Generally the combo regimen Folfirinox is used in individuals age 70 and under unless the patients physical assessment score is ECOG 2 or greater, frailty that may result from co-morbidities of significance. In patients over age 70 who have an ECOG physical assessment score of 0-1, they can usually tolerate Folfirinox. There are a number of anti-emetic and inti-diarrheal agents taken proactively, during and for a few days following disconnection from the infusion pump of 5-Fluorouricil ameliorates or prevents side effects leading to a better patient experience.

In getting 5-FU and Irinotecan (Folfiri), it is the irinotecan which causes diarrhea as it’s side effect. For many people, Imodium is enough to ameliorate it. For me, it had no effect so I was prescibed Rx anti-diarrheals. The ones that worked for me were Loperimide which is the Rx form of Imodium, Lomax, Lomotil and the genetic diphenoxylate atropine. I would take between 24-36 hours prior to the start of chemotherapy until three days following disconnection of the pump provided sufficient amelioration of symptoms. When I was finally prescribed a pancrealipase (Creon), that took are or residual diarrhea caused by an insufficiency of digestive enzymes many patients experience with tumors in the pancreas-particularly in the head.

There is leeway in reducing the concentration of both 5-FU and the irinotecan components for better tolerability. Another dosing technique is called metronomic dosing. This is particularly helpful in older patients for providing better tolerability and I know of several octogenarians that found the technique better tolerated. The concentrations are lowered but the infusions are more frequent to result in therapeutic benefit. It is often used in trying to get a patient through neoadjuvant chemo with the goal of having Whipple resection.

I was on the 5 fu irinotecan oxaliplatin combo for my pancreatic cancer. It wiped me out. I was then diagnosed with Mets to my liver and placed on g/a. I weathered the treatment well, however, the side effects were almost deadly. My weight went from 128 lbs to 172lbs in 3 months. Ended up with acute renal failure, on dialysis, and several new blood pressure medications.