# Living with FOLFOX, CAPOX, FOLFIRI and the EGFR antibodies

Source: https://onco.cc/terms/chemotherapy-side-effects-colorectal/  
OnCo record `chemotherapy-side-effects-colorectal` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The bowel cancer regimens share low blood counts, tiredness, sickness and a sore mouth. Oxaliplatin adds cold-triggered tingling, irinotecan adds early and late diarrhoea, capecitabine adds hand-foot syndrome and needs a DPD test first, and cetuximab or panitumumab add an acne-like rash and low magnesium. The rule for all of them: ring the 24-hour number rather than wait.

## Summary

Macmillan's drug pages set out what each part does. Oxaliplatin: numbness, tingling or pain in fingers and toes, often made worse by cold during treatment, so keep warm, avoid iced drinks, take care opening the fridge and use gloves for frozen food; rarely a spasm around the voicebox causing difficulty swallowing or breathing during or in the first days after treatment, worse in the cold, after which later doses may be given over 4 to 6 hours. Irinotecan: diarrhoea within 24 hours of treatment is the cholinergic reaction, usually prevented or controlled with atropine, and needs a call to the 24-hour number so more can be given; diarrhoea 24 hours or more afterwards is treated with the anti-diarrhoea drugs you were sent home with, taken immediately and exactly as instructed, with a call to the 24-hour number if they have not worked within 24 hours. Capecitabine: a blood test for DPD gene changes comes first, because low or absent DPD raises the risk of serious or life-threatening side effects and causes no symptoms of its own; hand-foot syndrome makes the palms and soles sore, red, dry or peeling, helped by washing in cool water and gentle moisturising. Cetuximab and panitumumab: an acne-like rash on face, neck, chest and back, most likely in the first 2 or 3 weeks, with dry, itchy, scaly or tender skin; contact the hospital as soon as possible for any skin change because creams, steroids or antibiotics may be needed; avoid alcohol-based and anti-acne products unless prescribed, moisturise with unperfumed products and use sun cream of at least SPF 30 with clothing and a hat; magnesium and calcium are monitored and supplements prescribed if low; sore, swollen skin around the nails is a same-day call. Across all of them, Macmillan says to contact the hospital straight away on the 24-hour number for a temperature outside the range your team gave you, for shivering, for feeling unwell even with a normal temperature, for unexplained bruising or bleeding, for vomiting once or twice in 24 hours, and for signs of a blood clot. Bowel Cancer UK adds that oxaliplatin neuropathy can appear during the cycle and for up to two weeks afterwards, may get worse before it gets better, and in some people lasts months or years.

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: FOLFOX side effects; CAPOX side effects; oxaliplatin cold sensitivity; irinotecan diarrhoea; cetuximab rash; DPD test
- Tags: gi; colorectal

## Sources

- Macmillan: oxaliplatin: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/oxaliplatin
- Macmillan: irinotecan: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/irinotecan
- Macmillan: capecitabine: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/capecitabine
- Macmillan: cetuximab (Erbitux): https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/cetuximab
- Macmillan: panitumumab (Vectibix): https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/panitumumab
- Macmillan: FOLFOX: https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfox
- Bowel Cancer UK: long term and late side effects: https://www.bowelcanceruk.org.uk/about-bowel-cancer/living-with-and-beyond-bowel-cancer/long-term-and-late-side-effects/
- NICE NG151: colorectal cancer, recommendations: https://www.nice.org.uk/guidance/ng151/chapter/Recommendations

## Connected records

- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [CAPOX (capecitabine, oxaliplatin)](https://onco.cc/drugs/capox/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [FOLFIRI (5-FU, leucovorin, irinotecan)](https://onco.cc/drugs/folfiri/), [FOLFOX (5-FU, leucovorin, oxaliplatin)](https://onco.cc/drugs/folfox/), [Irinotecan (and liposomal irinotecan)](https://onco.cc/drugs/irinotecan/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Panitumumab](https://onco.cc/drugs/panitumumab/)
- terms: [Febrile neutropenia](https://onco.cc/terms/febrile-neutropenia/), [Hand-foot syndrome and hand-foot skin reaction](https://onco.cc/terms/hand-foot-syndrome/), [Mucositis and stomatitis](https://onco.cc/terms/mucositis/), [Neutropenia](https://onco.cc/terms/neutropenia/), [Peripheral neuropathy (chemotherapy-induced)](https://onco.cc/terms/peripheral-neuropathy/), [Rash and skin toxicity (acneiform rash, paronychia)](https://onco.cc/terms/rash-skin-toxicity/)

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