PLYMOUTH MEETING, PA — Recent research published in the Journal of the National Comprehensive Cancer Network (JNCCN) proposes a significant shift in the administration of 5-fluorouracil (5-FU) for metastatic gastrointestinal (GI) cancers. The study explores the possibility of using 5-FU solely via continuous infusion, excluding the bolus, without compromising patient outcomes. This finding is crucial in refining treatment protocols for advanced colorectal, gastroesophageal, and pancreatic cancers.
The comprehensive study examined data from 11,765 patients across 280 cancer clinics, spanning diagnoses between January 2011 and May 2022. Results indicated that 13.7% of patients who did not receive the 5-FU bolus component experienced no reduction in overall survival rates. Notably, these patients benefited from a marked decrease in cytopenias like neutropenia and thrombocytopenia, conditions that significantly hinder immune function and increase bleeding risks, respectively.
Lead researcher Shun Yu, MD, from NYU Langone Health, emphasized the empirical support the study provides for what many clinicians have suspected. “The most significant benefit of this adjustment is that it makes the treatment more tolerable, potentially easing the chemotherapy experience for patients.” Historically, the dual administration of 5-FU, combining a bolus injection with continuous infusion, was standard. However, emerging multi-drug regimens have not thoroughly evaluated the bolus’s necessity, leaving its role largely assumed rather than proven.
The study’s findings resonate with many oncologists who have already started to exclude the bolus, particularly amid recent 5-FU shortages. Elena Gabriela Chiorean, MD, from the Fred Hutch Cancer Center, who was not involved in the study, noted, “This large study shows that omitting the bolus 5-FU has no detrimental effect on survival but reduces side effects and healthcare costs.”
The implications of this research are profound. By potentially eliminating the bolus component in FOLFOX, FOLFIRI, and FOLFIRINOX regimens, healthcare professionals could enhance treatment tolerability and reduce adverse effects, offering a more patient-friendly approach to managing GI cancers. As treatment paradigms evolve, ongoing research and clinical adjustments will remain pivotal in optimizing cancer care and patient quality of life.
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