Background: Colorectal cancer (CRC) is a major global health problem and public healthrnissue. Despite the improved outcome with cytotoxic treatment of CRC, outcomes are affectedrnby adverse treatment effects and their sequel, often resulting in low Relative dose intensityrn(RDI), considerable, mortality, morbidity and costs. However, there are no previous studiesrnconducted in our clinical practice setting describing the Relative dose intensity of FOLFOX4rnor its predicters.rnObjective: Our main objective of the study was to determine FOLFOX4 regimen RDI and itsrnpredicters, describe incidence of dose delay and dose limiting neutropenia.rnMethods: We conducted a retrospective medical record review on 82 CRC patients treated atrnTikur Anbessa hospital between May 2019 and July 2020 with FOLFOX4. RDI wasrncalculated with Excel 2019 and entered in to SPSS 26.0 for summary statistics. Reason forrndelay were assessed through all the 12 cycles. Dose delay were categorized as > 7 days, 7 torn18 days, and more than 18 days. To identify predicters, sensitivity analyses was performed byrncategorizing RDI based on 25rnthrn and 75rnthrn percentile and covariates were entered in tornmultinomial logistic regression model for multivariate analysis. rnResults: We identified 82 patients receiving FOLFOX chemotherapy as first line treatment.rnThe mean age was 45 years, and 42.7% were female. The average RDI was 48.6 %. Thernproportion of patients receiving average RDI less than 85% is 92.7% (N=76). Among stagernII and III subgroups, the patients receiving RDI > 70%, are 22.2% and 19% respectively.rnMyelosuppression in particular Grade II to IV neutropoenias were dose delaying reason inrn61.3% of the cases, while non cytopenia related dose delays were observed in 31.7%(n=26)rnof the patients. Dose schedule modification resulting in treatment prolongation more than 18rndays were affecting 38.3% (N=239) of the cycles. The odds of receiving RDI less than 35%rnincreases by 66%, for each decrease in the cycle number for nadir neutropenia countrncompared to above 60%; AOR=0.44(CI: 0.22, 0.89) at statistically significant p-value=0.02. rnConclusion: Overall FOLFOX chemotherapy RDI was low. Dose limiting myelotoxicityrnwere the main reason for dose modification and were observed at higher rate affectingrnmajority of cycles, and patients. Cycle number for nadir neutropenia independently predictedrnthe risk of falling in to 25rnthrn RDI percentile compared 75rnthrn percentile, on the sensitivityrnanalysis.