FOLFIRI is a combination chemotherapy regimen used to treat various cancers. It is a standard approach for managing certain malignancies, aiming to slow disease progression and improve patient outcomes.
What is FOLFIRI?
The FOLFIRI regimen combines three distinct medications: folinic acid (leucovorin), fluorouracil (5-FU), and irinotecan (Camptosar). Folinic acid, a vitamin B derivative, enhances the effectiveness of fluorouracil by stabilizing its binding to a target enzyme, thymidylate synthase. Fluorouracil is an antimetabolite that interferes with the synthesis of DNA and RNA, inhibiting the growth of cancer cells. Irinotecan, a topoisomerase I inhibitor, prevents DNA from uncoiling and duplicating, leading to cancer cell death.
The FOLFIRI regimen is administered intravenously in cycles, repeated every 14 days. On the first day of a cycle, irinotecan and folinic acid are given as infusions, concurrently. This is followed by a bolus injection of fluorouracil, then a continuous infusion of fluorouracil over 46 hours, delivered via a portable pump that allows patients to return home. Dosages and schedules may be adjusted based on the individual’s condition, weight, and response to treatment.
Primary Cancers Treated by FOLFIRI
FOLFIRI is a chemotherapy regimen primarily used for metastatic colorectal cancer. It is a standard option for patients with stage IV colorectal cancer, which has spread beyond its initial location. This regimen can be used as an initial treatment or as a second-line therapy for those who have experienced disease progression after other chemotherapy regimens, such as oxaliplatin-based treatments like FOLFOX.
Beyond its primary use in colorectal cancer, FOLFIRI is also used for other gastrointestinal cancers. This includes advanced or metastatic gastric cancer, gastroesophageal cancer, pancreatic cancer, cholangiocarcinoma, gallbladder cancer, and ampullary cancers. In these instances, FOLFIRI is considered when other treatment approaches have not been successful.
Factors Affecting Life Expectancy with FOLFIRI
Life expectancy for individuals undergoing FOLFIRI treatment is influenced by factors related to the cancer itself and the patient’s overall health. The stage and extent of cancer progression significantly impact prognosis; for example, metastatic disease, where cancer has spread widely, presents a more complex challenge than localized cancer. How well the tumor responds to FOLFIRI, whether through shrinkage or stabilization, also influences outcomes.
An individual’s general health and performance status, including age and other medical conditions, affect their ability to tolerate treatment and can influence life expectancy. Genetic markers and biomarkers, such as RAS status in colorectal cancer, can predict how a tumor might respond to FOLFIRI or to targeted therapies, influencing prognosis. Whether FOLFIRI is administered as a first-line, second-line, or subsequent treatment also alters the expected course of the disease. Supportive care in managing treatment-related effects contributes to maintaining quality of life and can extend the period an individual remains on active treatment.
Navigating the FOLFIRI Treatment Experience
Undergoing FOLFIRI treatment involves a structured cycle, lasting 14 days, with therapy continuing for up to 12 cycles over about six months. Patients receive the intravenous infusions at an outpatient center, returning home with a portable pump for the continuous fluorouracil infusion. This approach allows for treatment flexibility while ensuring consistent medication delivery.
Patients experience physical effects during FOLFIRI therapy. Fatigue is a reported sensation, peaking several days after treatment and worsening with successive cycles. Nausea and vomiting are common, though they can be managed with anti-nausea medications prescribed by the healthcare team. Diarrhea, sometimes severe, is another effect, and patients are provided with medication like loperamide to manage it.
Other common effects include a temporary decrease in white blood cell counts, which can increase the risk of infection, as well as mouth sores, hair thinning or loss, and changes in taste. Supportive care and close communication with the healthcare team are important for managing these effects effectively. A multidisciplinary approach, involving oncologists, nurses, and other specialists, helps ensure patient well-being during chemotherapy.