FOLFIRI+BEVA; FOLFIRI
FOLFIRI+BEVA Treatment
This handout gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
FOLFIRI+BEVA is the code name of your colorectal cancer treatment regimen.
A regimen is a combination of medications to treat cancer.
This regimen name is made up of 1 or more letters from the names of the 4 medications in your treatment.
Here are the name(s) of the medication(s) in this regimen:
FOL = FOLinic acid (also called leucovorin)
F = Fluorouracil (also called 5-FU)
IRI = IRInotecan
+
BEVA = BEVAcizumab
Treatment is divided into cycles. Each cycle is 2 weeks long. Your health care team will tell you how many cycles you need.
Here is a picture of the schedule for FOLFIRI+BEVA treatment:
Cycle 1 FOLFIRI+BEVA (2 weeks)
Repeat FOLFIRI+BEVA (2 weeks)
Your health care team will tell you how many cycles you will have.
During each 2-week cycle, you will have FOLFIRI+BEVA treatment on day 1 at the hospital. Your nurse will also start an IV of fluorouracil that will continue at home for a total of 46 hours. See below for more information.
Each cycle looks like this:
Day 1
Treatment Day:
Go to the hospital for FOLFIRI+
BEVA treatment. Fluorouracil infusion will continue for 46 hours.
2
Fluorouracil
infusion
continues
at home.
3
Fluorouracil infusion continues at home. A nurse will disconnect it.
4
No
FOLFIRI+
BEVA
Treatment
5
6
7
8
9
10
11
12
13
14
Remember To:
-
Tell your health care team about all of the other medications you are taking.
-
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
Your health care team may ask you to have a blood test to check for DPD deficiency before starting treatment.
- DPD deficiency is when you have low or no activity of an enzyme called DPD (dihydropyrimidine dehydrogenase). A deficiency can cause you to have severe side effects from fluorouracil.
- See the Testing for people taking capecitabine or 5-fluorouracil (5-FU) pamphlet for more information.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
The medications in your treatment are given through an IV (injected into a vein) at the hospital on day 1 of your treatment. You will also be given a device to take home that will continue to give you fluorouracil at home. The device looks like a bottle. It slowly gives you fluorouracil over 46 hours.
Your health care team may suggest that you get a PICC line or a Port-a-Cath.
-
These are special IV’s used to give medicines and fluids into larger veins.
-
A PICC or Port-a-Cath can be safer for some medications that can cause reactions
when given through an IV in your hand. -
If you have a PICC or Port-a-Cath you do not need an IV (needle) put into your arm
every time you come for treatment.
- Talk to your healthcare team about the benefits and risks of a PICC or a Port-a-Cath to see if one of these options is right for you.
You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.
To Prevent Nausea and Vomiting
You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
- These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), dexamethasone or others.
To Treat Diarrhea
The Irinotecan in your treatment regimen can cause diarrhea. Diarrhea is when you have loose bowel movements (watery poo) or you need to go poo (have bowel movements) more often than usual. Diarrhea may start a few days after your treatment.
You will be given a medication called loperamide (Imodium®) to help treat your diarrhea. Take this medication only if you need it.
Keep your loperamide with you all the time. When diarrhea starts, take the loperamide right away
If you start to have diarrhea
- Take 2 tablets (4mg) of loperamide right away.
- Take 1 tablet (2mg) every 2 hours after that.
- During the night you may take 2 tablets (4mg) every 4 hours.
- Keep taking loperamide until you have no diarrhea for 12 hours.
-
DO tell your health care team about any other medical conditions that you have such as heart, liver, lung or kidney problems, diabetes or any allergies.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO protect your skin from the sun. Wear a long sleeved shirt, long pants and a hat. Apply sunscreen with UVA and UVB protection and an SPF of at least 30. Your skin may be more sensitive to the sun and you could develop a bad sunburn or rash more easily.
-
DO talk to your health care team about your risk of heart problems with this treatment.
-
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products, without checking with your health care team.
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DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
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DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
-
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
-
DO tell your health care team about any other medical conditions that you have such as heart, liver, lung or kidney problems, diabetes or any allergies.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO protect your skin from the sun. Wear a long sleeved shirt, long pants and a hat. Apply sunscreen with UVA and UVB protection and an SPF of at least 30. Your skin may be more sensitive to the sun and you could develop a bad sunburn or rash more easily.
-
DO talk to your health care team about your risk of heart problems with this treatment.
-
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products, without checking with your health care team.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
-
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- natural health products such as vitamins, herbal teas, homeopathic medicines and other supplements
Check with your health care team before starting or stopping any of them.
If you are taking seizure medications (such as phenytoin), your health care team will monitor your blood levels closely and may change your dose.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Supplements such as vitamin C
- Alcoholic drinks
- Tobacco
- All other drugs, such as marijuana (medical or recreational)
-
Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
-
Fever can be a sign of infection that may need treatment right away.
-
If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
-
How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
-
You have a fever if your temperature taken in your mouth (oral temperature) is:
-
38.3°C (100.9°F) or higher at any time
-
-
OR
-
38.0°C (100.4°F) or higher for at least one hour.
-
If you do have a fever:
-
Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
-
Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
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How this treatment may affect your sexual health.
-
How this treatment may affect your ability to have a baby, if this applies to you.
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time while you are on treatment. Talk to your health care team about which birth control options are best for you, and how long you should use them after your last treatment dose.
- Do not breastfeed while on this treatment. Talk to your health care team about how long to wait before you start breastfeeding after your last treatment dose, if this applies to you.
