Capox vs Folfiri for Colon Cancer

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Stage 4 metastatic colon cancer.

Hello, im just wondering if anyone knows why a certain chemotherapy combination is chosen. 
Specifically for colorectal cancer, why are some patients placed on Capox/folfox as a first line but some patients are placed on folfiri? 


  • Hello CxO

    Thanks for getting in touch. My name is Helen, I’m one of the Cancer Information Nurses on the Macmillan Support Line.

    Welcome to the online community. I see you have joined the bowel cancer forum and hope you find it a warm and supportive community.

    You have asked why certain chemotherapy regimes are used and in particular you have asked why Capox or Folfox may be chosen for some patients and Folfiri for others in the treatment of a colorectal (bowel) cancer.

    In general, cancer treatments are tested through cancer clinical trials. This type of research is important because it shows which treatments are most effective and safe. This helps healthcare teams plan the best treatment for the people they care for. 

    A cancer clinical trial is the best way to test if a new treatment is more effective than the current treatment. It also gets information about the safety and side effects of the treatment.

    Some trials help answer questions about treatments already in use. The trials may test whether combining treatments is more effective. Or they may research different ways to give a treatment, so it works better or causes fewer side effects.

    Capox, Folfox and Folfiri are all drug combinations that have been through a clinical trials process. The combinations are shown to be useful for patients whose disease is at a certain stage.

    The multidisciplinary team’s decision to offer one over another will depend on the stage and grade of the cancer, whether the person’s fitness level means they are likely to tolerate the treatment and if the patient has any other conditions that will be made worse with any of the treatment options (such as already existing heart or lung conditions).

    When the expected outcomes are likely to be similar, patients’ preference will help make the final decision.

    Bowel Cancer UK has some more information on treatment options and how clinical decisions might be made.

    I hope this information is useful and helps answer your question. 

    Please don’t hesitate to get back in contact by email, webchat or phone, if you need further information or support.

    The Macmillan Support Line offers practical, clinical, financial and emotional support. You can call us free from landlines and from most mobile phone networks on 0808 808 00 00, 7 days a week, 8am – 8pm.


    Best wishes, Helen

    Cancer Information Nurse Specialist 


    Ref HM/LJ