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FOLFOX chemotherapy regimen

The FOLFOX regimen includes 5-fluorouracil (5-FU), oxaliplatin and folinic acid. It is used in the treatment of colorectal carcinoma. Which drugs in regimen is causal in yet unclear

Last update : 09/10/2016

I.a Pneumonitis (ILD), acute and/or severe (may cause ARDS)

I.b Pneumonitis (ILD)

I.c Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

I.d Organizing pneumonia pattern (an area or areas of consolidation on imaging)

I.v Abnormal lung function/pulmonary physiology (PFTs) without necessarily imaging or clinical evidence

I.y Progression, acceleration or exacerbation of preexisting ILD/fibrosis

II.b ARDS - Acute lung injury

III.a Alveolar hemorrhage (AH), diffuse AH (DAH)

VIII.c Upper airway obstruction other than angioedema or hematoma

X.k Sarcoid-like granulomatosis (endo-/extrathoracic)

XV.c Path: Organizing pneumonia (OP/BOOP) pattern (see also Id)

XV.f Path: Diffuse alveolar damage (DAD-pattern) (see also IL)

Diagnosing DIRD

Drug and radiation history

Drug singularity - Correct identification of the drug

Consistent timing of exposure v. onset of symptoms

Clinical, imaging, BAL, pathological pattern consistent with the specific drug

Careful exlusion of another cause

Remission of symptoms with removal of drug

Recurrence with rechallenge (rarely advisable)

Causality assessment

More detailed checklist

The Drug-Induced Respiratory Disease Website

Philippe Camus, M.D.

Dijon, France