The following table lists side effects that you may have when getting FOLFIRI+BEVA treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Keep this information during your treatment, so that you can refer to it if you need to.
It is common for people who are treated with FOLFIRI+BEVA to have mild side effects only.
Very Common Side Effects (50 or more out of 100 people) | |
Side effects and what to do | When to contact health care team |
Low neutrophils (white blood cells) in the blood (neutropenia)(May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for:
You have a fever if your temperature taken in your mouth (oral temperature) is:
OR
What to do:If your health care team has told you that you have low neutrophils:
If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away.
|
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away. |
Low platelets in the blood(May be severe) When your platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for:
What to do:If your health care team has told you that you have low platelets:
|
Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency medical help right away. |
Anemia (low red blood cells)(May be severe) What to look for:
|
Talk to your health care team if it does not improve or if it is severe |
Nausea and vomiting(Generally mild) What to look for:
|
Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe |
FatigueWhat to look for:
What to do:
Ask your health care team for the Fatigue pamphlet for more information.
|
Talk to your health care team if it does not improve or if it is severe |
Hair thinning or loss(Generally mild) What to look for:
|
Talk to your health care team if this bothers you |
Low Appetite, weight lossWhat to look for:
What to do:
See our Loss of Appetite pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
Diarrhea and other early side effects of irinotecan that start during treatment or within 24 hours What to look for:
|
Tell your health care team right away if you have any of these symptoms |
Diarrhea that starts more than 24 hours after treatment.
What to look for:If you have diarrhea:
Ask your health care team for the Diarrhea pamphlet for more information. |
Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in 1 day) |
Common Side Effects (25 to 49 out of 100 people) | |
Side effects and what to do | When to contact health care team |
High blood pressureWhat to look for:
What to do:
If you have a severe headache get emergency help right away as it may be a sign your blood pressure is too high. |
Talk to your health care team if it does not improve or if it is severe |
Proteins in Urine (pee)Your health care team may do urine tests to check for proteins in your pee.
|
Talk to your health care team if it does not improve or if it is severe |
Headache, mild joint, muscle pain or crampsWhat to look for:New pain in your muscles or joints, muscle cramps, or feeling achy.
|
Talk to your health care team if it does not improve or if it is severe |
Liver problemsYour health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms.
|
Get emergency medical help right away |
ConstipationWhat to look for:
|
Talk to your health care team if it does not improve or if it is severe |
Mouth soresWhat to look for:
|
Talk to your health care team as soon as you notice mouth or lip sores, or if it hurts to eat, drink or swallow |
Eye problemsWhat to look for:
|
Talk to your health care team as soon as possible |
Less Common Side Effects (10 to 24 out of 100 people) | |
Side effects and what to do | When to contact health care team |
Rash; dry, itchy skinWhat to look for:
|
Talk to your health care team if it does not improve or if it is severe |
Trouble SleepingYour medications may cause trouble sleeping. It may get better once your body gets used to the medication or when your treatment ends. What to look for:
What to do:Talk to your health care team if it does not improve or if it is severe. |
Talk to your health care team if it does not improve or if it is severe |
Blood clotsWhat to look for:
A blood clot in your lungs can cause: coughing, problems breathing, pain in your chest or coughing up blood A blood clot in your brain (stroke) can cause: trouble seeing, speaking, or using your arms and legs A blood clot in your heart (heart attack) can cause: chest pain, shortness of breath and pain in your belly or arms
|
Get emergency medical help right away |
Swelling inside your noseWhat to look for:
What to do:Talk to your health care team if it does not improve or if it is severe. |
Talk to your health care team if it does not improve or if it is severe |
DizzinessWhat to look for:
What to do:
|
Talk to your health care team if it does not improve or if it is severe |
Cough and feeling short of breathWhat to look for:
|
Talk to your health care team. If you are not able to talk to your health care team for advice, and you have a fever or severe symptoms, you MUST get emergency medical help right away. |
Heart problemsWhat to look for:
What to do:Get emergency medical help right away. |
Get emergency medical help right away |
Rash on your hands and feet (hand-foot syndrome)What to look for:
|
Talk to your health care team if it does not improve or if it is severe |
Heartburn, upset stomach and bloatingWhat to look for:
|
Talk to your health care team if it does not improve or if it is severe |
FlushingWhat to look for:
What to do:Talk to your health care team if no improvement or if severe. |
Talk to your health care team if it does not improve or if it is severe |
Speech problemsWhat to look for:
What to do:Talk to your health care team if no improvement or if severe. |
Talk to your health care team if it does not improve or if it is severe |
Mild swelling What to look for:
What to do:To help prevent swelling:
If you have swelling:
|
Talk to your health care team if it does not improve or if it is severe |
Other rare, but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
- Signs of allergic reaction: flushing, itchiness, rash, swollen lips, face or tongue, wheezing, chest and throat tightness
- Severe belly pain
- Any new teeth or mouth pain and swelling, mouth sores that do not heal, unusual discharge from gums, loosening of teeth and the feeling of numbness or heaviness in the jaw
- Severe headache, passing out (fainting)
- Confusion, seizures
- Any changes to your vision
- Severe weakness, problems with your balance or have falls
- Unusual muscle spasms, tremors, irregular or jerky movements
- Redness or rash in areas where you had radiation before
- Red-brown coloured pee
- Wounds that take longer than normal to heal or don’t fully heal
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
December 2023 Updated "How will this treatment affect sex, pregnancy and breast feeding?" section
For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.
The information set out in the medication information sheets, regimen information sheets, and symptom management information(for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.
A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.