FOLFIRINOX is a multi-agent chemotherapy regimen combining oxaliplatin, irinotecan, leucovorin, and fluorouracil (5-FU). It is a standard first-line regimen for metastatic pancreatic cancer and is also used in colorectal cancer.
Metastatic pancreatic cancer (first-line): Patients with good performance status (ECOG 0–1). Colorectal cancer: Used as FOLFIRINOX or modified mFOLFIRINOX in metastatic and adjuvant settings. Gastric/GEJ cancer: Investigational in some settings.
FOLFIRINOX (standard, every 2 weeks):
Day 1: Oxaliplatin 85 mg/m² IV over 2 hours, then leucovorin 400 mg/m² IV over 2 hours (concurrently with irinotecan), then irinotecan 180 mg/m² IV over 90 minutes, then 5-FU 400 mg/m² IV bolus, then 5-FU 2400 mg/m² continuous IV infusion over 46–48 hours.
Modified mFOLFIRINOX: Irinotecan 150 mg/m², oxaliplatin 85 mg/m², leucovorin 400 mg/m², 5-FU 2400 mg/m² CI (no bolus 5-FU) — may have improved tolerability.
Neutropenia (46%), Nausea (73%), Fatigue (76%), Diarrhea (45%), Vomiting (47%), Peripheral neuropathy (56%), Alopecia (11%), Thrombocytopenia (33%)
Adverse reaction frequencies reflect combination regimen data. Consult individual prescribing information for complete details.
FOLFIRINOX combines four agents with distinct mechanisms: Oxaliplatin (DNA cross-linking, platinum compound), Irinotecan (topoisomerase I inhibition via active SN-38 metabolite), Leucovorin (enhances 5-FU binding to thymidylate synthase), and 5-Fluorouracil (thymidylate synthase inhibition and RNA incorporation). The combination achieves synergistic multi-pathway cytotoxicity.