FOLFIRI+BEVA; FOLFIRI

Langue Anglais

Regimen Monograph References:

Bevacizumab, fluorouracil and irinotecan drug monographs, Cancer Care Ontario.

André T, Louvet C, Maindrault-Goebel F, et al: CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-infusion 5-fluorouracil (FOLFIRI) for pretreated metastatic colorectal cancer. GERCOR. Eur J Cancer 35:1343-1347, 1999.

Clinical Practice Guidelines in Oncology (NCCN Guidelines). Colon Cancer. Version 3.2015. NCCN.org

Douillard JY, Cunningham D, Roth AD et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomized trial. The Lancet, March 2000; 355: 1041-47.

Hurwitz H, Fehrenbacher L, Novotny W et al. Bevacizumab plus irinotecan, fluorouracil and leucovorin in metastatic colorectal cancer. N Engl J Med. 2004; 350: 2335-42.

Mahfoud T, Tanz R, Mesmoudi M, et al. Bevacizumab 5 or 7.5 mg/kg in Metastatic Colorectal Cancer Can Be Infused Safely Over 10 Minutes. J Gastrointest Cancer. 2011 Jan 4. [Epub ahead of print] Reidy DL, Chung KY, Timoney JP, et al. Bevacizumab 5 mg/kg can be infused safely over 10 minutes. J Clin Oncol. 2007;25(19):2691-5.

National Comprehensive Cancer Network. Colon Cancer (Version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accesse....

Reidy DL, Chung KY, Timoney JP, et al. Bevacizumab 5 mg/kg can be infused safely over 10 minutes. Journal of Clinical Oncology 2007; 25: 2691-5.

Sobrero A, Ackland S, Clarke S, et al. Phase IV Study of Bevacizumab in Combination with Infusional Fluorouracil, Leucovorin and Irinotecan (FOLFIRI) in First-Line Metastatic Colorectal Cancer. Oncology 2009; 77: 113-9.

Tournigand C, André T, Achile E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004; 22(2): 229-37.

Van Cutsem E, Rivera F, Berry S, et al. Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 2009; 20: 1842-7.

Zaanan A, Costes L, Gaauthier M et al. Chemotherapy of advanced small-bowel adenocarcinoma: a multicentre AGEO study. Ann Oncol 2010; 21: 1786-93.

Cancer Type: Gastrointestinal Colorectal Small bowel and appendix Type of Content: Regimen Regimen Code:

FOLFIRI

FOLFIRI+BEVA

Intent: Palliative Regimen Category:

Evidence-Informed

Funding Program:

New Drug Funding Program

Funding Instance:

Bevacizumab (Biosimilar) - Metastatic Colorectal, Small Bowel, or Appendiceal Cancer Drugs Used: irinotecan leucovorin fluorouracil fluorouracil bevacizumab Regimen Monograph Name:

FOLFIRI ± BEVA_GI_COL_P

Regimen Monograph Body:

Regimen Monograph

A - Regimen Name

FOLFIRI Regimen

Folinic Acid (Leucovorin)-Fluorouracil-Irinotecan

FOLFIRI+BEVA Regimen

Folinic Acid (Leucovorin)-Fluorouracil-Irinotecan-Bevacizumab

Disease Site

Gastrointestinal

Colorectal
Small bowel and appendix

Intent

Palliative

Regimen Category

Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR). Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.

Rationale and Uses

Treatment of metastatic colorectal, small bowel or appendiceal cancer

Supplementary Public Funding

bevacizumab
New Drug Funding Program (Bevacizumab (Biosimilar) - Metastatic Colorectal, Small Bowel, or Appendiceal Cancer) (NDFP Website )

B - Drug Regimen

Different bevacizumab products are not interchangeable.

irinotecan

180 mg /m²

IV over 90 minutes

Day 1

leucovorin

400 mg /m²

IV over 120 minutes concurrently with irinotecan

Day 1

fluorouracil

400 mg /m²

IV bolus, after leucovorin

Day 1

THEN

fluorouracil

2400 mg /m²

IV continuous infusion over 46 hours only

Start on Day 1

with or without:

bevacizumab

^{3, 4}

5 mg /kg

IV over 90 minutes for initial dose

Day 1

Irinotecan and leucovorin may be infused at the same time by using a y-connector, but not in the same bag, then fluorouracil.
¹Commercially available form is d,l-racemic. Some studies specified the dose of leucovorin as 200mg/m² in the l-isomer form. Since only the l-isomer is active in the racemic form, thus the dose is doubled.
² Dose may be escalated to 3000 mg/m² if toxicity ≤ grade 1 during the first two cycles.
³ If tolerated, next infusion can be given over 60 minutes; can thereafter be given over 30 minutes as maintenance dose. Alternative administration rates have been described by Mahfoud et al and Reidy et al, but these have not been approved by Health Canada.
⁴ Sequence of administration: Bevacizumab has been given prior to chemotherapy in several phase III clinical trials.

C - Cycle Frequency

REPEAT EVERY 14 DAYS

Until evidence of disease progression or unacceptable toxicity

D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate

Other Supportive Care:

Irinotecan:
Unless contraindicated, atropine 0.25-1mg IV/SC may be used for cholinergic adverse effects (early diarrhea)
Diarrhea (abdominal cramp = diarrhea) may be severe and delayed with irinotecan; use loperamide 4mg at the onset of diarrhea, then 2mg q2h until patient is diarrhea-free for 12 hours
Patients with ileus, fever or febrile neutropenia should receive antibiotics

5FU:
May advise patients to suck on ice chips during bolus injection of 5FU, to reduce stomatitis

Also refer to CCO Antiemetic Summary

E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated.

