2 Week 2  no treatment

Treatment may continue for as long as you are benefiting from treatment and not having
too many side effects, as determined by your oncologist.

What will happen when I get my drugs?

• A blood test is done each cycle, on or before the first day of each cycle. The dose and
timing of your chemotherapy may be changed based on your blood counts and/or other side
effects.

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SIDE EFFECTS AND WHAT TO DO ABOUT THEM

Unexpected and unlikely side effects can occur with any drug treatment. The ones listed below
are particularly important for you to be aware of as they are directly related to the common
actions of the drugs in your treatment plan.

Your doctor will review the risks of treatment and possible side effects with you before starting
treatment. The chemotherapy nurse will review possible side effects of the drugs and how to
manage those side effects with you on the day you receive your first treatment.

SERIOUS SIDE EFFECTS MANAGEMENT

DURING TREATMENT
Tell your nurse if you feel like you have • These symptoms will disappear in a few
difficulty breathing or swallowing during or hours, and may not require treatment.
immediately after your oxaliplatin infusion. • If you have these symptoms with a 2-hour
This may occur rarely. infusion, your next treatment may be given
over 6 hours.
Allergic reactions may very rarely occur. Tell your nurse if this happens while you are
Signs of an allergic reaction are dizziness, receiving the drugs or contact your doctor
feeling faint, confusion, shortness of breath, immediately if this happens after you leave the
and wheezing. This may occur immediately or clinic.
several hours after receiving the drugs. It can
occur after the first dose, or after many doses.
Oxaliplatin and fluorouracil will burn if it leaks Tell your nurse or doctor immediately if you
under the skin. feel burning, stinging, or any other change
while the drug is being given.
Nausea and vomiting may occur after your You may be given a prescription for an
treatment and may last for 24- 48 hours. antinausea drug(s) to take before your
Some people have little or no nausea. chemotherapy treatment and/or at home. It is
easier to prevent nausea than treat it once it
has occurred, so follow directions closely.
• Drink plenty of liquids.
• Eat and drink often in small amounts.
• Try the ideas in Practical Tips to Manage
Nausea*
You may feel tingling or a loss of feeling in • Avoid cold air if possible.
your hands, feet, nose, or throat. They may • Protect yourself from the cold, which can
be made worse by exposure to cold. This is cause or worsen these symptoms. Wear
very common after oxaliplatin treatment. gloves, socks, and something that covers
These problems often disappear after a few your mouth and nose when outside in cold
hours or days. weather.
• Do not drink cold beverages or eat cold
food for a few days after treatment.
• If symptoms continue for more than a
week, or interfere with how your hands
work, talk to your doctor.
• Try the ideas in Coping With/Preventing
Oxaliplatin Cold Dysesthesias*.

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 SERIOUS SIDE EFFECTS MANAGEMENT
DURING TREATMENT
Diarrhea may occur during your treatment. To help diarrhea:
This is very common. • Drink plenty of fluids
• Eat and drink often in small amounts
• Eat low fibre foods & avoid high fibre foods
as outlined in Food Choices to Help
Manage Diarrhea*
If you have an increase of less than 4 stools
per day more than normal, or a mild increase
in ostomy output, start the following:
• Loperamide (IMODIUM®) 2 mg, take 2
tablets (4 mg) to start, followed by 1 tablet
(2 mg) every 4 hours, or after each
unformed stool to a maximum of 8 tablets
(16 mg) daily, unless otherwise directed by
a physician
Sore mouth may occur during treatment. This • Brush your teeth gently after eating and at
is common. Mouth sores can occur on the bedtime with a very soft toothbrush. If your
tongue, the sides of the mouth or in the throat. gums bleed, use gauze instead of a brush.
Mouth sores or bleeding gums can lead to Use baking soda instead of toothpaste.
an infection. • Make a mouthwash with ½ teaspoon baking
soda or salt in 1 cup warm water and rinse
several times a day.
• Try soft, bland foods like puddings,
milkshakes and cream soups.
• Avoid spicy, crunchy or acidic food, and
very hot or cold foods.
• Try ideas in Food Ideas to Try with a Sore
Mouth*
Your white blood cells will decrease 7 – 10 To help prevent infection:
days after your treatment. They usually return • Wash your hands often and always after
to normal 2 weeks after your last treatment. using the bathroom.
White blood cells protect your body by fighting • Take care of your skin and mouth.
bacteria (germs) that cause infection. When • Call your doctor immediately at the first
they are low, you are at greater risk of sign of an infection such as fever (over
having an infection. 100ºF or 38ºC by an oral thermometer),
chills, cough, or burning when you pass
urine.

