FOLFIRI

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The FOLFIRI regimen is a therapeutic scheme for adjuvant chemotherapy of colorectal cancer with the active ingredients :

Therapy schemes

There are many variants of this treatment (for example with weekly administration and correspondingly lower doses or different infusion times and the resulting 1-, 2- or 3-day treatment regimen). The therapy is basically an outpatient therapy, ie the patient does not have to be admitted to the hospital as an inpatient. A prerequisite is the prior implantation of a port catheter , via which the 5-FU continuous infusion can then take place.

The therapy is often carried out fortnightly in twelve cycles according to the following scheme per cycle:

FOLFIRI
Active ingredient dose application Duration Gift on day
Irinotecan 180 mg / m² iv infusion 2 h 1
Folinic acid 200 mg / m² iv infusion 2 h 1 + 2
5-fluorouracil 400 mg / m² iv bolus 2 min 1 + 2
5-fluorouracil 600 mg / m² iv infusion 22 h 1 + 2

(mg / m² = amount / body surface / day)

Another variant that requires not two, but only one day of therapy every 14 days, is the following.

FOLFIRI
Active ingredient dose application Duration Gift on day
Irinotecan 180 mg / m² iv infusion 2 h 1
Folinic acid 400 mg / m² iv infusion 2 h 1
5-fluorouracil 400 mg / m² iv bolus 2 min 1
5-fluorouracil 2400 mg / m² iv infusion 46 h 1

(mg / m² = amount / body surface / day)

Combination with cetuximab

FOLFIRI is often given in combination with the antibody cetuximab . Administration of cetuximab only makes sense if the colon cancer does not show any mutations in the KRAS or NRAS genes . Cetuximab is usually administered iv once a week (initial dose 400 mg / m², all subsequent doses 250 mg / m²). If bi-weekly medication is desired, it is common practice to simply double the dose of cetuximab (ie starting dose 800 mg / m², all subsequent bi-weekly doses 500 mg / m²).

Supportive therapy

Since administration can lead to nausea , an antiemetic from the group of 5-HT 3 receptor inhibitors should always be given. In addition to dexamethasone are added (eg. B. 8 mg).

To prevent a cholinergic syndrome (sweating, chills, abdominal pain, hypotension ...) after administration of irinotecan, subcutaneous administration of 0.25 mg atropine 30 minutes before the start of the infusion is recommended. The patient should also have a reliever medication made of loperamide in the event of diarrhea.

See also

Individual evidence

  1. ↑ Colon cancer. onkologie2017.de, accessed on June 2, 2017 .
  2. ↑ Volker Heinemann: Randomized study on the effectiveness of FOLFIRI in combination with cetuximab vs. Bevacizumab in the first-line treatment of metastatic colorectal cancer with K-RAS wild type. Cancer Center Munich, accessed on June 2, 2017 .
  3. ^ Josep Tabernero, Per Pfeiffer, Andrés Cervantes: Administration of Cetuximab Every 2 Weeks in the Treatment of Metastatic Colorectal Cancer: An Effective, More Convenient Alternative to Weekly Administration? The Oncologist 2008; 13 (2): 113-119. doi : 10.1634 / theoncologist.2007-0201
  4. ↑ Irinotecan, a cytostatic drug. Pharmaceutical newspaper online, 2002, accessed June 1, 2017 .