Lokich J
Neoplastic Disease, Cancer Center of Boston, MA 02120, USA.
J Infus Chemother. 1995 Fall;5(4):208-11.
5-Fluorouracil (5-FU) has been studied over the past two decades in five prospective randomized trials comparing bolus with infusional schedules. Response rates and time to progression are improved with infusional schedules and survival as determined by the proportion of patients alive at 2 years is also superior for infusional administration. Biochemical modulation of infusional 5-FU by leucovorin or interferon does not increase the therapeutic effect (in contrast to the modulation of bolus delivery) but does effect the toxicity profile adversely. Time modulation of infusional 5-FU has been reported to improve response rates, and survival over constant or flat infusion and additional studies are ongoing. A proposed experimental design for a comparative trial in advanced colon cancer is presented to address the questions of the optimal infusion duration; the role of dose intensity; and the role of chronomodulation. The application of infusional 5-FU into the adjuvant setting seems to be a reasonable step, and such trials have been initiated in both the United States and the United Kingdom. Bolus single agent 5-FU should be abandoned as a treatment option for colon cancer.
在过去二十年中，五项前瞻性随机试验对5-氟尿嘧啶（5-FU）的推注给药方案与输注给药方案进行了研究。输注给药方案可提高缓解率和疾病进展时间，且就2年生存率而言，输注给药也更具优势。亚叶酸或干扰素对输注5-FU进行生化调节并不会增加治疗效果（与推注给药的调节情况相反），但会对毒性特征产生不利影响。据报道，对输注5-FU进行时间调节可提高缓解率，且与持续或匀速输注相比能改善生存率，更多研究正在进行中。本文提出了一项针对晚期结肠癌比较试验的实验设计，以解决最佳输注持续时间、剂量强度的作用以及时间调节的作用等问题。将输注5-FU应用于辅助治疗似乎是合理的一步，美国和英国均已启动此类试验。应摒弃推注单药5-FU作为结肠癌的治疗选择。