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 OTHER SIDE EFFECTS DURING MANAGEMENT
TREATMENT
Pain or tenderness may occur where the • Apply warm compresses or soak in warm
needle was placed. water for 15-20 mins. several times a day.
Fever may occur shortly after treatment with • Take acetaminophen (e.g. TYLENOL®)
oxaliplatin. Fever should last no more than 24 every 3 – 4 hours.
hours. • Fever which occurs more than 48 hours
after treatment may be the sign of an
infection. See “white blood cells” above.
Your platelets may decrease during or after To help prevent bleeding problems:
your treatment. They will return to normal • Try not to bruise, cut, or burn yourself.
after your last treatment. This is common. • Clean your nose by blowing gently. Do not
Platelets help to make your blood clot when pick your nose.
you hurt yourself. You may bruise or bleed • Avoid constipation.
more easily than usual. • Brush your teeth gently with a soft
toothbrush as your gums may bleed more
easily. Maintain good oral hygiene.
Some medications such as ASA (e.g.
ASPIRIN®) or ibuprofen (e.g. ADVIL®) may
increase your risk of bleeding.
• Do not stop taking any medication that has
been prescribed by your doctor (e.g. ASA
for your heart).
• For minor pain, try acetaminophen (e.g.
TYLENOL®) first, but occasional use of
ibuprofen may be acceptable.
Skin rashes are uncommon but may occur. To help itching:
• You can use calamine lotion.
• If very irritating, call your doctor during
office hours.
• Otherwise mention it at your next visit.
Your skin may sunburn easily. To help prevent sunburn:
• Avoid direct sunlight.
• Wear a hat, long sleeves and long pants or
skirt outside on sunny days.
• Apply a sun block lotion with an SPF (sun
protection factor) of at least 30.
• Refer to Your Medication Sun Sensitivity
and Sunscreens* or the BC Health Guide
for more information.
• After sun exposure, if you have a severe
sunburn or skin reaction such as itching,
rash, or swelling, contact your doctor.
Loss of appetite is uncommon but may occur Try the ideas in Food Ideas to Help with
and may persist long after discontinuation of Decreased Appetite.*
fluorouracil.

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 OTHER SIDE EFFECTS DURING MANAGEMENT
TREATMENT
Tiredness and lack of energy may occur. • Do not drive a car or operate machinery if
you are feeling tired.
• Try the ideas in the handout titled
Fatigue/Tiredness*
Hair loss is uncommon with fluorouracil and • Use a gentle shampoo and soft brush.
rare with oxaliplatin. If you experience hair • Care should be taken with use of hair
loss, your hair will grow back once you stop spray, bleaches, dyes and perms.
treatment. Colour and texture may change.
Abnormal heart rhythm (QT prolongation) Minimize your risk of abnormal heart rhythm
rarely occurs. by:
• Always checking with your pharmacist and
doctor about drug interactions when starting
a new medication, herbal product, or
supplement.
• Tell your doctor immediately or get
emergency help if your heart is beating
irregularly or fast, or if you feel faint,
lightheaded, or dizzy.
*Please ask your chemotherapy nurse, pharmacist, or dietitian for a copy.