Patients should be tested for DPD deficiency before starting treatment with fluorouracil. Refer to the DPD Deficiency Guidance for Clinicians for more information.

In patients with unrecognized DPD deficiency, acute, life-threatening toxicity may occur; if grade 2-4 acute toxicity develops, treatment should be stopped immediately and permanent discontinuation considered based on clinical assessment of the toxicities.

Refer to bevacizumab drug monograph for additional details on bevacizumab.

Dosage with toxicity

See general recommendations for hematologic toxicity.

FOLFIRI

Patients should not be re-treated with irinotecan until recovery (to baseline) from GI toxicity (without loperamide for at least 24 hours) has occurred, platelets ≥ 100 x 10⁹/L, and ANC ≥ 1.5 x 10⁹/L. All dose adjustments should be based on the worst preceding toxicity.

Patients with ileus, fever or febrile neutropenia should receive antibiotics.

Do not use in patients with ECOG PS of 3 or 4, nor in patients with moderate or severe increases in bilirubin.

Consider a reduction in the starting dose described below for elderly patients (≥ 70 years), patients with prior abdominal or pelvic irradiation, patients with a poor performance status (ECOG of 2), patients with mild increases in bilirubin (including Gilbert’s syndrome), patients homozygous for UGT1A1*28 allele or patients with a history of myelosuppression with previous treatment.

Suggested Dose Levels:

Regimen	Drug	Starting dose (mg/m²)	Dose level -1 (mg/m²)	Dose Level -2 (mg/m²)
FOLFIRI	Irinotecan	180	150	120
	Leucovorin infusion	400	No change	No change
	5-FU bolus	400	320	240
	5-FU infusion (start day 1 over 46h*)	2400	2000	1600

_{* This 5-FU dosing is not approved by Health Canada, but has been used in some phase III trials.}

Dosage with Toxicity:

Dose Adjustments for Irinotecan in Combination with Fluorouracil:

Worst Toxicity Grade from Previous Cycle		At the start of subsequent cycles^{1, 2}(FOLFIRI)
Hematologic
Grade 1		No change
Grade 2		No change
Grade 3		reduce by 1 dose level
Grade 4 or febrile neutropenia		reduce by 2 dose levels
Diarrhea
Grade 1: 2-3/day > pre-treatment		No change
Grade 2: 4-6/day > pre-treatment		No change
Grade 3: 7-9/day > pre-treatment		reduce by 1 dose level
Grade 4: ≥10/day > pre-treatment		reduce by 2 dose levels
Other Non-hematologic toxicities (excludes alopecia, anorexia and fatigue). For mucositis/stomatitis, decrease 5FU only.
Grade 1	No change
Grade 2	Hold until ≤ grade 1, no change in dose
Grade 3	Hold until ≤ grade 2, reduce by 1 dose level
Grade 4	Hold until ≤ grade 2, reduce by 2 dose levels
¹_{Relative to the starting dose used in the previous cycle.}²_{Patients should not be retreated until GI toxicity resolved to baseline (without loperamide for at least 24 h), platelets ≥ 100 x 10}⁹_{/L, and ANC ≥ 1.5 x 10}⁹_{/L. If no recovery after a 2-week delay, consider discontinuing treatment.}

Hepatic Impairment

No dose adjustment required for leucovorin. OMIT leucovorin if 5FU is omitted.

Transaminases	Bilirubin	Irinotecan	5FU
	1-1.5 X ULN or Gilbert's	Consider ↓	No change
> 3 X ULN*	2-4 X ULN	Omit	No change
	> 4 XULN	Omit	Omit
^{* or 5 X ULN with liver metastases; consider investigating for reversible causes such as biliary obstruction and reevaluate after stent}

Renal Impairment

No dose adjustment required for leucovorin.

Creatinine Clearance (mL/min)	Fluorouracil (% previous dose)	Irinotecan (% previous dose)
>60	No change	No change
30-60	No change	Caution; no data available
<30	Caution; consider dose ↓	Caution; no data available

Dosage in the elderly

Consider reducing starting dose for patients ≥ 70 years. Monitor patients ≥ 65 years closely.

F - Adverse Effects

Refer to irinotecan, leucovorin, fluorouracil (± bevacizumab) drug monograph(s) for additional details of adverse effects

The following adverse effects table is related to FOLFIRI+BEVA:

Very common (≥ 50%)

Common (25-49%)

Less common (10-24%)

Uncommon (< 10%),

but may be severe or life-threatening

Myelosuppression ± infection, bleeding (may be severe)
Nausea, vomiting
Fatigue
ECG changes (asymptomatic)
Alopecia (generally mild)
Abdominal pain
Anorexia, weight loss
Diarrhea (may be severe)

Hypertension
Proteinuria
Headache
↑ LFTs
Constipation
Mucositis
Cholinergic symptoms
Conjunctivitis and / or tearing

Rash / dry skin
Insomnia
Venous thromboembolism
Rhinitis
Dizziness
Musculoskeletal pain
Cough, dyspnea
Cardiotoxicity
Hand-foot syndrome
Dyspepsia
Flushing
Dysphonia
Edema

Arterial thromboembolism
Hypersensitivity
Delayed wound healing / dehiscence
GI perforation, ulceration, obstruction
Fistula, organ perforation
Ataxia / acute cerebellar syndrome
Bradycardia
Confusion
Dysarthria
Arrhythmia
Extrapyramidal or cortical dysfunction
Hemolysis
Leukoencephalopathy
Necrotizing fasciitis
Optic neuritis, oculomotor disturbance, tear duct fibrosis
Osteonecrosis of jaw and other
Pancreatitis
Pneumonitis
Pulmonary hypertension
Radiation recall reaction, photosensitivity
Renal failure
RPLS / PRES
Thrombotic microangiopathy

G - Interactions

Refer to irinotecan, leucovorin, fluorouracil drug monograph(s) for additional details

Refer to bevacizumab drug monograph for additional details on bevacizumab.

