FOLFOXIRI

Say it: foll-FOX-eer-ee

Leucovorin, fluorouracil, oxaliplatin and irinotecan

FOLFOXIRI is a strong four medicine chemotherapy plan for colon and rectal cancer that has spread, used for people who are fit enough to handle it, often together with bevacizumab.

Also called: mFOLFOXIRI, modified FOLFOXIRI, FOLFOXIRI plus bevacizumab, FOLFOXIRI with bevacizumab, FOLFOXIRI-bev, triplet chemotherapy, FOLFOXIRI chemotherapy

What it is

It combines all the main chemotherapy medicines used for colon cancer at the same time, instead of one plan after another. This can shrink the cancer more and sometimes make surgery possible, but it also has more side effects than FOLFOX or FOLFIRI. It uses the same four medicines as FOLFIRINOX, but in a different order and with different amounts, and it does not use the quick push of fluorouracil.

Often used for

• Colon or rectal cancer that has spread, in people who are fit and active
• Cancer that has spread to the liver, to try to shrink it enough for surgery
• Faster growing tumors, such as those with a BRAF gene change or on the right side of the colon, in some cases

FOLFOXIRI plus bevacizumab

The most common way it is used. Bevacizumab is given on day 1 of each cycle. It can raise blood pressure and slow wound healing, so your team will plan carefully around any surgery.

Modified FOLFOXIRI

Some centers use smaller amounts of one or more medicines to make the plan easier to handle, especially for people who are a bit older or have other health problems.

Maintenance after FOLFOXIRI

After up to about 12 cycles (6 months), many people switch to a lighter plan, often fluorouracil and leucovorin with bevacizumab, to keep the cancer under control with fewer side effects.

The medicines in this plan

Irinotecan

Chemotherapy that breaks cancer cell DNA. Given through a vein over about 60 to 90 minutes on day 1, usually first. Main cause of diarrhea.

Oxaliplatin

Platinum chemotherapy. Given through a vein over about 2 hours on day 1. It is the medicine that causes cold sensitivity and tingling.

Leucovorin

A form of folic acid that makes fluorouracil work better. Given through a vein over about 2 hours on day 1, at the same time as oxaliplatin.

Fluorouracil (5-FU)

Chemotherapy that blocks cancer cells from copying their DNA. Given by a small take-home pump over about 46 to 48 hours. No quick push is given in this plan.

Bevacizumab

Only in the bevacizumab version. An antibody that cuts off the blood supply that tumors need to grow. Given through a vein on day 1, before the chemotherapy.

Pegfilgrastim

Sometimes given. A growth factor shot after each cycle, or by an on body injector, to help white blood cells recover and lower infection risk.

How you get it

FOLFOXIRI 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 7 hours in the clinic, then you go home with a small pump that gives fluorouracil over about 2 days. Each cycle is 14 days. Most people get up to 8 to 12 cycles, then switch to a lighter maintenance plan, or have surgery if the cancer shrinks enough. Your schedule may be different.

A typical cycle

Day 1

Blood tests and a check in. Anti-nausea medicines, then bevacizumab (if used), then irinotecan, then oxaliplatin and leucovorin together. Then the take-home fluorouracil pump is connected.

Days 1 to 3

The pump runs at home for about 2 days. You may feel tired, queasy and sensitive to cold.

Day 3

The pump is disconnected at the clinic or by a home nurse. Some people get a white blood cell booster shot at this visit.

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

• Diarrhea. Start your diarrhea medicine at the first loose stool and drink plenty of fluids.
• Low blood counts and higher infection risk. Wash hands often and stay away from people who are sick.
• Tingling or numbness in fingers, toes or around the mouth, often set off by cold. Wear gloves and avoid cold drinks for a few days after treatment.
• 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.
• Sweating, cramping or a runny nose during or soon after irinotecan. Tell your nurse, because a medicine can stop it.
• Mouth sores. Rinse often with a mild salt and baking soda rinse and use a soft toothbrush.
• Hair thinning or hair loss.
• With bevacizumab: higher blood pressure and nosebleeds. Your blood pressure will be checked at each visit.

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, diarrhea 4 or more times a day above your normal, or diarrhea with fever
• Not able to keep fluids down, or feeling dizzy when you stand
• Chest pain, or trouble breathing or swallowing (rarely, oxaliplatin can cause a throat squeeze feeling, or an allergic reaction during the infusion)
• Bleeding that will not stop, black stools or vomiting blood
• Severe belly pain
• A problem with your pump, such as a leak, alarm or wet bandage
• Swelling or pain in one leg, or a very bad headache

Good to know

• This is a demanding plan meant for people who are fit and active. Your team will check your strength, blood counts and liver tests 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 over time. Tell your team about trouble buttoning, writing or walking, so they can adjust the plan.
• Ask whether testing for gene changes that affect how your body handles fluorouracil (DPD) or irinotecan (UGT1A1) is right for you.
• Bevacizumab is usually paused for several weeks around surgery because it slows wound healing. Your team will time this.
• Scans are done every 2 to 3 months to see if the cancer is shrinking and if surgery might become possible.

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 on your face for several days after each treatment.
• Keep the pump dry and in its carry case. Never pull on the line.
• Keep a thermometer at home and check your temperature if you feel unwell.

Questions to ask

• Why is FOLFOXIRI a better choice for me than FOLFOX or FOLFIRI?
• Will bevacizumab be added?
• Is there a chance the cancer could shrink enough for surgery?
• How many cycles will I get, and what comes after?
• Will I get a white blood cell booster shot?
• What should I do about diarrhea at night or on weekends?

Colorectal 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.