Skip to main content

What is the FOLFOX chemo regimen and is it effective?

Medically reviewed by Kristianne Hannemann, PharmD. Last updated on May 13, 2025.

Official Answer by Drugs.com

FOLFOX is a combination chemotherapy regimen primarily used to treat colorectal cancer, in both early-stage and advanced-stage settings. It includes folinic acid (leucovorin), fluorouracil, and oxaliplatin. These drugs work together to destroy cancer cells by disrupting their DNA synthesis and function.

What Is FOLFOX?

FOLFOX is an acronym that stands for the three medications in the chemotherapy regimen:

The FOLFOX chemotherapy regimen combines these drugs to treat colorectal and other gastrointestinal cancers, such as:

It can be used as an adjuvant therapy (after surgery) to kill any remaining cancer cells and reduce the risk of the cancer coming back, for advanced or metastatic cancer, and as a palliative treatment in late-stage cancer.

There are several variations of the FOLFOX regimen, such as FOLFOX-4, FOLFOX-6, modified FOLFOX-6 (mFOLFOX-6), and FOLFOX-7, which differ in the doses and schedules of the drugs.

How Does FOLFOX Work?

The three drugs in the FOLFOX regimen attack cancer cells in different ways, which can make the combination treatment more effective than using a single drug.

The treatment is delivered in cycles, each lasting 14 days (2 weeks), and patients may receive up to 12 cycles over about 6 months. The medications are given intravenously, often through a central line, PICC line, or portacath. Fluorouracil is usually given through a small pump that you can wear at home.

Below is an example of a typical FOLFOX schedule, but the instructions provided by your healthcare provider may differ.

Day 1
  • Oxaliplatin and folinic acid infused over 2 hours.
  • Fluorouracil is injected into your vein for about 5 minutes, then given as an infusion for 44-46 hours through a portable pump.
Day 2 Continue fluorouracil infusion.
Days 3 to 14 No treatment to allow the body to recover.

How Effective Is FOLFOX?

FOLFOX is a standard and well-studied regimen for both adjuvant (after surgery) and metastatic (advanced) colorectal cancer.

Adjuvant Setting

Metastatic Disease

Keep in mind that individual responses to FOLFOX depend on factors such as cancer stage, patient health, and adjunct therapies.

Related questions

Who Can Benefit From FOLFOX?

FOLFOX is a chemotherapy regimen most commonly used to treat colorectal cancer, but it is also utilized for other cancer types. The patients who can benefit from FOLFOX include:

Patients should have adequate organ function (blood counts, liver, and kidney function) and a good performance status (able to carry out daily activities independently). Treatment should be personalized, and your healthcare provider might recommend alternative treatment options based on your specific health conditions.

Common Side Effects of FOLFOX

FOLFOX can cause a range of side effects, including but not limited to:

Your healthcare provider may suggest supportive care or dose adjustments as needed to manage side effects. You’ll typically be prescribed anti-nausea medications to take during chemotherapy treatment to help with nausea and vomiting.

Summary: Is FOLFOX Right for You?

FOLFOX is a well-established and effective chemotherapy regimen for colorectal cancer, improving survival rates in both early and advanced disease. It is also being explored for other cancers, such as esophageal cancer.

While side effects can be significant, FOLFOX remains a cornerstone of modern cancer therapy due to its proven benefits. Cancer treatment decisions are individualized, and it is important to consult with an oncologist about the best treatment for you.

