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Where do we stand with 5-fluorouracil?
H J Schmoll1, T Büchele, A Grothey
1Department of Hematology/Oncology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
Seminars in Oncology
|December 22, 1999
Summary
For decades, 5-fluorouracil (5-FU) has been a standard colorectal cancer treatment. Research explores optimizing 5-FU efficacy through new schedules, combinations, and oral prodrugs for improved patient survival.
Area of Science:
- Oncology
- Medical Chemistry
Background:
- 5-fluorouracil (5-FU) has been the primary treatment for colorectal cancer for nearly 40 years.
- Limited alternatives have driven efforts to enhance 5-FU efficacy through varied delivery schedules and biomodulation.
Purpose of the Study:
- To review the current role and future directions of 5-fluorouracil (5-FU) in colorectal cancer treatment.
- To evaluate the efficacy of different 5-FU administration methods and its combination with novel chemotherapeutic agents.
Main Methods:
- Review of meta-analyses and clinical studies on 5-FU treatment protocols for colorectal cancer.
- Analysis of combination chemotherapy data involving 5-FU with oxaliplatin, irinotecan, and raltitrexed.
Main Results:
- Bolus 5-FU with folinic acid remains the standard for adjuvant and first-line palliative chemotherapy.
- Infusional 5-FU shows modest survival benefits but higher costs; protracted infusion with radiation is standard for rectal cancer.
- 5-FU in combination with new agents like oxaliplatin yields high response rates (50% in untreated, 15-25% in refractory patients).
Conclusions:
- While infusional 5-FU offers marginal survival benefits, its complexity and cost limit its standard adoption.
- Future strategies include oral 5-FU prodrugs and combination therapies with newer agents.
- 5-FU remains crucial in colorectal cancer chemotherapy, with potential in targeted gene therapy models.