FOLFIRI is a specific combination of drugs used in chemotherapy to treat certain types of cancer. Its primary application is for advanced or metastatic colorectal cancer. The regimen’s name is an acronym for the drugs used in the combination. This treatment is one of the standard options available to oncologists when designing a care plan for patients with this stage of disease.
The FOLFIRI regimen is considered for patients whose cancer has progressed or is widespread. It is administered with the goal of slowing tumor growth and managing symptoms. The treatment involves a structured schedule of receiving the medications, followed by a period of rest and recovery.
The Components of FOLFIRI and Their Roles
The name FOLFIRI is an abbreviation for the three different drugs that work together in this regimen. The combination is designed so that the drugs act on the cancer in different ways, increasing the overall effectiveness compared to using a single drug alone.
The first part of the acronym, “FOL,” stands for folinic acid, which is also known as leucovorin. It is important to note that folinic acid is not a chemotherapy drug itself. Instead, it is a form of vitamin B that plays a supportive role. Its primary function is to enhance the action of the chemotherapy drug fluorouracil.
The “F” in FOLFIRI represents fluorouracil, often abbreviated as 5-FU. This drug is a type of chemotherapy known as an antimetabolite. It functions by interfering with the cancer cells’ ability to create and repair DNA. By disrupting this fundamental process, 5-FU helps to stop the proliferation of malignant cells.
Finally, “IRI” stands for irinotecan. This chemotherapy drug is classified as a topoisomerase I inhibitor. It blocks a specific enzyme that cancer cells need to untangle their DNA for replication. By preventing this enzyme from working, irinotecan causes the DNA strands to break, leading to the death of the cancer cells.
The FOLFIRI Treatment Process
Receiving FOLFIRI chemotherapy follows a structured and repeating schedule, referred to as a cycle. A standard FOLFIRI cycle lasts 14 days, or two weeks. This cycle includes the day of drug administration and the subsequent time for the body to rest and recover.
On the first day of the cycle, the patient visits a hospital or an outpatient infusion center for the drug administration. Before the chemotherapy drugs are given, patients receive pre-medications, such as anti-nausea drugs, to help prevent or reduce side effects. The treatment itself involves receiving the drugs intravenously, often through a central line, such as a PICC line or portacath, for easier vein access over multiple treatment cycles.
The infusion begins with irinotecan and folinic acid, which are given over a period of 90 minutes to two hours. Following this, the fluorouracil (5-FU) is administered in two parts. First, a quick intravenous injection, known as a bolus, is given at the clinic. Then, the patient is connected to a small, portable infusion pump that they will take home. This pump continuously delivers the remainder of the 5-FU dose over approximately 46 hours.
Common Side Effects and Management
The combination of drugs in the FOLFIRI regimen can lead to a range of side effects, which vary in intensity from person to person. Open communication with the healthcare team is important for managing these effects promptly and effectively.
Gastrointestinal issues are particularly common with FOLFIRI. Diarrhea is a frequent and potentially serious side effect, largely associated with irinotecan. It can occur in two forms: early-onset, which happens within 24 hours of treatment, and late-onset, which requires immediate management with medication like loperamide to prevent dehydration. Nausea and vomiting are also common, though they are often well-controlled with anti-sickness medications. Mouth sores, or mucositis, can also develop.
FOLFIRI also impacts blood cell production in the bone marrow. This can lead to a drop in white blood cells, a condition called neutropenia, which increases the risk of infection. A decrease in red blood cells, known as anemia, can cause fatigue and shortness of breath. Fewer platelets, which help with blood clotting, can lead to easier bruising or bleeding.
Other effects that patients may experience include hair thinning, rather than complete loss, and general fatigue. Some individuals may also notice skin changes or increased sensitivity to the sun. It is important for patients to report any new or worsening side effects to their medical team, as dose adjustments may be needed.
Monitoring Treatment and Measuring Success
Throughout the FOLFIRI regimen, doctors closely monitor the treatment’s impact on both the cancer and the patient’s overall health. Before each treatment cycle, blood tests are performed to check blood cell counts and assess how well the liver and kidneys are functioning. These tests, such as a Complete Blood Count (CBC) and a Comprehensive Metabolic Panel (CMP), help ensure it is safe to proceed with the next dose of chemotherapy.
To determine how the cancer is responding to the treatment, imaging scans are performed periodically, usually every two to three months. These scans might include a CT (computed tomography), PET (positron emission tomography), or MRI (magnetic resonance imaging). The images allow the oncology team to see if the tumors are shrinking, growing, or remaining stable. Blood tests for tumor markers, such as the carcinoembryonic antigen (CEA), may also be used to help track the cancer’s activity.
The definition of a “successful” outcome with FOLFIRI can vary depending on the individual’s situation and the goals of treatment. In the context of advanced or metastatic colorectal cancer, the primary aim is often not a cure but control. Success may be measured by the shrinkage of tumors, which is known as a partial or complete response.
Another positive outcome is “stable disease,” where the cancer stops growing and spreading, even if it doesn’t shrink. A primary goal of treatment is palliative, meaning it aims to reduce cancer-related symptoms, such as pain, and improve the patient’s quality of life.