Clinical significance of bolus 5-fluorouracil for recurrent or metastatic colorectal cancer treated with FOLFOX therapy.

Yoshida, Yoko; Hasegawa, Junichi; Nezu, Riichiro; Mikata, Shoki; Kim, Y.; Nishimura, Junji; Hirota, Masashi; K, Ota; Yoshikawa, Kenzo

doi:10.1200/jco.2010.28.15_suppl.e14078

Cited by 4 publications

(6 citation statements)

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“…Neutropenia is the most common cause of chemotherapy dose reduction and delay [ 5 ]. The frequency of neutropenia differs according to the chemotherapy regimen even if the same anticancer drug is administered [ 6 , 7 ]. Grade 3–4 hematologic toxicity, mainly neutropenia, was approximately seven times more frequent in the 5-FU bolus arm, whereas hand-foot syndrome was approximately two times more frequent in the 5-FU continuous infusion arm [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Difference in Neutropenia due to Administration Schedule of TAS-102

et al. 2017

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TAS-102 significantly improves overall survival in patients with metastatic colorectal cancer. The most common adverse event of TAS-102 is bone marrow suppression, which leads to neutropenia. The incidence of neutropenia is high, and there is no known effective prevention method. Furthermore, the administration method of TAS-102 is complicated. We reported that neutropenia could be avoided by changing to a simple administration method of TAS-102.

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Section: Discussionmentioning

confidence: 99%

Difference in Neutropenia due to Administration Schedule of TAS-102

et al. 2017

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“…A Japanese retrospective study aimed to compare mFOLFOX6 plus bevacizumab with mFOLFOX7 (without 5-FU bolus) plus bevacizumab in 39 patients with metastatic colorectal cancer to assess the clinical relevance of omitting bolus 5-FU. 6 Given the better toxicity profile and similar clinical outcomes, the authors raised the question whether bolus 5-FU could definitely be omitted when prescribing FOLFOX. Although the omission of 5-FU bolus has never been directly tested against its use, mFOLFOX7 (without 5-FU bolus) has already been part of some phase III trial arms.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, retrospective data have pointed toward a better toxicity profile without compromising efficacy. [4][5][6] Although the utility of administering 5-FU in bolus in regimens of infusional 5-FU has been questioned, how often this is practiced by oncologists is unknown. Therefore, we aimed to quantify the use of 5-FU bolus in infusional regimens for GI malignancies among Brazilian oncologists and to investigate oncologists' characteristics associated with the administration of 5-FU bolus.…”

Section: Introductionmentioning

confidence: 99%

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Fluorouracil Bolus Use in Infusional Regimens Among Oncologists—A Survey by Brazilian Group of Gastrointestinal Tumors

Peixoto

Coutinho²,

Weschenfelder

et al. 2021

JCO Global Oncology

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PURPOSE The utility of administering fluorouracil (5-FU) in bolus in regimens of infusional 5-FU has been questioned. We aimed to quantify the use of 5-FU bolus in infusional regimens for gastrointestinal malignancies among Brazilian oncologists. METHODS This was a cross-sectional electronic survey composed of eight multiple-choice questions sent to Brazilian oncologists during 14 days in February 2021. The survey instrument collected demographic data of participants and assessed practices in terms of 5-FU bolus use. We evaluated the association of demographic variables and 5-FU prescribing patterns with Fisher’s exact test (odds ratio [OR]). RESULTS The survey was completed by 332 medical oncologists. Overall, 37% were experienced oncologists and 32% were gastrointestinal specialists. In the first-line metastatic and in the adjuvant settings, 40% and 67% of oncologists always prescribe 5-FU bolus in infusional regimens, respectively. Experienced oncologists more frequently omit 5-FU bolus when compared with early-career oncologists, both in the metastatic (41% v 26%; OR, 1.98; P = .005) and adjuvant settings (28% v 14%; OR, 2.32; P = .003). In addition, more GI specialists remove 5-FU bolus when compared with generalists, but only in the metastatic setting (44% v 25%; OR, 2.33; P = .001). GI specialists are more likely to consider that treatment efficacy is not affected by 5-FU bolus withdrawal than are generalists (89% v 75%; OR, 2.65; P = .003). Most respondents (67%) keep leucovorin at the same doses when omitting 5-FU bolus, and only 16% always recommend dihydropyrimidine dehydrogenase testing. CONCLUSION Our survey indicates that experience in oncology practice and percentage of time dedicated to treat GI cancers influence the prescription of 5-FU bolus in Brazil, with more frequent omission of it among experienced gastrointestinal specialists, particularly in the metastatic setting.

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“…Longer immunotherapy dosing intervals with similar pharmacokinetics were favored to reduce infusion visits [ 69 , 70 ]. When using 5-FU, experts recommended dropping the bolus which is associated with higher rates of hematologic toxicity and unclear survival benefit [ 71 ].…”

Section: Systemic Therapymentioning

confidence: 99%

Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic

Mukherji

Marshall

2021

Curr. Treat. Options in Oncol.

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Opinion statement The COVID-19 pandemic forced us to rapidly and dramatically shift our medical priorities and decision making. With little literature or experience to rely on, the initial priority was to minimize patient exposure to the hospital and to others. It remains unclear whether cancer patients are at higher risk of infection or serious complications, or if it is our traditional therapies that place them to be at higher risk. By far, the greatest negative impact was on screening. Routine colonoscopies were considered elective, and as a result, delays in diagnosis will be felt for years to come. The most positive changes were the incorporation of tele-visits, increased use of oral therapies, alterations in treatment schedules of both chemotherapy and radiation, and an increased emphasis on neoadjuvant therapy. These too will be felt for years to come. The colorectal cancer medical community has responded collaboratively and effectively to maintain treatment and to optimize outcomes for our patients during the COVID-19 pandemic.

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Clinical significance of bolus 5-fluorouracil for recurrent or metastatic colorectal cancer treated with FOLFOX therapy.

Cited by 4 publications

References 0 publications

Difference in Neutropenia due to Administration Schedule of TAS-102

Difference in Neutropenia due to Administration Schedule of TAS-102

Fluorouracil Bolus Use in Infusional Regimens Among Oncologists—A Survey by Brazilian Group of Gastrointestinal Tumors

Lessons Learned in Managing Patients with Colorectal Cancer During the COVID-19 Pandemic

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