Folfirinox is the current “gold standard” in first-line treatment for pancreatic cancer. The pump that is taken home does a slow infusion of 5-Fluorouricil (5-FU) over 46 hours. The first chemo agent administered after pre-meds is Oxaliplatin (brand name Eloxatin). Besides it’s own cytotoxic effects to malignant cells, it acts as a sensitizer and enhances the killing effects of Irinotecan and the 5-FU.

The side effects of Oxaliplatin are cumulative and continue to become more intense for a few months after chemo is completed. I advocated to do more than 12 cycles because I was being treated for metastatic disease and minimal residual disease is a significant concern should one achieve the goal of “No Evidence of Disease” (NED). Permanent peripheral nerve damage would have occurred taking 24 cycles if administered continuously. Even at 12 continuous cycles, neuropathy can be permanent or last a considerable amount of time. In 2012 when I began treatment, my oncologist took permanent neuropathy into consideration because of doing more aggressive chemo as a curative goal.I would get six cycles of Folfirinox over 3 months every 15th day when a new cycle began and then it was alternated with six cycles of 5-FU/Leucovorin to allow my body to recover- especially the peripheral nerves. Although I experienced neuropathy, it was not permanent although the feet took many years to fully resolve.

Since my treatment that ended in 2014 having been very successful, a technique called “cold therapy” was first used by patients with colon cancer as oxaliplatin is also used in that setting. By using chilled gel-lined gloves and booties for hands and feet worn 5-10 minutes before infusion of oxaliplatin, it constricts the capillaries and prevents concentrated drug to reach peripheral nerves of the hands/fingers, feet and toes, thus preventing damage. Holding ice chips in the mouth serves the same purpose and prevents cold sensitivity when eating cold food and drinking chilled beverages.

In my role as a patient research advocate I attend many pancreatic cancer meetings in person and via teleconference. I have a lot of contact with leading pancreatic cancer oncologists and their N.P.’s. They are becoming receptive to the benefits of cold therapy and how it provides for a better patient experience, improves quality of life and helps patients at least tolerate the standard of care 12 cycles. The anecdotal observations on its effectiveness led to a phase II trial that was very successful. A phase III trial with a very large cohort is currently in progress. Major high-volume pancreatic cancer centers have recognized the benefits of cold therapy such as MSKCC and Medical College of Wisconsin/Froedert Hospital.

Below are a number of links describing the purpose of the technique and how it is administered. It is best started at the initial treatment cycle before any neuropathic damage to nerves occurs. I wish it was available to me 11 years ago. I would have done it in a heartbeat. Neuropathy was no fun when I experienced it.

NEUROPATHY PREVENTION WHEN TAKING FOLFIRINOX/ICING

LetsWinPC.org feature story on cold therapy
https://letswinpc.org/disease-management/ice-prevent-neuropathy/
https://www.uspharmacist.com/article/ice-chips-prevent-hyperalgesia-with-oxaliplatin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810270/
https://learn.colontown.org/topic/managing-neuropathy-and-cold-sensitivity/
https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.e16140
https://paltown.org/icing/
https://letswinpc.org/research/more-research-needed-for-neuropathy/
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-cold-cap-therapy-can-reduce-hair-loss-caused-by-chemotherapy/