H - Drug Administration and Special Precautions

Refer to irinotecan, leucovorin, fluorouracil drug monograph(s) for additional details

Different bevacizumab products are not interchangeable.

Refer to bevacizumab drug monograph for additional details on bevacizumab.

I - Recommended Clinical Monitoring

Refer to bevacizumab drug monograph for additional details on bevacizumab
Treating physicians may decide to monitor more or less frequently for individual patients but should always consider recommendations from the product monograph.

Recommended Clinical Monitoring

CBC, electrolytes, liver & renal function tests; baseline and before each cycle
Clinical toxicity assessment (including diarrhea, infection, dehydration, stomatitis, nausea and vomiting, fatigue and cardiac effects); at each visit
Close monitoring of above parameters in elderly patients and patients who are receiving pelvic radiotherapy.
Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

Suggested Clinical Monitoring

Blood glucose, especially in patients with diabetes; baseline and regular

J - Administrative Information

Approximate Patient Visit

FOLFIRI

3 hours

FOLFIRI+BEVA

First cycle: 4.5 hours; Second cycle: 4 hours; Subsequent cycles: 3.5 hours

Pharmacy Workload (average time per visit)

FOLFIRI

37.403 minutes

FOLFIRI+BEVA

43.916 minutes

Nursing Workload (average time per visit)

FOLFIRI

61.667 minutes

FOLFIRI+BEVA

75.333 minutes

K - References

Bevacizumab, fluorouracil and irinotecan drug monographs, Cancer Care Ontario.

Clinical Practice Guidelines in Oncology (NCCN Guidelines). Colon Cancer. Version 3.2015. NCCN.org

Hurwitz H, Fehrenbacher L, Novotny W et al. Bevacizumab plus irinotecan, fluorouracil and leucovorin in metastatic colorectal cancer. N Engl J Med. 2004; 350: 2335-42.

National Comprehensive Cancer Network. Colon Cancer (Version 2.2017). https://www.nccn.org/professionals/physician_gls/pdf/colon.pdf. Accessed June 30, 2017.

Reidy DL, Chung KY, Timoney JP, et al. Bevacizumab 5 mg/kg can be infused safely over 10 minutes. Journal of Clinical Oncology 2007; 25: 2691-5.

Tournigand C, André T, Achile E, et al. FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 2004; 22(2): 229-37.

Zaanan A, Costes L, Gaauthier M et al. Chemotherapy of advanced small-bowel adenocarcinoma: a multicentre AGEO study. Ann Oncol 2010; 21: 1786-93.

PEBC Advice Documents or Guidelines

April 2023 Updated DPD deficiency information in the Dose Modifications section and fluorouracil antidote information in the Other Notes section.

L - Other Notes

Diarrhea can be severe, with either immediate or delayed onset. Patients must be instructed in the use of Loperamide as treatment for diarrhea, and must have a supply of this drug upon starting Irinotecan treatments.

Antidote for Fluorouracil Overdose:

Uridine triacetate is a prodrug of uridine and is a specific antidote for treating fluorouracil overdose or severe early onset toxicities. If available, consider administering as soon as possible (i.e. within 96 hours) for suspected overdose. If not available, treatment is symptomatic and supportive.

For usage approval and supply, contact Health Canada’s Special Access Program (SAP) (Phone: 613-941-2108. On-call service is available for emergencies). Uridine triacetate (Vistogard®) is supplied by its manufacturer in the United States (Wellstat Therapeutics).

The recommended dosing and administration for uridine triacetate in patients ≥18 years is:

10 grams (1 packet of coated granules) orally every 6 hours for 20 doses in total, without regards to meals.
Granules should not be chewed. They should be mixed with 3 to 4 ounces of soft foods such as applesauce, pudding or yogurt.
The dose should be ingested within 30 minutes of preparation, followed by at least 4 ounces of water.
Refer to the prescribing information on dose preparation for NG-tube or G-tube use.

Additional resources on the management of fluorouracil infusion overdose:

Management of Fluorouracil Infusion Overdose Guideline (Alberta Health Services)
Management of Fluorouracil Infusion Overdose at the BCCA - Interim Guidance (BC Cancer Agency)

M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph. Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for 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.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.

Regimen Info Sheet Name: FOLFIRI (Colorectal) Regimen Info Sheet Name 2: FOLFIRI+BEVA (Colorectal) Regimen Info Sheet Body:

FOLFIRI 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.

Who do I contact if I have questions or need help?

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.

What is this treatment?

FOLFIRI 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 one or more letters from the names of the 3 medications in your treatment.

Here are the names of the medications in this regimen:

FOL = FOLinic acid (also called leucovorin)

F = Fluorouracil (also called 5-FU)

IRI = IRInotecan

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 treatment:

Cycle 1

FOLFIRI

(2 weeks)

Repeat 

FOLFIRI

(2 weeks)

Your health care 
team will tell you
how many cycles 
you will have.

