FOLFIRINOX Side Effects: What to Expect, How Long They Last, and How to Cope

FOLFIRINOX is a combination of four chemotherapy drugs used to treat pancreatic cancer. It works by targeting and killing fast-growing cancer cells, but it can also affect healthy cells. This can cause strong side effects, such as extreme tiredness, stomach trouble, or nerve pain that makes you sensitive to the cold. Your health care team will suggest FOLFIRINOX only if they think your body is strong enough to receive it. Everyone reacts differently to FOLFIRINOX, but learning about side effects and how to handle them can help you feel better and stay on your treatment plan.

One of the drugs in FOLFIRINOX (oxaliplatin) can cause nerve pain. After a few rounds of FOLFIRINOX treatment, you may notice numbness, tingling, burning, or pain in your arms, legs, hands, and feet. Nerves are slow to heal, but you can take these steps to lower nerve pain:

Exercise. Walking, yoga, and strength training can boost your blood flow and ease nerve pain.

Massage. Gently massage your hands and feet every day.

Try assistive devices. Talk to your doctor about using a cane, wearing a brace, or getting another assistive device if walking becomes difficult.

Use calming creams. Try cocoa butter, menthol-based creams, or a blend of essential oils.

FOLFIRINOX can also make you very sensitive to cold for a few days to a few weeks after each treatment. For example, you may find it painful to swallow a cold drink or be in an air-conditioned space. You can manage this by:

Changing your diet. Limit eating cold foods such as ice cream and smoothies. Go for warm drinks and foods instead.

Protecting your hands. Wear gloves when you reach into your refrigerator or freezer.

Covering up. Put on extra layers when you go outside in cold weather.

Some other drugs in FOLFIRINOX can cause nausea and vomiting. This may happen right when you start or after a few days. Your health care team can give you medication to prevent or improve any nausea. Make sure to take it exactly as prescribed, even when you feel OK. Here are other lifestyle changes that can help settle your stomach:

Eat small portions. Try eating many small snacks during the day instead of three large meals.

Try ginger. Sipping ginger tea or sucking on hard ginger candies can help.

Choose easy-to-digest foods. Avoid fried foods as they're harder to digest, and try a meal replacement shake if eating solid food is difficult.

Cancer drugs such as FOLFIRINOX lower the platelet count, the cells that help your blood clot. This usually happens within the first or second week and can make it easier to bruise and bleed. For example, your gums may bleed when you brush your teeth, or you could have nosebleeds. Here are some tips to stay safe and handle bleeding:

If you cut yourself. Keep first aid items like sterile gauze and bandages on hand, and use more pressure than usual to stop the bleeding. 

To protect yourself. Wear gloves when you're doing an activity that could cause cuts and scrapes, such as yard work.

If you're still bleeding. If a wound or nosebleed is still bleeding after a few minutes, call your health care team right away.

FOLFIRINOX lowers the levels of white blood cells your body uses to fight germs. This tends to happen after one to two weeks of treatment,  making it easier to get an infection. The signs of infection include fever, muscle aches, cough, headache, burning while peeing, and chills. Keep a thermometer so you can check if you have a fever any time. Call your doctor right away if you think you're getting sick. In some cases, they may prescribe medication to help you. But you can also protect yourself by:

• Washing your hands often
• Avoiding people who are ill
• Eating properly washed and fully cooked foods

FOLFIRINOX can cause painful mouth sores. These may develop about 5-10 days into your cancer treatment. If you find it hard to eat or drink, notice any bleeding, or think your sores are infected, tell your health care team right away. They can prescribe a special mouthwash to help lower the pain and ease irritation. Things you can do to manage mouth sores include:

Rinsing your mouth. Use salt water or a mixture of baking soda and water for rinsing. If you use a mouthwash, choose one without alcohol.

Brushing your teeth. Use a soft toothbrush to avoid more damage to your mouth and lower pain.

Changing your diet. Choose bland, soft foods instead of crunchy, spicy, or acidic ones.

Feeling tired for no reason is one of the most common side effects of pancreatic cancer treatment, such as FOLFIRINOX. It usually lasts a few days after the treatment, but it may last longer. If you feel tired, your doctor can prescribe medication that helps. It can also help to:

Keep busy. Focus on the activities that are most important to you or that you most enjoy.

Eat. Keep easy snacks on hand for an energy boost, especially foods high in protein like eggs.

Ask for help. Accept help from family and friends when you need it.

Get enough fluid. Drink plenty of water, as dehydration can make fatigue worse.

Stay active. Short walks and other gentle exercise may also help boost your energy.

Brain fog, also called "chemo brain," can make it harder for you to focus, learn new things, or remember details. Some cancer medicines, such as FOLFIRINOX, can cause this. It can feel even worse if you are stressed, very tired, or not eating well. Chemo brain can sometimes linger for months or even years, but tell your health care team if it gets in the way of your daily life. They may refer you to a specialist, such as a therapist or neurologist, for more support.

Here are some things you can do to help with brain fog:

Try brain exercises. Puzzles, word games, and brain teasers can help keep your mind active.

Practice relaxation activities. Meditation and other calming activities can help lower stress and improve focus.

Go outdoors. Spending time outside can also help you relax and improve your focus.

As you have more rounds of FOLFIRINOX, it can build up in your body and worsen side effects. Managing these side effects along with your cancer can be stressful. Ask your doctor for a list of symptoms that need immediate medical attention, and know how to reach them outside office hours with questions. Your care team has many ways to help you avoid or treat FOLFIRINOX side effects so you can focus on your day-to-day life.