Folfox or Capox

aq122

Hi there,

My mom was diagnosed with Colorectal Cancer Stage 3B. She will be starting her first round of chemo within the next week. My brother (who is doctor but not an oncologist) and I have read and researched the differences between Folfox and Capox. We were both set on Capox but our mother's oncologist strongly recommends we go with Folfox b/c it is better tolerated due to the lower toxicity levels.

Our mom is 72years old, 5'0" and 95 pounds. Prior to her surgery and diagnosis, she lived a pretty active lifestyle, but considering her petite stature, age, and oncologist's preferences, we are starting to reconsider our choice of Capox. If anyone could weigh in, I would greatly appreciate it.

Thank you so much in advance.

Trubrit

FOLFOX

I was on the FOLFOX and there was nothing easy about it for me. Of course, each person reacts differently, so it will be hard to know just how your mum reacts. 

We have another member here, Lizzard/Grace, who is around your mum's age and weight. I'm sure she will see this post and give her advice. She is one strong lady, despite her petite build. 

It is a very hard decison. I wish your mum the best. She has great support with you and your brother - and no dount many more loved ones - and that will carry her a long way. 

Tru

Annabelle41415

Treatment

Folfox is no picnic and only being 50 thru me for a loop.  I'm still dealing with side effects from it 9 years later.  I've never heard of the other treatment you are talking about so I'm not able to comment on that.  It's a hard decision but something you need to fully look into before beginning treatment.  Hope your mom can get the answers she needs.

Kim

Woodytele

Dr advice

I have learned to listen to my Oncologist.  They do this everyday, know everything about it.  I wouldn’t go against their advice, but ask the Dr. their reasoning for specific treatment.  Once they tell you, it should make sense.  

Mikenh

I'm on CAPOX and chose it for

I'm on CAPOX and chose it for the convenience. I don't need to carry around the pump for 40+ hours and deal with the issues related to sleeping and showering.

That said I don't think that either option is easy because of the Oxaliplatin side-effects. The Xeloda side-effects are much milder than the Oxaliplatin though there are still side-effects.

One other aspect: you need to be able to reliably take the pills. That is have a meal, wait a bit, take the Xeloda with a lot of water and that's twice a day. If you can't manage that, then Folfox might be better as it's harder to forget it with an attached pump. One last aspect is that many health insurance plans require you to use a mail-order pharmacy for Xeloda and they are a pain in the neck to deal with. You really have to get the order in ahead of time and make sure that there are no issues between the doctors office and the pharmacy.

abrub

Annabelle41415 said:

Treatment

Folfox is no picnic and only being 50 thru me for a loop.  I'm still dealing with side effects from it 9 years later.  I've never heard of the other treatment you are talking about so I'm not able to comment on that.  It's a hard decision but something you need to fully look into before beginning treatment.  Hope your mom can get the answers she needs.

Kim

Capox = Xelox

Same chemo, with oral 5FU as opposed to the pump.

lizard44

Folfox

I'm the  petite older person  around your mother's age that Tru mentioned :-)  I was 70  when I began chemo in May 2015 after being diagnosed with stage 4 rectal cancer. I weighed about 83  pounds (my weight fluctuates between 85-90 normally) and possible weight loss  was a concern the oncologist had.  I'm one of the fortunate ones who  made it through  8 rounds of Folfox plus Avastin with no  debilitating side efects and I actually  gianed a couple of pounds  during treatment..  I think  part of that may have been due to my not having had surgery prior to beginning chemo, so my body wasn't  in recovery mode from surgery, and the fact that   I was in fairly good health (other than having stage 4 cancer, scoliosis, a touch of emphysema and a little atherosclerosis that is  ). As best I recall fatigue was my major problem and I had to learn to pace myself- work a while, rest a while, etc. I was able to keep up with most of my normal activites  like gardening, housework, shopping, walking the dogs, etc., although everything took a  bit longer because of the  frequent breaks.  l did take up yoga and I think it really helped.  I began to have low  white blood cell counts after a few treatments, which delayed a treatment or two, then  began getting Neupogen shots (17 in all)  over the  final three months of  treatment and that took care of the problem. I do have a bit of neuropathy in one foot, probably from the Oxaliplatin ( the "ox" part of FOLFOX). It's still here, three years later, but it isn't too  bad and is worse  if I let my feet get cold.  One bit of very helpful advice I was given by the nurses in the beginning was to avoid anything cold- I wore gloves to reach into the fridge,  never drank or ate anything  colder than room temperature and wore socks all the time, even to sleep in. Nausea was not a problem for me and I never had a problem with my appetite- so I never lost weight.