During each 2-week cycle, you will have FOLFIRI treatment on day 1 at the hospital. Your nurse will also start an infusion (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 treatment.
Fluorouracil infusion will
continue for 46 hours.

Fluorouracil infusion continues at home.

Fluorouracil infusion continues at home. A nurse will disconnect it.

FOLFIRI

Treatment

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.

How is this treatment given?

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.

What other medications are given with this 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 have bowel movements (go poo) 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 (4 mg) of loperamide right away.
Take 1 tablet (2 mg) every 2 hours after that.
During the night you may take 2 tablets (4 mg) every 4 hours.
Keep taking loperamide until you have no diarrhea for 12 hours.

DO this while on treatment

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 getting other cancers and 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 do this while on treatment

Stop Icon

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.

DO this while on treatment

Check Mark Icon

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 getting other cancers and 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 do this while on treatment

Stop Icon

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.

Will this treatment interact with other medications or natural health products?

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.

Talk to your health care team BEFORE taking or using these :

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 or cannabis (medical or recreational)

What should I do if I feel unwell, have pain, a headache or a fever?

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.

How will this treatment affect sex, pregnancy and breast feeding?

Talk to your health care team about:

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.

What are the side effects of this treatment?

The following table lists side effects that you may have when getting FOLFIRI 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 paper during your treatment so that you can refer to it if you need to.

It is common for people who are treated with FOLFIRI 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? If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol® (acetaminophen), or Advil® (ibuprofen)). Do not eat or drink anything hot or cold right before taking your temperature. 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. What to do? If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. 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 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? Watch for signs of bleeding: bleeding from your gums unusual or heavy nosebleeds bruising easily or more than normal black coloured stools (poo) or blood in your stools (poo) coughing up red or brown coloured mucus dizziness, constant headache or changes in your vision heavy vaginal bleeding red or pink coloured urine (pee) What to do? If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your health care team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (saltwater) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	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? You may feel more tired or weaker than normal. Pale skin and cold hands and feet. You may feel short of breath, dizzy or lightheaded. This may occur in days to weeks after your treatment starts. What to do? If your health care team has told you that you have anemia (low red blood cells): Rest often and eat well. Light exercise, such as walking may help. You may need medication or a blood transfusion. If it is very bad, your doctor may need to make changes to your treatment regimen.	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? Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do? To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. If you were given anti-nausea medication(s), take them as prescribed, even if you do not feel like throwing up. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: nausea lasts more than 48 hours vomiting lasts more than 24 hours or if it is severe	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
Fatigue What to look for? Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do? Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise. Pace yourself, do not rush. Put off less important activities. Rest when you need to. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. 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 What to look for? Your hair may become thin or fall out during or after treatment. In most cases, your hair will grow back after treatment. The texture or colour may change. In very rare cases, hair loss may be permanent. What to do? Use a gentle soft brush. Do not use hair sprays, bleaches, dyes and perms.	Talk to your health care team if this bothers you
Low appetite, weight loss What to look for? Loss of interest in food or not feeling hungry. Weight loss. What to do? Try to eat your favourite foods. Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite. Ask your health care team for the 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? Loose, watery, unformed stool (poo) Some other symptoms you may have include sweating a lot, belly cramps, runny nose, watery eyes, more saliva (spit) in your mouth than usual, redness (flushing) on your face or neck. What to do? Let your healthcare team know right away if this happens. Medication(s) may be given to you to control these symptoms	Tell your health care team right away if you have any of these symptoms
Diarrhea that starts more than 24 hours after treatment. Loose, watery, unformed stool (poo) Diarrhea may be severe in some cases and it might cause dehydration (when your body doesn’t have enough water) What to do? If you have diarrhea: Take the loperamide (Imodium®) that your health care team prescribed or told you to take. Do not have foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol. Eat many small meals and snacks instead of 2 or 3 large meals. Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less. Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy. Talk to your health care team if your diarrhea does not get better after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in one day. 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 one day)

