FOLFIRI

FOLFIRI

Classification
External resources

FOLFIRI is a chemotherapy regimen used in the treatment of colorectal cancer. It is a combination of three drugs: Folinic acid (leucovorin), Fluorouracil (5-FU), and Irinotecan. This regimen is often used as a first-line or second-line treatment for metastatic colorectal cancer.

Components

Folinic Acid

Folinic acid, also known as leucovorin, is a form of folic acid that is used to "rescue" normal cells from the toxic effects of methotrexate and to enhance the effectiveness of fluorouracil. It is not a chemotherapy agent itself but plays a crucial role in the FOLFIRI regimen by stabilizing the binding of fluorouracil to the enzyme thymidylate synthase, thereby enhancing its cytotoxic effects.

Fluorouracil

Fluorouracil (5-FU) is an antimetabolite that interferes with the synthesis of DNA and RNA by inhibiting the enzyme thymidylate synthase. This inhibition prevents the formation of thymidine, a nucleotide necessary for DNA replication, leading to cell death. 5-FU is a cornerstone drug in the treatment of various cancers, including colorectal cancer.

Irinotecan

Irinotecan is a topoisomerase inhibitor that prevents DNA from unwinding and duplicating. It is a prodrug that is converted in the body to its active form, SN-38, which inhibits the enzyme topoisomerase I. This inhibition leads to DNA damage and cell death. Irinotecan is particularly effective in treating colorectal cancer when combined with other agents like 5-FU and leucovorin.

Mechanism of Action

The FOLFIRI regimen works by combining the effects of its three components to maximize cancer cell death. Folinic acid enhances the binding of 5-FU to thymidylate synthase, increasing its effectiveness. 5-FU disrupts DNA synthesis, while irinotecan causes DNA damage by inhibiting topoisomerase I. Together, these actions lead to increased apoptosis of cancer cells.

Administration

FOLFIRI is administered intravenously, typically in a hospital or clinical setting. The regimen is usually given every two weeks, with specific dosages and schedules determined by the treating oncologist based on the patient's health status and response to treatment.

Side Effects

Common side effects of FOLFIRI include:

• Diarrhea
• Nausea and vomiting
• Neutropenia (low white blood cell count)
• Alopecia (hair loss)
• Fatigue
• Mucositis

Patients receiving FOLFIRI are closely monitored for these side effects, and supportive care measures are implemented to manage them.

Clinical Use

FOLFIRI is primarily used in the treatment of metastatic colorectal cancer. It may be used as a first-line treatment or after other treatments have failed. The choice of FOLFIRI over other regimens, such as FOLFOX, depends on various factors, including the patient's overall health, previous treatments, and specific characteristics of the cancer.

Also see

• Colorectal cancer
• Chemotherapy
• FOLFOX
• Oncology