Since the FOLFOX, I've had radiation plus chemo (28 treatments)  4 rounds of Avastin plus 5-FU and Fusilev,   an ablation of my liver tumor,  and in October 2017 had  abdominoperineal surgery, so I now have a permanent colostomy.  I've been on Erbitux and Irinotecan  every other week since  April 2016 with breaks for the ablation and APR surgery. I  still feel pretty good most of the time and I honestly  don't know whether to blame my  occasional lack of energy on chemo or old age!  Same with the chemo brain-  although it is kind of nice to be able to blame my memory lapses on something other than old age and senility

I hope your mother does  as well as I have done and I hope her treatments are successful. While my chemo experience has been more positve than negative, it's good to know all the possible bad side effects since everyone reacts to treatment differently. We all hope to defeat the  monster or at least keep  it dormant and at bay as long as possible, but I know that with my stage 4, there is always the possibility the cancer monster will  rear its ugly head and attack again, so whatever seems to  work at keeping it down is worth putting up with, I think, as long as it doesn't interfere too much with one's quality of life.  I've found it's a good idea to hope for the best outcome possible but be prepared for the worst, too. Meanwhile seize each day and wring as much  life, love and laughter out of it as you can. And make sure that your mother  lets her oncologist know  about any side effects she does have.  Many of the potential side effects can be  minimized with  pre-meds  or dosage reductions. Good luck to you both.

Grace/lizard44

SandiaBuddy

Mikenh said:

I'm on CAPOX and chose it for

I'm on CAPOX and chose it for the convenience. I don't need to carry around the pump for 40+ hours and deal with the issues related to sleeping and showering.

That said I don't think that either option is easy because of the Oxaliplatin side-effects. The Xeloda side-effects are much milder than the Oxaliplatin though there are still side-effects.

One other aspect: you need to be able to reliably take the pills. That is have a meal, wait a bit, take the Xeloda with a lot of water and that's twice a day. If you can't manage that, then Folfox might be better as it's harder to forget it with an attached pump. One last aspect is that many health insurance plans require you to use a mail-order pharmacy for Xeloda and they are a pain in the neck to deal with. You really have to get the order in ahead of time and make sure that there are no issues between the doctors office and the pharmacy.

Ditto

Ditto to what Mike said, but I would add that capecitabine is also a hair more effective than the IV.  Plus, if you hate needles and IV's like I do, a pill is far preferrable.  Also with the capecitabine pill, you can adjust the dose to deal with side effects.  I recall skipping an evening dose when my stomach was particularly upset.  I was able to jockey the dose to minimize side effects (in consultation with the oncologist).  Also, when the drug caused a heart-attack like reaction, I was able to quit on the spot.  Also, there may be a financial incentive for the chemical infusion that your doctor does not receive if you take the pill (See: https://csn.cancer.org/node/313768 ).  Many people trust their doctors unconditionally, but it is your health that is at stake and sometimes a little research goes a long way.  If you are not familiar with pubmed, you should give it a try, it can be a great resource.  You could start by researching the effectiveness of CAPOX v. FOLFOX.  Pubmed: https://www.ncbi.nlm.nih.gov/pubmed/

Annabelle41415

abrub said:

Capox = Xelox

Same chemo, with oral 5FU as opposed to the pump.

Xeloda

Was just wonder if that is similar to Xeloda which was taken along with my radiation, then 5FU for me.  Thanks for the clarification.

Kim