Common Side Effects (25 to 49 out of 100 people)
Side effects and what to do	When to contact health care team
Liver problems Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms. What to look for? Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe. What to do? If you have any symptoms of liver problems, get emergency medical help right away.	Get emergency medical help right away
Constipation What to look for? Having bowel movements (going poo) less often than normal. Small hard stools (poo) that look like pellets. The need to push hard and strain to have any stool (poo) come out. Stomach ache or cramps. A bloated belly, feeling of fullness, or discomfort. Leaking of watery stools (poo). Lots of gas or burping. Nausea or vomiting. What to do? To help prevent constipation: Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains. Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less. Be Active. Exercise can help to keep you regular. If you take opioid pain medication, ask your health care team if eating more fibre is right for you. To help treat constipation: If you have not had a bowel movement in 2 to 3 days you may need to take a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do. Ask your health care team for the Constipation Pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Mouth sores What to look for? Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard to swallow, eat or brush your teeth. They may last for 3 days or longer. What to do? To help prevent mouth sores: Take care of your mouth by gently brushing and flossing regularly. Rinse your mouth often with a homemade mouthwash. To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water. Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth. If you have mouth sores: Avoid hot, spicy, acidic, hard or crunchy foods. Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection. Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow. Ask your health care team for the Oral Care (Mouth Care) pamphlet for more information.	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 problems What to look for? Your eyes may feel dry, irritated, or painful. They may look red and have a lot of tears. They may feel sensitive to light and your vision may be blurry. What to do? Avoid wearing contact lenses. Wear sunglasses with UV protection. Use protective eyewear (goggles or helmet with face mask) when playing sports, mowing the lawn or doing anything that may get particles or fumes in your eyes. You may try artificial tears (eye drops) or ointment.	Contact 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
Cough and feeling short of breath (May be severe) What to look for? You may have a cough and feel short of breath. Symptoms that commonly occur with a cough are: wheezing or a whistling breathing runny nose sore throat heartburn weight loss fever and chills Rarely this may be severe with chest pain, trouble breathing or coughing up blood. What to do? Check your temperature to see if you have a fever. Read the above section "What should I do if I feel unwell, have pain, a headache or a fever?". If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away. If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away.	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
Rash; dry, itchy skin What to look for? You may have cracked, rough, flaking or peeling areas of the skin. Your skin may look red and feel warm, like a sunburn. Your skin may itch, burn, sting or feel very tender when touched. The rash may be seen in areas where you have had radiation before. What to do? To prevent and treat dry skin: Use fragrance-free skin moisturizer. Protect your skin from the sun and the cold. Use sunscreen with UVA and UVB protection and a SPF of at least 30. Avoid perfumed products and lotions that contain alcohol. Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less. Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.	Talk to your health care team if it does not improve or if it is severe
Trouble Sleeping Your 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? You may find it hard to fall asleep or stay asleep. How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep. You may wake up too early or not feel well-rested after a night's sleep. You may feel tired or sleepy during the day. 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
Headache; Mild joint, muscle pain or cramps What to look for? Mild headache New pain in your muscles or joints, muscle cramps, or feeling achy What to do? Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed. Read the above section: "What should I do if I feel unwell, have pain, a headache or a fever?" before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding. Rest often and try light exercise (such as walking) as it may help. Ask your health care team for the Pain pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Swelling inside your nose You may have a stuffy, sneezy, itchy, runny nose. What to do? Talk to your healthcare team if it does not improve or if it is severe.	Talk to your healthcare team if it does not improve or if it is severe
Dizziness What to look for? You may feel light-headed and like you might faint (pass out). What to do? Lay down right away so you do not fall. Slowly get up and start moving once you feel better. Do not drive a motor vehicle or use machinery if you feel dizzy.	Talk to your health care team if it does not improve or if it is severe
Rash on your hands and feet (hand-foot syndrome) What to look for? Tingling or swelling of the skin on the palms of your hands and the bottoms of your feet. This can become painful, red and numb. In worse cases your skin may start to peel and you can get blisters or sores. This may happen days or weeks after you start treatment What to do? To help prevent Hand-foot syndrome: Do not do activities that cause rubbing or pressure on your skin, like heavy-duty washing, gripping tools, typing, playing musical instruments, and driving. Moisturize your hands and feet often, especially in the skin folds. Wear loose, comfortable footwear and clothes. Rest and try to keep off your feet. Do not let your hands and feet get too hot. Ask your health care team for the Hand-foot syndrome pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Flushing What to look for? Your face may feel warm and the skin on your neck, upper chest, or face may quickly get red. 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
Heartburn; upset stomach; bloating What to look for? Pain or burning in the middle or top part of your chest. It may get worse when you are lying down or bending over or when you swallow. A bitter or acidic taste in your mouth. What to do? Drink clear liquids and eat small meals. Do not eat acidic, fatty or spicy foods. Limit caffeine (like coffee, tea) and avoid alcohol. Avoid smoking or being around tobacco. Sit up or stand after eating. Do not lie down. Raise the head of your bed six to eight inches. You may need to use extra pillows to do this.	Talk to your health care team if it does not improve or if it is severe
Mild swelling What to look for? You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe. What to do? To help prevent swelling: Eat a low-salt diet. If you have swelling: Wear loose-fitting clothing. For swollen legs or feet, keep your feet up when sitting.	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:

Severe belly pain
Severe headache, passing out (fainting)
Confusion, seizures
Any changes in your vision (eye sight)
Coughing up blood or trouble breathing
Pain and swelling of a vein in your arm or leg
Severe weakness, problems with your balance, or have falls
Unusual muscle spasms, tremors, irregular or jerky movements
Signs of allergic reaction: flushing, itchiness, rash, swollen lips, face or tongue, wheezing, chest and throat tightness
Unusual weight gain
Passing very little or no pee
Red-brown coloured pee

For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.

Notes

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.

Regimen Info Sheet Body 2:

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 information does not replace the advice of your health care team. Always talk to your health care team about your treatment.

Who do I contact if I have questions or need help?

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 does not replace the advice of your health care team. Always talk to your health care team about your treatment.

What is this 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.

Fluorouracil
infusion
continues
at home.

Fluorouracil infusion continues at home. A nurse will disconnect it.

No
FOLFIRI+
BEVA
Treatment

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.

How is this treatment given?

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.

What other medications are given with this 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 this while on treatment

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 do this while on treatment

Stop Icon

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.

DO this while on treatment

Check Mark Icon

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 do this while on treatment

Stop Icon

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.

Will this treatment interact with other medications or natural health products?

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.

Talk to your health care team BEFORE taking or using these :

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)

What should I do if I feel unwell, have pain, a headache or a fever?

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 if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.

How will this treatment affect sex, pregnancy and breast feeding?

Talk to your health care team about:

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.

What are the side effects of this treatment?

