Summary for doctors
- Every 14 days; fluorouracil by a 46-hour pump through a central venous catheter [1].
- Adjuvant treatment of stage 3 colorectal cancer: 12 cycles (6 months); at low risk (T1-3 and N1), three months of CAPOX is enough [3].
- Moderately emetogenic; low risk of febrile neutropenia (below 10%).
- Limiting toxicity: cumulative oxaliplatin neuropathy [2, 3].
Dose and schedule
mFOLFOX6
Colorectal cancer: adjuvant stage 3 and high-risk stage 2, and metastatic disease (with bevacizumab, or an anti-EGFR antibody in RAS wild-type); gastric and oesophageal cancerCycle length: Every 14 days
Colorectal cancer: adjuvant stage 3 and high-risk stage 2, and metastatic disease (with bevacizumab, or an anti-EGFR antibody in RAS wild-type); gastric and oesophageal cancer
| Drug | Dose | Route | Schedule |
|---|---|---|---|
| Oxaliplatin | 85 mg/m² | IV over 2 hours | Day 1 |
| Leucovorin (folinic acid) | 400 mg/m² | IV over 2 hours, at the same time as oxaliplatin | 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 NSABP C-08 study [1]. Levofolinic acid 200 mg/m² is equivalent to leucovorin 400.
Dose source: [5].
Evidence: IDEA (2018)
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: a 5-HT3 antagonist with dexamethasone on day 1 (antiemetic tool).
- 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 [4].
- Cold: acute oxaliplatin neuropathy is triggered by cold; avoid cold drinks and exposure to cold for a few days after the infusion.
- Primary G-CSF prophylaxis is usually not needed.
Monitoring and dose adjustment
- Before each cycle: full blood count, creatinine, liver enzymes and bilirubin; common thresholds for starting a cycle: ANC 1500 and platelets 75,000 to 100,000 or more.
- Neuropathy: persistent paraesthesia between cycles: reduce oxaliplatin to 65 to 75 mg/m² or hold it; functional impairment: stop oxaliplatin and continue the fluoropyrimidine [2].
- Hypersensitivity reactions usually occur after several cycles (often from cycle 6 onwards).
- Grade 3 diarrhoea, mucositis or hand-foot syndrome: hold until recovery and reduce the fluorouracil dose.
Main evidence
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MOSAIC: adding oxaliplatin (FOLFOX4) to fluorouracil as adjuvant treatment of stage 2 and 3 colon cancer increased 3-year disease-free survival from 72.9% to 78.2% [2]. IDEA: in stage 3, three months of treatment did not prove non-inferior in the whole group, but with CAPOX and in the low-risk group (T1-3 and N1), three months was almost equivalent to 6 months, with much less grade 2 or higher neuropathy [3].
Common questions
Related cancer types
Treatment regimens (physicians)
References
5 referencesShow all references, 3 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
- 2
- 3
- 4Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update
- 5A phase II study of perioperative pembrolizumab plus mFOLFOX in patients with potentially resectable esophagus, gastroesophageal junction (GEJ), and stomach adenocarcinoma
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.
Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/folfox/