Special note:

Heart Problems: Serious heart problems can occur when starting fluorouracil. These can
rarely be fatal. Problems such as chest pain, heart attack, abnormal heart rhythm, or heart
failure can occur. Having a history of heart problems with capecitabine, a related chemotherapy
drug, is a risk factor, as is having a history of prior angina (heart pain) or heart attack. Seek
medical attention promptly if you experience feelings of heavy pressure or pain in the chest,
trouble breathing, significant worsening leg swelling, or marked lightheadedness. These
symptoms can occur within days after starting fluorouracil. If your symptoms are severe, you
may need to call for emergency help.

INSTRUCTIONS FOR THE PATIENT

• Tell your doctor if you have ever had an unusual or allergic reaction to the following drugs
before starting this treatment:
1. oxaliplatin, cisplatin (PLATINOL®) or carboplatin (PARAPLATIN®).
2. fluorouracil or capecitabine (XELODA®).
3. leucovorin.
• The drinking of alcohol (in small amounts) does not appear to affect the safety or
usefulness of fluorouracil, oxaliplatin or leucovorin.
• Fluorouracil may cause sterility in men and menopause in women. If you plan to have
children, discuss this with your doctor before being treated with fluorouracil.
• Fluorouracil and oxaliplatin may damage sperm and may harm the baby if used during
pregnancy. It is best to use birth control while being treated with fluorouracil. Tell your

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 doctor right away if you or your partner becomes pregnant. Do not breast feed during
treatment.
• Tell doctors, dentists and other health professionals that you are being treated with
oxaliplatin, fluorouracil and leucovorin before you receive any treatment from them.

Medication Interactions:
• Other drugs may interact with leucovorin and oxaliplatin. Other drugs such as warfarin
(COUMADIN®), phenytoin (DILANTIN®) and fosphenytoin (CEREBYX®) may interact with
fluorouracil. Tell your doctor if you are taking this or any other drugs as you may need extra
blood test or your dose may need to be changed. Check with your doctor or pharmacist
before you start taking any new drugs

THE FOLLOWING INFORMATION IS VERY IMPORTANT

SEE YOUR DOCTOR OR GET EMERGENCY HELP IMMEDIATELY IF YOU HAVE:

• Signs of an allergic reaction (rare) soon after a treatment including dizziness, fast heart
beat, face swelling or breathing problems.
• Signs of an infection such as fever (over 100ºF or 38ºC by an oral thermometer); chills,
cough, pain or burning when you pass urine.
• Signs of bleeding problems such as black, tarry stools, blood in urine, pinpoint red spots
on skin, extensive bruising.
• Signs of heart or lung problems such as fast or uneven heartbeat, chest pain, chest
pressure, shortness of breath, or difficulty in breathing, swelling of ankles, or fainting.
• Sudden abdominal pain or tenderness.
• Seizures or loss of consciousness with or without confusion, headache, or
changes in eyesight.
• Uncontrolled nausea, vomiting, or diarrhea.

SEE YOUR DOCTOR AS SOON AS POSSIBLE (DURING OFFICE HOURS) IF YOU

HAVE:
• Painful hand-foot skin reaction such as painful redness, peeling, tingling, numbness,
swelling or blistering of the palms of your hands and/or the bottoms of your feet.
• Signs of anemia such as unusual tiredness or weakness.
• Signs of liver problems such as yellow eyes or skin, white or clay-coloured stools.
• Severe skin irritation.

CHECK WITH YOUR DOCTOR IF ANY OF THE FOLLOWING CONTINUE OR

BOTHER YOU:
• Painless hand-foot skin reaction such as redness, peeling, tingling, numbness, swelling, or
blistering of the palms of your hands and/or bottoms of your feet.
• Easy bruising or minor bleeding.
• Tingling or a loss of feeling in your hands, feet, nose or throat
• Redness, swelling, pain, or sores where the needle was placed.
• Redness, swelling, pain, or sores on your lips, tongue, mouth, or throat.
• Heartburn; mild to moderate abdominal or stomach pain.
• Dizziness or trouble walking.

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• Eye irritation or changes in eyesight.
• Skin rash or itching.

If you experience symptoms or changes in your body that have not been
described above but worry you, or if any symptoms are severe, contact:

________________________________at telephone number:___________________

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