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: If you feel hot or unwell (for example if you have chills or a new cough), you must check your temperature to see if you have a fever. Do not take medications that treat a fever before you take your temperature (for example, Tylenol® (acetaminophen), or Advil® (ibuprofen)). Do not eat or drink anything hot or cold right before taking your temperature. 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 1 hour. What to do: If your health care team has told you that you have low neutrophils: Wash your hands often to prevent infection. Check with your health care team before getting any vaccines, surgeries, medical procedures or visiting your dentist. Keep a digital thermometer at home so you can easily check for a fever. 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: Watch for signs of bleeding: Bleeding from your gums Unusual or heavy nosebleeds Bruising easily or more than normal Black coloured stools (poo) or blood in your stools (poo) Coughing up red or brown coloured mucus Dizziness, constant headache or changes in your vision Heavy vaginal bleeding Red or pink coloured urine (pee) What to do: If your health care team has told you that you have low platelets: Tell your pharmacist that your platelet count may be low before taking any prescriptions or over-the-counter medication. Check with your healthcare team before you go to the dentist. Take care of your mouth and use a soft toothbrush. Try to prevent cuts and bruises. Ask your healthcare team what activities are safe for you. Your treatment may have to be delayed if you have low platelets. Your health care team may recommend a blood transfusion. If you have signs of bleeding: If you have a small bleed, clean the area with soap and water or a saline (salt water) rinse. Apply pressure for at least 10 minutes. If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away.	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: You may feel more tired or weaker than normal. Pale skin and cold hands and feet. You may feel short of breath, dizzy or lightheaded. This may occur in days to weeks after your treatment starts. What to do: If your health care team has told you that you have anemia (low red blood cells): Rest often and eat well. Light exercise, such as walking may help. You may need medication or a blood transfusion. If it is very bad, your doctor may need to make changes to your treatment regimen.	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: Nausea is feeling like you need to throw up. You may also feel light-headed. You may feel nausea within hours to days after your treatment. What to do: To help prevent nausea: It is easier to prevent nausea than to treat it once it happens. Take your anti-nausea medication(s) as prescribed, even if you do not feel like throwing up. Drink clear liquids and have small meals. Get fresh air and rest. Do not eat spicy, fried foods or foods with a strong smell. Limit caffeine (like coffee, tea) and avoid alcohol. If you have nausea or vomiting: Take your rescue (as-needed) anti-nausea medication(s) as prescribed. Ask your health care team for the Nausea & Vomiting pamphlet for more information. Talk to your health care team if: Nausea lasts more than 48 hours Vomiting lasts more than 24 hours or if it is severe	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
Fatigue What to look for: Feeling of tiredness or low energy that lasts a long time and does not go away with rest or sleep. What to do: Be active. Aim to get 30 minutes of moderate exercise (you are able to talk comfortably while exercising) on most days. Check with your health care team before starting any new exercise. Pace yourself, do not rush. Put off less important activities. Rest when you need to. Ask family or friends to help you with things like housework, shopping, and child or pet care. Eat well and drink at least 6 to 8 glasses of water or other liquids every day (unless your health care team has told you to drink more or less). Avoid driving or using machinery if you are feeling tired. 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: Your hair may become thin or fall out during or after treatment. In most cases, your hair will grow back after treatment. The texture or colour may change. In very rare cases, hair loss may be permanent. What to do: Use a gentle soft brush. Do not use hair sprays, bleaches, dyes and perms.	Talk to your health care team if this bothers you
Low Appetite, weight loss What to look for: Loss of interest in food or not feeling hungry. Weight loss. What to do: Try to eat your favourite foods. Eat small meals throughout the day. You may need to take meal supplements to help keep your weight up. Talk to your health care team if you have no appetite. 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: Loose, watery, unformed stool (poo) Some other symptoms you may have include sweating a lot, belly cramps, runny nose, watery eyes, more saliva (spit) in your mouth than usual, redness (flushing) on your face or neck. Let your healthcare team know right away if this happens. Medication(s) may be given to you to control these symptoms.	Tell your health care team right away if you have any of these symptoms
Diarrhea that starts more than 24 hours after treatment. Loose, watery, unformed stool (poo) Diarrhea may be severe in some cases and it might cause dehydration (when your body doesn’t have enough water) What to look for: If you have diarrhea: Take the loperamide (Imodium®) that your health care team prescribed or told you to take. Do not have foods or drinks with artificial sweetener (like chewing gum or ‘diet’ drinks), coffee and alcohol. Eat many small meals and snacks instead of 2 or 3 large meals. Drink at least 6 to 8 cups of liquids each day, unless your health care team has told you to drink more or less. Talk to your health care team if you can’t drink 6 to 8 cups of liquids each day when you have diarrhea. You may need to drink special liquids with salt and sugar, called Oral Rehydration Therapy. Talk to your health care team if your diarrhea does not get better after 24 hours of taking diarrhea medication or if you have diarrhea more than 7 times in 1 day. 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 pressure What to look for: There are usually no signs of high blood pressure. Rarely, you may have headaches, shortness of breath or nosebleeds. What to do: Check your blood pressure regularly. Your doctor may prescribe medication to treat high blood pressure. 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. What to look for: Swelling in your face, legs, or belly. Recent weight gain that is not normal for you. Foamy, frothy or bubbly-looking pee. 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
Headache, mild joint, muscle pain or cramps What to look for: New pain in your muscles or joints, muscle cramps, or feeling achy. What to do: Take pain medication (acetaminophen or opioids such as codeine, morphine, hydromorphone, oxycodone) as prescribed. Read the above section: “What should I do if I feel unwell, have pain, a headache or a fever?” before taking acetaminophen (Tylenol®), ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or Aspirin. These medications may hide an infection that needs treatment or they may increase your risk of bleeding. Rest often and try light exercise (such as walking) as it may help. Ask your health care team for the Pain pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Liver problems Your health care team may check your liver function with a blood test. Liver changes do not usually cause any symptoms. What to look for: Rarely, you may develop yellowish skin or eyes, unusually dark pee or pain on the right side of your belly. This may be severe. What to do: If you have any symptoms of liver problems, get emergency medical help right away.	Get emergency medical help right away
