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FOLFOX is the workhorse chemotherapy combination for bowel cancer, used after surgery to cure and in advanced disease as the backbone that targeted drugs are added to.
Infusional 5-fluorouracil with leucovorin plus oxaliplatin every 2 weeks. MOSAIC (2004) established it as adjuvant therapy for stage III colon cancer; IDEA (2018) showed 3 months suffices for low-risk stage III with CAPOX. In mCRC it pairs with bevacizumab, cetuximab/panitumumab, encorafenib + cetuximab (BREAKWATER), or tucatinib + trastuzumab (MOUNTAINEER-03). Cumulative oxaliplatin neuropathy is the limiting toxicity.
5-FU inhibits thymidylate synthase (potentiated by leucovorin); oxaliplatin forms platinum-DNA adducts.
1.Oxaliplatin crosslinks DNA so it cannot be copied
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| Region | Year | Indication |
|---|---|---|
| US | 2004 | Adjuvant stage III colon cancer (oxaliplatin, MOSAIC) |
| Adverse event |
|---|
| Peripheral sensory neuropathy Cumulative, often persistent; oxaliplatin |
| Neutropenia |
| Diarrhoea, mucositis |
| Cold-induced dysaesthesia Acute, oxaliplatin |
Events listed without rates were not read from a primary source; see the label. Blank cells mean the figure was not sourced, not that it is zero.
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A UK-led trial that moved part of colon cancer chemotherapy in front of the operation, and showed that tumour regression grade after six weeks predicts recurrence, which is the basis for using the response itself to choose what follows.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
The second total neoadjuvant therapy schedule to change practice, and the one that shows the advantage is partly deliverability: chemotherapy given before an operation is completed by far more patients than chemotherapy given after one.
FOLFOX became the guideline second-line option for gallbladder cancer on this trial. The gain is real but small, which is why later-line care now starts with a search for a HER2 or other targetable alteration.
The first total neoadjuvant therapy trial to change practice in high-risk rectal cancer, and the schedule that makes organ preservation possible by giving the tumour months rather than weeks to respond.
The European rulebook for what happens after a colon cancer operation, and the reason a patient with a T3 N1 tumour is now offered three months of chemotherapy rather than six.
The standard-of-care rows on the appendiceal pages, particularly who is referred for cytoreductive surgery and who receives chemotherapy, follow this consensus and the NCCN appendiceal section.
The largest de-escalation exercise in adjuvant oncology, and the reason a patient with a T3 N1 colon cancer is now offered four cycles of CAPOX rather than twelve of FOLFOX, with a fraction of the neuropathy.
Query for this drug: (TITLE:"FOLFOX" OR ABSTRACT:"FOLFOX" OR TITLE:"5-FU, leucovorin, oxaliplatin" OR ABSTRACT:"5-FU, leucovorin, oxaliplatin" OR TITLE:"mFOLFOX6" OR ABSTRACT:"mFOLFOX6") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about FOLFOX (5-FU, leucovorin, oxaliplatin), not a curated reading list.
Shares Induction Chemotherapy Combined With Neoadjuvant Immunotherapy for MSS Colon Cancer, A Phase 2 Study Evaluating the Safety and Efficacy of JS207 With or Without JS015 in Combination With Chemotherapy in Patients With Colorectal Cancer, A Pilot Study Evaluating β-hydroxybutyrate Supplementation Concomitant to Short-Course Radiotherapy Followed by Immunotherapy Combined With CAPEOX Neoadjuvant T, Assess the Efficacy of Radiotherapy and Sequential Chemotherapy and AK104 Before TME Surgery for Local CRC（AK104-IIT-13）.
Shares BALLAD, Cediranib (AZD2171, RECENTIN™) in Addition to Chemotherapy in Patients With Untreated Metastatic Colorectal Cancer, CLOCC, COLOPEC.
Shares Irinotecan Liposomes in Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer, mFOLFOXIRI Plus PD-1 Inhibitor vs mFOLFOX6 as Neoadjuvant Therapy for Locally Advanced Colon Cancer, Induction Chemotherapy Combined With Neoadjuvant Immunotherapy for MSS Colon Cancer, mFOLFOX6 + Bevacizumab + PD-1 Monoclonal Antibody Vs. mFOLFOX6 in Locally Advanced pMMR/MSS CRC.
Shares BALLAD, Cediranib (AZD2171, RECENTIN™) in Addition to Chemotherapy in Patients With Untreated Metastatic Colorectal Cancer, Hypofractionated Radiotherapy Combined With NALIRIF, PD-1 Antibody in Locally Recurrent Rectal Cancer(NOVELTY-R), Circulating Tumor DNA Testing in Predicting Treatment for Patients With Stage IIA Colon Cancer After Surgery.
Shares Efficacy, Safety and Exploratory Clinical Study of Bevacizumab Combined With Oxaliplatin and TAS-102 in First-line Treatment of Advanced Colorectal Cancer, Hypofractionated Radiotherapy Combined With NALIRIF, PD-1 Antibody in Locally Recurrent Rectal Cancer(NOVELTY-R), Short-Course Radiotherapy Combined with Intracavitary Brachytherapy Followed by Pucotenlimab, Bevacizumab, Oxaliplatin, and Trifluridine/Tipiracil (TAS-102) for, JS212 Combination Therapies in Metastatic Colorectal Cancer.
Shares A Phase 2 Study of VS-7375 in Patients With KRAS G12D-Mutated Colorectal Cancer, A Study of Durvalumab (MEDI4736) and Monalizumab in Solid Tumors, The Phase 1b/IIa, Open-label, Dose Escalation and Dose Expansion to Evaluate Safety, Tolerability, and Preliminary Efficacy of the Combination of HCB101, Cetuxi, Anti-EGFR antibody + chemotherapy in left-sided RAS/BRAF wild-type mCRC.
Shares BALLAD, Cediranib (AZD2171, RECENTIN™) in Addition to Chemotherapy in Patients With Untreated Metastatic Colorectal Cancer, Circulating Tumor DNA Testing in Predicting Treatment for Patients With Stage IIA Colon Cancer After Surgery, A Study of MRG007 Combination Therapy for Advanced Colorectal Cancer.
Shares Adjuvant mFOLFIRINOX for High-risk Stage III Colon Cancer, Adjuvant mFOLFOXIRI vs. mFOLFOX6 in MRD Positive Stage II-III Colorectal Cancer (AFFORD), Neoadjuvant FOLFIRINOX and Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer Patients, Neoadjuvant Treatment With mFOLFOXIRI Plus Cadonilimab (AK104) Versus mFOLFOX6 in Locally Advanced Colorectal Cancer.