{"entity":{"id":"chemotherapy-side-effects-pancreatic","kind":"term","name":"Living with FOLFIRINOX, NALIRIFOX and gemcitabine with nab-paclitaxel","aka":["FOLFIRINOX side effects","irinotecan diarrhoea","oxaliplatin cold sensitivity","nab-paclitaxel side effects","DPD test"],"tldr":"The three main regimens share low blood counts, tiredness, sickness and sore mouth; FOLFIRINOX and NALIRIFOX add irinotecan diarrhoea and oxaliplatin's cold-triggered tingling and rare throat spasm, gemcitabine with nab-paclitaxel adds hair loss and neuropathy, and every regimen comes with the same temperature rule for ringing the 24-hour line.","summary":"Macmillan's FOLFIRINOX page: each cycle is 2 weeks, with oxaliplatin, folinic acid and irinotecan as drips on day 1 and fluorouracil by injection then through a small pump for about 46 hours, often via a PICC line; a DPD blood test comes first because low DPD raises the risk of severe fluorouracil side effects. Irinotecan can cause sweating, cramps, watery eyes and diarrhoea within 24 hours (acute cholinergic syndrome, prevented with atropine); oxaliplatin can rarely cause a throat spasm in the cold in the first days, so avoid iced drinks and cover your mouth in cold weather. Ring the 24-hour number straight away for a temperature above 37.5 C or below 36 C, feeling unwell even with a normal temperature, diarrhoea 4 or more times a day or at night, cramps, or anti-diarrhoea medicine not working within 24 hours, unexplained bruising or bleeding, sore red or peeling palms and soles, or a sore mouth that stops you eating; call 999 for chest pain or difficulty breathing (fluorouracil affects the heart in under 1 in 100).\n\nMacmillan's nab-paclitaxel page: given weekly for 3 weeks then a week off with gemcitabine; nearly everyone loses the hair on their head (scalp cooling may be offered); ring for 3 or more loose stools a day; tingling or numb hands and feet should be reported so the dose can be changed. Pancreatic Cancer UK says neuropathy is most common with FOLFIRINOX, FOLFOX and nab-paclitaxel, is worse in the cold, normally improves after treatment but can worsen in the first months, and that a diary of side effects helps at each visit. Its blood clot rule: pain, swelling or redness in a limb, sudden chest pain or breathlessness means calling the emergency number or going to A&E. NALIRIFOX (liposomal irinotecan, oxaliplatin, fluorouracil) shares the FOLFIRINOX pattern; in NAPOLI 3 diarrhoea and low potassium were more frequent than with gemcitabine and nab-paclitaxel, and neuropathy and low white cells less so. This is orientation from public patient pages and guidelines, not advice for your case: your own team's instructions and 24-hour number come first.","asOf":"2026-09-24","links":[{"label":"Macmillan: FOLFIRINOX","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/folfirinox"},{"label":"Macmillan: nab-paclitaxel (Abraxane)","url":"https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/nab-paclitaxel"},{"label":"Pancreatic Cancer UK: side effects of chemotherapy","url":"https://www.pancreaticcancer.org.uk/information-and-support/treatments-for-pancreatic-cancer/chemotherapy/side-effects-of-chemotherapy/"},{"label":"Cancer Research UK: chemotherapy for pancreatic cancer","url":"https://www.cancerresearchuk.org/about-cancer/pancreatic-cancer/treatment/chemotherapy"},{"label":"Wainberg et al., NALIRIFOX versus nab-paclitaxel and gemcitabine in treatment-naive metastatic pancreatic cancer, NAPOLI 3 (Lancet 2023)","url":"https://doi.org/10.1016/S0140-6736(23)01366-1"},{"label":"Loprinzi et al., ASCO guideline update on chemotherapy-induced peripheral neuropathy (JCO 2020)","url":"https://doi.org/10.1200/JCO.20.01399"}],"tags":["gi","pancreatic"],"related":[],"cancers":["pancreatic"],"sections":[],"technologies":[],"targets":[],"drugs":["folfirinox","nalirifox","gemcitabine-nab-paclitaxel"],"companies":[],"institutions":[],"pathways":[],"terms":["peripheral-neuropathy","neutropenia","febrile-neutropenia","hand-foot-syndrome","mucositis","vte"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Side effects"},"route":"/terms/chemotherapy-side-effects-pancreatic/","neighbours":{"cancer":[{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"drug":[{"id":"folfirinox","kind":"drug","name":"FOLFIRINOX / mFOLFIRINOX","route":"/drugs/folfirinox/"},{"id":"gemcitabine-nab-paclitaxel","kind":"drug","name":"Gemcitabine + nab-paclitaxel","route":"/drugs/gemcitabine-nab-paclitaxel/"},{"id":"nalirifox","kind":"drug","name":"NALIRIFOX (liposomal irinotecan + oxaliplatin + 5-FU/LV)","route":"/drugs/nalirifox/"}],"term":[{"id":"febrile-neutropenia","kind":"term","name":"Febrile neutropenia","route":"/terms/febrile-neutropenia/"},{"id":"hand-foot-syndrome","kind":"term","name":"Hand-foot syndrome and hand-foot skin reaction","route":"/terms/hand-foot-syndrome/"},{"id":"mucositis","kind":"term","name":"Mucositis and stomatitis","route":"/terms/mucositis/"},{"id":"neutropenia","kind":"term","name":"Neutropenia","route":"/terms/neutropenia/"},{"id":"peripheral-neuropathy","kind":"term","name":"Peripheral neuropathy (chemotherapy-induced)","route":"/terms/peripheral-neuropathy/"},{"id":"vte","kind":"term","name":"Venous thromboembolism (VTE)","route":"/terms/vte/"}]}}