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Developments in fluoropyrimidine therapy for gastrointestinal cancer
1Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Current Opinion in Oncology
|July 23, 1999
Summary
Infusional 5-fluorouracil (5-FU) combined with leucovorin shows improved response rates and reduced toxicity in metastatic colorectal cancer compared to bolus 5-FU. However, median survival remains unchanged, with ongoing research into novel drug combinations.
Area of Science:
- Oncology
- Gastrointestinal Oncology
- Pharmacology
Background:
- 5-fluorouracil (5-FU) and leucovorin are standard treatments for metastatic colorectal cancer and Dukes' C colon cancer.
- Optimal administration methods for 5-FU/leucovorin in metastatic colorectal cancer are still debated.
- Emerging research in 1998 focused on novel therapeutic strategies for advanced colorectal cancer.
Purpose of the Study:
- To evaluate the efficacy and toxicity of infusional versus bolus 5-fluorouracil (5-FU) and leucovorin regimens.
- To review the development of new drugs and combination therapies for advanced colorectal cancer.
- To assess the progress of orally administered fluoropyrimidines in colorectal cancer treatment.
Main Methods:
- Comparative analysis of infusional 5-fluorouracil (5-FU) with bolus 5-FU/leucovorin regimens.
- Review of ongoing clinical trials involving novel agents like oxaliplatin, CPT-11, and raltitrexed in combination with 5-FU/leucovorin.
- Examination of randomized studies comparing oral fluoropyrimidines (UFT, capecitabine, eniluracil/5-FU) with 5-FU/leucovorin.
Main Results:
- Infusional 5-fluorouracil (5-FU) demonstrated higher response rates and a better toxicity profile than bolus 5-FU/leucovorin.
- Median survival rates were not significantly different between the infusional and bolus 5-FU regimens.
- New active drugs are under development, but none have yet proven superior to optimal 5-FU regimens as single agents.
Conclusions:
- Infusional 5-fluorouracil (5-FU) offers an improved therapeutic index over bolus administration in metastatic colorectal cancer.
- Future research priorities include identifying the most effective drug combinations and treatment sequences.
- The development of oral fluoropyrimidines represents a significant advancement, with ongoing trials to establish their efficacy against standard 5-FU/leucovorin.