Grem J L
Developmental Therapeutics Department, Medicine Branch, Division of Clinical Sciences, National Cancer Institute, National Naval Medical Center, Bethesda, Maryland, USA.
Oncology (Williston Park). 2001 Jan;15(1 Suppl 2):13-9.
Randomized studies have tested a variety of strategies to improve the activity of 5-fluorouracil (5-FU) in colorectal cancer patients. Results from 14 randomized trials comparing 5-FU administered via intravenous (i.v.) bolus either as a single agent or modulated by leucovorin indicate a significantly higher response rate with 5-FU/leucovorin (25% vs 13% of assessable patients). Sequential methotrexate followed by i.v. bolus 5-FU is associated with a higher response rate. Continuous infusion schedules also produce superior response rates compared to bolus 5-FU alone. Published meta-analyses indicate a small, but statistically significant, survival advantage for methotrexate/5-FU and infusional 5-FU, but not for leucovorin-modulated 5-FU. Although the incidence of hand-foot syndrome is higher with protracted infusional 5-FU, the incidence of other toxicities including myelosuppression, diarrhea, and mucositis is low. Oral administration of 5-FU may simulate infusional schedules while avoiding catheter-related complications.
随机研究已经测试了多种策略来提高5-氟尿嘧啶（5-FU）在结直肠癌患者中的活性。14项随机试验的结果比较了静脉推注5-FU作为单一药物或用亚叶酸调节后的效果，结果显示5-FU/亚叶酸组的缓解率显著更高（可评估患者中分别为25%和13%）。序贯甲氨蝶呤后静脉推注5-FU与更高的缓解率相关。与单独静脉推注5-FU相比，持续输注方案也能产生更高的缓解率。已发表的荟萃分析表明，甲氨蝶呤/5-FU和持续输注5-FU有微小但在统计学上显著的生存优势，但亚叶酸调节的5-FU则没有。虽然持续输注5-FU导致手足综合征的发生率更高，但包括骨髓抑制、腹泻和粘膜炎在内的其他毒性发生率较低。口服5-FU可能模拟持续输注方案，同时避免与导管相关的并发症。
