Summary for doctors
- Every 14 days; first or second line in metastatic colorectal cancer, usually with bevacizumab or an anti-EGFR antibody [1].
- Treat delayed irinotecan diarrhoea early with high-dose loperamide.
- UGT1A1*28 homozygotes are at greater risk of severe neutropenia.
Dose and schedule
FOLFIRI
Metastatic colorectal cancer; gastric cancer (second line)Cycle length: Every 14 days
Metastatic colorectal cancer; gastric cancer (second line)
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Irinotecan | 180 mg/m² | IV over 90 minutes | Day 1 |
| Leucovorin | 400 mg/m² | IV over 2 hours | Day 1 |
| Fluorouracil | 400 mg/m² | IV bolus | Day 1 |
| Fluorouracil | 2400 mg/m² | Continuous 46-hour infusion | Starting on day 1 |
Doses as in the GERCOR study; in that study the 46-hour infusion was increased to 3000 mg/m² from cycle 3 if tolerated [1].
Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.
Premedication and supportive care
- Antiemetics: 5-HT3 and dexamethasone.
- Cholinergic syndrome (early diarrhoea, sweating, abdominal cramps in the first 24 hours): atropine 0.25 to 1 mg subcutaneous or IV.
- Delayed diarrhoea: loperamide 4 mg at the first loose stool, then 2 mg every 2 hours until 12 hours without diarrhoea; if it lasts more than 48 hours or there is fever, seek care urgently.
- DPYD: before the first fluoropyrimidine dose, consider testing for DPD deficiency (DPYD genotype); in carriers of one reduced-function allele the starting dose is reduced by about 50%, and these drugs are contraindicated in complete deficiency [2].
Monitoring and dose adjustment
- Before each cycle: full blood count, electrolytes and bilirubin; a raised bilirubin increases the risk of irinotecan toxicity.
- Grade 3 to 4 diarrhoea or neutropenia: give the next cycle after recovery with reduced irinotecan (for example to 150) and fluorouracil.
- UGT1A1*28 homozygotes: consider a lower starting dose of irinotecan.
Main evidence
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Treatment regimens (physicians)
References
2 referencesShow all references, 1 with a study cardClose the reference list
Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
- 1
- 2Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update
This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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