FOLFIRINOX

Say it: foll-FEER-ee-nox

Leucovorin, fluorouracil, irinotecan and oxaliplatin

FOLFIRINOX is a strong four medicine chemotherapy plan for pancreatic cancer, used for people who are fit enough to handle it.

Also called: mFOLFIRINOX, modified FOLFIRINOX, FOLFIRINOX, FOLFIRINOX chemotherapy, m-FOLFIRINOX

What it is

It combines the medicines in FOLFOX and FOLFIRI, so it attacks cancer cells in several ways at once. It is one of the most effective chemotherapy plans for pancreatic cancer, but it also has more side effects. After surgery, the goal is to lower the chance of the cancer coming back. Before surgery, it can shrink the tumor. When the cancer has spread, the goal is to control it and help you live longer.

Often used for

• Pancreatic cancer after surgery, to lower the chance it comes back
• Pancreatic cancer before surgery or radiation, to shrink it
• Pancreatic cancer that has spread

Modified FOLFIRINOX (mFOLFIRINOX)

The version most often used today. It usually leaves out the quick push of fluorouracil and may use a lower amount of irinotecan, which makes it easier to handle while still working well.

After surgery (adjuvant)

Usually 12 cycles over about 6 months, starting once you have healed from surgery.

The medicines in this plan

Leucovorin

A form of folic acid that makes fluorouracil work better. Given through a vein over about 2 hours on day 1.

Fluorouracil (5-FU)

Chemotherapy that stops cancer cells from copying their DNA. Given by a small take-home pump over about 46 hours, sometimes with a quick push first.

Irinotecan

Chemotherapy that breaks cancer cell DNA. Given through a vein over about 90 minutes on day 1. Main cause of diarrhea.

Oxaliplatin

Platinum chemotherapy. Given through a vein over about 2 hours on day 1. Causes cold sensitivity and tingling.

How you get it

FOLFIRINOX is given in an outpatient infusion clinic through a port (a small device under the skin of the chest). Day 1 takes about 5 to 6 hours in the clinic, then you go home with a small pump that gives fluorouracil over about 2 days. Each cycle is 14 days. After surgery, most people get 12 cycles (6 months); in other settings, the number depends on how the cancer responds. Your schedule may be different.

A typical cycle

Day 1

Blood tests and a check in. Anti-nausea medicines, then oxaliplatin, leucovorin and irinotecan through your port. Then the take-home fluorouracil pump is connected.

Days 1 to 3

The pump runs at home for about 46 hours. Some people get a shot to boost white blood cells after the pump comes off.

Day 3

The pump is disconnected at the clinic or by a home nurse.

Days 4 to 14

Rest and recovery. Diarrhea and low blood counts are most likely during this time, with counts lowest around days 7 to 12.

Common side effects and what helps

• Tiredness, often strong for several days after each cycle. Plan rest and accept help.
• Nausea and vomiting. Take anti-nausea medicines on schedule, not only when you feel sick.
• Diarrhea. Start your diarrhea medicine at the first loose stool and drink plenty of fluids.
• Tingling or numbness in fingers and toes, worse with cold. Wear gloves and avoid cold drinks for a few days after treatment.
• Low blood counts and higher infection risk. Wash hands often and avoid sick people.
• Poor appetite and weight loss. Eat small meals often and ask to see a dietitian.
• Mouth sores. Rinse often with a mild salt and baking soda rinse.
• Hair thinning. Use a gentle shampoo and a soft hat or scarf.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Diarrhea that does not improve within 24 hours of your diarrhea medicine, or diarrhea with fever
• Not able to keep fluids down, or dizziness when standing
• Chest pain or trouble breathing
• Yellow skin or eyes, or very dark urine
• Bleeding that will not stop, or black stools
• A problem with your pump, such as a leak, alarm or wet bandage
• New swelling or pain in one leg (people with pancreatic cancer have a higher risk of blood clots)

Good to know

• This is a demanding plan. Your team will check that your strength, liver and blood counts are good enough before each cycle.
• Many people get a white blood cell booster shot after each cycle to lower infection risk.
• Nerve symptoms from oxaliplatin can build up. Tell your team about trouble with buttons, writing or walking.
• Ask whether testing for gene changes that affect how your body handles fluorouracil (DPD) or irinotecan (UGT1A1) is right for you.
• Blood tests are done before every cycle, and scans are done every few months to check how the cancer is responding.

At home

• Keep diarrhea and nausea medicines at home before your first cycle and know your plan for each.
• Drink about 8 to 10 cups of fluid a day unless your team says otherwise.
• Avoid cold drinks, cold food and cold air for several days after each treatment.
• Keep the pump dry and in its case. Never pull on the line.
• If you take enzyme pills with meals for pancreatic cancer, keep taking them as directed; they can help with weight and loose stools.

Questions to ask

• Am I getting the full or the modified version, and why?
• Will I get a white blood cell booster shot?
• How many cycles will I get, and when will I have scans?
• What should I do about diarrhea at night or on weekends?
• Should I see a dietitian to help with weight and appetite?

Pancreatic cancer

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.