References
  1. American Cancer Society. 2024. Treatment of Colon Cancer, by Stage. Accessed May 13, 2025 at https://www.cancer.org/cancer/types/colon-rectal-cancer/treating/by-stage-colon.html
  2. André, T., et. al. 2004. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. The New England journal of medicine, 350(23), 2343–2351. https://doi.org/10.1056/NEJMoa032709
  3. André, T., et. al. 2020. Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials. The Lancet. Oncology, 21(12), 1620–1629. https://doi.org/10.1016/S1470-2045(20)30527-1
  4. Cancer Research UK. 2023. Folinic acid, fluorouracil and oxaliplatin (FOLFOX). Accessed May 13, 2025 at https://www.cancerresearchuk.org/about-cancer/treatment/drugs/folfox
  5. EviQ. 2023. Colorectal adjuvant FOLFOX6 (modified) (fluorouracil leucovorin oxaliplatin). Accessed on May 13, 2025 at https://www.eviq.org.au/medical-oncology/colorectal/adjuvant-and-neoadjuvant/637-colorectal-adjuvant-folfox6-modified-fluoro
  6. Fluorouracil injection [package insert]. Updated 2024. Accord Healthcare, Inc. Accessed on May 13, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8eff167f-203a-4a81-b2fc-d8773bc3555e
  7. Fushiki, K., et. al. 2024. First-line FOLFOX therapy for advanced esophageal squamous cell carcinoma: Multicenter prospective study in Japan. In: Journal of Clinical Oncology. DOI: https://doi.org/10.1200/JCO.2024.42.3_suppl.280
  8. Hebbar, M., et. al. 2015. FOLFOX4 versus sequential dose-dense FOLFOX7 followed by FOLFIRI in patients with resectable metastatic colorectal cancer (MIROX): a pragmatic approach to chemotherapy timing with perioperative or postoperative chemotherapy from an open-label, randomized phase III trial. Annals of oncology : official journal of the European Society for Medical Oncology, 26(2), 340–347. https://doi.org/10.1093/annonc/mdu539
  9. Hecht, J. R., et. al. 2021. Randomized Phase III Study of FOLFOX Alone or With Pegilodecakin as Second-Line Therapy in Patients With Metastatic Pancreatic Cancer That Progressed After Gemcitabine (SEQUOIA). In: Journal of Clinical Oncology. DOI: https://doi.org/10.1200/JCO.20.02232
  10. Hedge, V. S., et. al. 2023. Leucovorin. In: StatPearls [Internet]. Accessed on May 13, 2025 at https://www.ncbi.nlm.nih.gov/books/NBK553114/
  11. Jeon, H. J., et. al. 2011. Adjuvant Chemotherapy Using the FOLFOX Regimen in Colon Cancer. Journal of the Korean Society of Coloproctology, 27(3), 140–146. https://doi.org/10.3393/jksc.2011.27.3.140
  12. Lee, S., et. al. 2011. Oxaliplatin, 5-FU, and leucovorin (FOLFOX) in advanced biliary tract cancer. In: Journal of Clinical Oncology. DOI: https://doi.org/10.1200/jco.2011.29.15_suppl.4106
  13. Leucovorin calcium injection [package insert]. Updated 2024. Fresenius Kabi USA, LLC. Accessed on May 13, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d5d4f0fd-7520-43a9-9acc-f7e117e1f6ee
  14. MacMillan Cancer Support. FOLFOX. Accessed May 13, 2025 at https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfox
  15. Masuishi, T., et. al. 2017. FOLFOX as First-line Therapy for Gastric Cancer with Severe Peritoneal Metastasis. In: Anticancer Research. DOI: https://doi.org/10.21873/anticanres.12174
  16. National Cancer Institute. NCI Dictionary of Cancer Terms: FOLFOX regimen. Accessed May 13, 2025 at https://www.cancer.gov/publications/dictionaries/cancer-terms/def/folfox-regimen
  17. National Comprehensive Cancer Network. (2021). NCCN guidelines for patients - colon cancer. Accessed on May 13, 2025 at https://www.nccn.org/patients/guidelines/content/PDF/colon-patient.pdf
  18. Oxaliplatin [package insert]. Updated 2023. Nextgen Pharmaceuticals LLC. Accessed May 13, 2025 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=95b05292-36a1-4946-b8b3-835a3a77f4a7
  19. Sanoff, H. K., et. al. 2008. Five-year data and prognostic factor analysis of oxaliplatin and irinotecan combinations for advanced colorectal cancer: N9741. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 26(35), 5721–5727. https://doi.org/10.1200/JCO.2008.17.7147
  20. Tournigand, C., et. al. 2006. OPTIMOX1: a randomized study of FOLFOX4 or FOLFOX7 with oxaliplatin in a stop-and-Go fashion in advanced colorectal cancer--a GERCOR study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 24(3), 394–400. https://doi.org/10.1200/JCO.2005.03.0106
  21. Tsai, Y. J., et. al. 2016. Adjuvant FOLFOX treatment for stage III colon cancer: how many cycles are enough?. SpringerPlus, 5(1), 1318. https://doi.org/10.1186/s40064-016-2976-9

Read next

What is FOLFIRINOX regimen​ and how is it used?

FOLFIRINOX is a four-drug chemotherapy regimen that contains folinic acid (leucovorin), fluorouracil (5-FU), irinotecan, and oxaliplatin. It is primarily used to treat advanced pancreatic cancer, including metastatic and locally advanced (inoperable) cases.

Continue reading

What is the FLOT chemotherapy regimen and how does it work?

FLOT chemotherapy contains a combination of fluorouracil, leucovorin, oxaliplatin, and docetaxel. It is highly effective for resectable gastroesophageal and gastric adenocarcinomas, offering superior survival and tumor response rates compared to both chemoradiotherapy (CROSS) and older chemotherapy regimens (ECF/ECX).

Continue reading

Does duct tape really remove warts?

There are conflicting results in studies about the effectiveness of duct tape for warts. Out of 3 studies, one study with duct tape saw a positive effect when compared to freezing the wart (cryotherapy), but 2 studies, when compared to a placebo (a corn pad or moleskin), did not see any advantage. Continue reading

See also:

Related medical questions

Drug information

Related support groups