Oncura

FOLFOX (Small Bowel Cancer): what to expect, day by day

Small Bowel14-day cycle6 effects documented

A every-2-week infusion (with a take-home 5-FU pump for ~46 hours). The standout effect is oxaliplatin nerve tingling that's set off by cold, plus lowered blood counts and diarrhea.

5-FU + leucovorin + oxaliplatin every 2 weeks. Onset is nadir-based (days since infusion). Oxaliplatin has TWO neuropathies: an immediate cold-triggered one, and a slow cumulative one that builds over months.

Get help straight away — this is true on any regimen, on any day.

A temperature of 100.4°F (38°C) or higher during treatment can mean a serious infection while your blood counts are low. Call your team or go to the ER — do not wait it out.

Also urgent: trouble breathing or chest pain · swelling of the face, lips or throat · new confusion or fainting · shaking chills · not being able to keep fluids down.

This is standing guidance shown to everyone. Nothing on this page is based on anything about you, and nobody is monitoring you.

Timed to the cycle

Day 1 is the day of your infusion. These are the effects a retrievable document ties to a day range for this regimen — not a prediction about you.

Peripheral neuropathy (acute, cold-triggered)

Typically around days 0–14

Within hours of the infusion, cold air, cold drinks, or cold objects can trigger tingling or a strange 'electric' feeling in the hands, feet, mouth, or throat. It's uncomfortable but eases over days. Avoid cold exposure for the first several days.

Call your team: Trouble breathing or swallowing after cold exposure — call your team.

reported by about ~30% of people · Timing from the manufacturer’s prescribing information · from Oxaliplatin

Neutropenia

Typically around days 9–14

A temporary drop in infection-fighting white cells.

Call your team urgently: A temperature of 100.4°F (38.0°C) or higher — an emergency.

reported by about 79% of people; severe in 41% · Timing from the manufacturer’s prescribing information · from Oxaliplatin, Fluorouracil

Thrombocytopenia

Typically around days 9–14

A drop in platelets (which help blood clot). Watch for easy bruising or bleeding.

Call your team: Bleeding that won't stop, or black/tarry stools.

reported by about 77% of people; severe in 5% · Timing from the manufacturer’s prescribing information · from Oxaliplatin

Not tied to a cycle day

These build with the number of doses, or are measured from when treatment started, so a cycle day would be the wrong shape for them. Each keeps the timing its own source states.

Peripheral neuropathy (chronic, cumulative)

builds over cycles/months; dose-dependent

With repeated cycles, a longer-lasting numbness/tingling in the hands and feet can build up. It's dose-related and your team tracks it closely, sometimes lowering or pausing oxaliplatin, because it can persist after treatment.

Call your team: Numbness that makes it hard to button clothes, walk, or feel the floor.

reported by about 92% of people; severe in 12% · from Oxaliplatin

Diarrhea

Loose or frequent stools. Stay hydrated and use anti-diarrheal medicine as your team directs.

Call your team: More than 6 stools above normal in a day, or any with dizziness/lightheadedness.

reported by about 56% of people; severe in 11% · from Fluorouracil, Oxaliplatin

Nausea

Sickness in the first 24 hours is the "acute" phase and usually peaks 2-3 hours in; anything from 24 to 120 hours is the "delayed" phase.

Usually mild-moderate and well controlled with anti-nausea medicine given before treatment.

Call your team: Can't keep fluids down for more than 12 hours.

reported by about ~65% of people; severe in 1-5% · Timing from a clinical guideline · from Oxaliplatin, Fluorouracil

Where this comes from

S1. André T, MOSAIC trial (FOLFOX4 adjuvant colon) (2004) — PMID 15175436
S2. Oxaliplatin (Eloxatin) FDA prescribing information — FDA label
S3. Fluorouracil (5-FU) FDA prescribing information — FDA label

Timing windows on this page rest on:

Eloxatin (oxaliplatin) FDA prescribing information — “occurring within hours or one to two days of dosing ... resolves within 14 days, and frequently recurs with further dosing” source
Fluorouracil injection prescribing information — “The nadir in neutrophil counts commonly occurs between 9 and 14 days after Fluorouracil administration” source
MASCC/ESMO antiemetic consensus — emesis phases — “acute 0-24 h, delayed 25-120 h, overall 0-120 h” source

A window appears here only where a retrievable document ties it to a drug in this regimen. Where nothing could be found, the window was removed rather than estimated — so a missing time is an honest gap, not an oversight.

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