Circadian-based infusional FUDR therapy

FUDR (5-fluoro-2'-deoxyuridine) is one of the few chemotherapeutic agents with activity against metastatic renal cell cancer. Diarrhea and dehydration with long-term, constant-rate intravenous infusion may be severe and life-threatening. This gastrointestinal toxicity can be reduced by altering the rate of the infusion so that most of the daily dose is given late in the day, and a minimal infusion rate is delivered in the early morning hours. This complex therapy can be automatically administered by the programmable, implantable Synchro-Med Infusion System. Using a circadian modification of infusion delivery, toxicity is diminished and the FUDR dose can be safely increased, which may result in greater anti-tumor activity. This paper describes Phase I studies with 54 patients who were treated with intravenous FUDR. It also discusses results of a Phase II study using circadian-modified intravenous delivery of FUDR in the treatment of 61 patients with renal cell cancer. It outlines the nursing implications for management of the implantable, programmable drug delivery system and addresses the nursing role in preventing, recognizing, and controlling FUDR-associated toxicities.