Constipation What to look for: Have bowel movements (going poo) less often than normal. Small hard stools (poo) that look like pellets. The need to push hard and strain to have any stool (poo) come out. Stomach ache or cramps. A bloated belly, feeling of fullness, or discomfort. Leaking of watery stools (poo). Lots of gas or burping. Nausea or vomiting What to do: To help prevent constipation: Try to eat more fiber rich foods like fruits with skin, leafy greens and whole grains. Drink at least 6 to 8 cups of liquids each day unless your health care team has told you to drink more or less. Be Active. Exercise can help to keep you regular. If you take opioid pain medication, ask your health care team if eating more fibre is right for you. To help treat constipation: If you have not had a bowel movement in 2 to 3 days you may need to a laxative (medication to help you poo) to help you have regular bowel movements. Ask your health care team what to do. See the Constipation pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Mouth sores What to look for: Round, painful, white or gray sores inside your mouth that can occur on the tongue, lips, gums, or inside your cheeks. In more severe cases they may make it hard to swallow, eat or brush your teeth. They may last for 3 days or longer. What to do: To help prevent mouth sores: Take care of your mouth by gently brushing and flossing regularly. Rinse your mouth often with a homemade mouthwash. To make a homemade mouthwash, mix 1 teaspoonful of baking soda and 1 teaspoonful of salt in 4 cups (1L) of water. Do not use store-bought mouthwashes, especially those with alcohol, because they may irritate your mouth. If you have mouth sores: Avoid hot, spicy, acidic, hard or crunchy foods. Your doctor may prescribe a special mouthwash to relieve mouth sores and prevent infection. Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow. Ask your health care team for the Mouth Care pamphlet for more information.	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 problems What to look for: Your eyes may feel dry, irritated, or painful. They may look red and have a lot of tears. They may feel sensitive to light and your vision may be blurry. What to do: Avoid wearing contact lenses. Wear sunglasses with UV protection. Use protective eyewear (goggles or helmet with face mask) when playing sports, mowing the lawn or doing anything that may get particles or fumes in your eyes. You may try artificial tears (eye drops) or ointment.	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 skin What to look for: You may have cracked, rough, flaking or peeling areas of the skin. Your skin may look red and feel warm, like a sunburn. Your skin may itch, burn, sting or feel very tender when touched. What to do: To prevent and treat dry skin: Use fragrance-free skin moisturizer. Protect your skin from the sun and the cold. Use sunscreen with UVA and UVB protection and an SPF of at least 30. Avoid perfumed products and lotions that contain alcohol. Drink 6 to 8 cups of non-alcoholic, non-caffeinated liquids each day, unless your health care team has told you to drink more or less. Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away.	Talk to your health care team if it does not improve or if it is severe
Trouble Sleeping Your 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: You may find it hard to fall asleep or stay asleep. How well you sleep may change over your treatment. For example, you may have several nights of poor sleep followed by a night of better sleep. You may wake up too early or not feel well-rested after a night’s sleep. You may feel tired or sleepy during the day. 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 clots What to look for: Blood clots can cause pain, swelling and hardening of the vein in the body part that has the clot. If the clot is severe it can block a big artery or vein. 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 What to do: Get emergency medical help right away.	Get emergency medical help right away
Swelling inside your nose What to look for: You may have a stuffy, sneezy, itchy, runny nose. 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
Dizziness What to look for: You may feel light headed and like you might faint (pass out). What to do: Lay down right away so you do not fall. Slowly get up and start moving once you feel better. Do not drive a motor vehicle or use machinery if you feel dizzy.	Talk to your health care team if it does not improve or if it is severe
Cough and feeling short of breath What to look for: You may have a cough and feel short of breath. Symptoms that commonly occur with a cough are: Wheezing or a whistling breathing Runny nose Sore throat Heartburn Weight loss Fever and chills Rarely this may be severe with chest pain, trouble breathing or coughing up blood. What to do: Check your temperature to see if you have a fever. Read the above section “What should I do if I feel unwell, have pain, a headache or a fever?”. If you have a severe cough with chest pain, trouble breathing or you are coughing up blood, get medical help right away. If you have a fever, try to talk to your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.	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 problems What to look for: You may have an irregular heartbeat, shortness of breath, chest pain or fainting spells. Swelling in your legs, ankles and belly. Sharp pain in the centre or left side of the chest (often worsens when taking a deep breath). Extreme tiredness that prevents you from exercising or doing normal activities. 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: Tingling or swelling of the skin on the palms of your hands and the bottoms of your feet. This can become painful, red and numb. In worse cases your skin may start to peel and you can get blisters or sores. This may occur days to weeks after the dose is given or after you start treatment. What to do? To help prevent Hand-foot syndrome: Do not do activities that cause rubbing or pressure on your skin, like heavy-duty washing, gripping tools, typing, playing musical instruments, and driving. Moisturize your hands and feet often, especially in the skin folds. Wear loose, comfortable footwear and clothes. Rest and try to keep off your feet. Do not let your hands and feet get too hot. Ask your health care team for the Hand-foot syndrome pamphlet for more information.	Talk to your health care team if it does not improve or if it is severe
Heartburn, upset stomach and bloating What to look for: You may feel pain or burning in the middle or top part of your chest. It may get worse when you are lying down, bending over or when you swallow. You may have a bitter or acidic taste in your mouth. What to do: Avoid acidic, fatty or spicy foods including caffeine. Drink clear liquids and eat small meals. Avoid smoking or being around tobacco. Stay upright after eating. Raise the head of your bed six to eight inches so that your head is higher than your belly.	Talk to your health care team if it does not improve or if it is severe
Flushing What to look for: Your face may feel warmth and the skin on your neck, upper chest, or face may quickly get red. 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 problems What to look for: Your voice may become hoarse or raspy. 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: You may have mild swelling or puffiness in your arms and/or legs. Rarely, this may be severe. What to do: To help prevent swelling: Eat a low-salt diet. If you have swelling: Wear loose-fitting clothing. For swollen legs or feet, keep your feet up when sitting.	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.

