Written by Jonny Puglia
FOLFOX is an acronym for a chemo regiment that is typically prescribed to individuals with advanced Colorectal Cancer (staged III to IV), as a first line of “deferment” of the disease. In clinical terms, we want these results: stable is when there is no spreading or growth on existing tumors, regression (or simply a smile on your oncologist’s face) means that your cancer has shrunk by some measurable way.
Folinic acid (leucovorin) “FOL”, Fluorouracil (5-FU) “F”, and Oxaliplatin (Eloxatin) “OX” are the drugs involved with this first chemotherapy regimen.
Folinic Acid (aka Leucovorin) is actually not a traditional chemo drug, in fact it’s a solution that helps boost the effects from the Fluorouracil. This is typically given alongside a more potent drug called Oxaliplatin. We’ll get to Oxyaliplatin in a minute – this is one chemotherapy that you need to know!
Leucovorin and Oxyaliplatin are typically given over a 90 minute period, via your chest port or vien. Leucovorin works by shielding your healthy cells from harmful effects of chemotherapy drugs, while synergistically allowing a longer lasting chemo drug, 5-FU, to invade tumor cells
During this infusion you most likely will not feel any immediate effects, although if you do – a rash, rising fever, or even chest pains – make sure your nurse is in walking distance. I remember my nurse giving me a hotel bell within finger distance to notify them if I started to feel any immediate side effects. As frustrating as this sounds, doctors and nurses do not have complete confidence that chemotherapy agents, like FOLFOX will be tolerated by your body until the actual infusion.
Fortunately, I had no immediate effects, just my adrenaline pumping through my veins, waiting nervously. Typically, your first infusion will take a few hours for any noticeable side-effects; nausea, vomiting, and just the overwhelming feeling of shit. Remember to always record your side-effects! I was so confident that I would remember each symptom, but as it turns out, a recently diagnosed 30-something year old has other things to do.
Mistake #1 – I had no idea how much side-effect tracking would help me understand how toxic my body was getting.
Oxaliplatin (Eloxatin), specifically, will cause extreme sensitivity to cold. The reason for this is due to the chemistry of this drug. Platinum-based infusions can be extremely effective against cancer, however, those benefits can come at a cost. The primary reason why this occurs is due to the drug’s target – inhibition of DNA development; putting at risk your healthy cells (along with cancer cells). Neuropathy develops as a result which can be temporary or permanent depending on that specific individual. This popular side effect has no predicted timeline, in fact, my experience was quite different from those who received this – both in young and older adults.
Through my maximum dosage of Oxaliplatin, the ONE huge side effect was the increased nerve numbness and pain I felt when around or touching anything at a fridge temperature or below (<~40F).
As I received my first Oxaliplatin infusion, I really wasn’t paying attention in the infusion room. To be honest, I completely zoned out during that 90 minute period, talking with my mom who came with me for the first treatment. After leaving the cancer center we went off to Ruby Tuesdays at the nearby mall. Sitting down, without even blinking an eye, we started to sip our ice water that just came out. My throat felt weird…and then it clicked…I just had Oxaliplatin and my doctor’s warnings rang out in my ear “You’ll feel extreme sensitivity to…”. I nearly spat out my water when I felt this weird sensation in the back of my throat. It wasn’t pain, more like an odd zing.
Being the neurotic person I am, I started to sweat and panic, almost like I accidentally ate rat poison (a similar by-product to what was flowing in my veins). Even though I was in no immediate pain, looking back now, it was like my body foreshadowing what was coming down the pipeline.