Cancer chemotherapy and infusional scheduling

The practice of infusional cancer chemotherapy has evolved over the past decade as our increased understanding of tumor cell kinetics and drug pharmacology has brought into focus the concentration x time formulation and its importance in tumor cell killing and host tolerance. Technologic advances have contributed substantially to the practical capability of infusional drug delivery, with improved vascular access and ambulatory infusion pumps. In the past 10 years, infusional schedules have been used for virtually every class of antineoplastic agent and have demonstrated an improved therapeutic index by reduced or altered toxicity (doxorubicin, fluorouracil, ifosfamide, platinum analogs) or increased tumor cell killing (fluorouracil, etoposide, cladribine). Although there are few phase III trials comparing infusion and bolus administration, the evidence is clear that toxicity is altered and therapeutic benefit is not diminished by infusional schedules of drug administration.