Notes

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.

Regimen Info Sheet (English):

FOLFIRI Colorectal.pdf Regimen Info Sheet (English) 2:

FOLFIRIBEVA Colorectal.pdf Regimen Monograph (English):

FOLFIRI BEVA_GI_COL_P.pdf Global Date: Vendredi, avril 21, 2023 Info Sheet Date: Mardi, janvier 16, 2024 Info Sheet Date 2: Mardi, janvier 16, 2024 AddThis: Universal Date: 2024-01-16 00:00:00 Monograph Status: Null Info Sheet Status: Null Info Sheet Status 10: Hidden Info Sheet Status 11: Hidden Info Sheet Status 12: Hidden Info Sheet Status 13: Hidden Info Sheet Status 14: Hidden Info Sheet Status 15: Hidden Info Sheet Status 16: Hidden Info Sheet Status 17: Hidden Info Sheet Status 18: Hidden Info Sheet Status 19: Hidden Info Sheet Status 2: Null Info Sheet Status 20: Hidden Info Sheet Status 3: Hidden Info Sheet Status 4: Hidden Info Sheet Status 5: Hidden Info Sheet Status 6: Hidden Info Sheet Status 7: Hidden Info Sheet Status 8: Hidden Info Sheet Status 9: Hidden QBP Drug Name: NULL NULL NULL NULL NULL QBP Type: NULL NULL NULL NULL NULL QBP Description: NULL NULL NULL NULL NULL Revision Summary:
Patient Info Sheet EN: (FOLFIRI) - Updated "How will this treatment affect sex, pregnancy and breast feeding?" section
Patient Info Sheet FR: (FOLFIRI) - Updated "How will this treatment affect sex, pregnancy and breast feeding?" section (Mise à jour de la section « Comment ce traitement influe-t-il sur la vie sexuelle, la grossesse et l’allaitement? »)
Patient Info Sheet EN: (FOLFIRI+BEVA) - Updated "How will this treatment affect sex, pregnancy and breast feeding?" section
Patient Info Sheet FR: (FOLFIRI+BEVA) - Updated "How will this treatment affect sex, pregnancy and breast feeding?" section (Mise à jour de la section « Comment ce traitement influe-t-il sur la vie sexuelle, la grossesse et l’allaitement? ») Info sheet Public Title: FOLFIRI Info sheet Public Title 2: FOLFIRI+BEVA Regimen Info Sheet (French) 2:

FOLFIRIBEVA Colorectal pour le patient.pdf Regimen Info Sheet (French):

FOLFIRI Colorectal pour le patient.pdf

FOLFIRI+BEVA; FOLFIRI

What to do?

To Prevent Nausea and Vomiting

To Treat Diarrhea

If you start to have diarrhea

Low neutrophils (white blood cells) in the blood (neutropenia)

What to look for:

What to do:

Low platelets in the blood

What to look for:

What to do:

Anemia (low red blood cells)

What to look for:

What to do:

Nausea and vomiting

What to look for:

What to do:

Fatigue

What to look for:

What to do:

Hair thinning or loss

What to look for:

What to do:

Low Appetite, weight loss

What to look for:

What to do:

Diarrhea that starts more than 24 hours after treatment.

What to look for:

High blood pressure

What to look for:

What to do:

Proteins in Urine (pee)

What to look for:

What to do:

Headache, mild joint, muscle pain or cramps

What to look for:

What to do:

Liver problems

What to look for:

What to do:

Constipation

What to look for:

What to do:

Mouth sores

What to look for:

What to do:

Eye problems

What to look for:

What to do:

Rash; dry, itchy skin

What to look for:

What to do:

Trouble Sleeping

What to look for:

What to do:

Blood clots

What to look for:

What to do:

Swelling inside your nose

What to do:

Dizziness

What to look for:

What to do:

Cough and feeling short of breath

What to look for:

What to do:

Heart problems

What to look for:

What to do:

Rash on your hands and feet (hand-foot syndrome)

What to look for:

What to do?

Heartburn, upset stomach and bloating

What to look for:

What to do:

Flushing

What to look for:

What to do:

Speech problems

What to look for: