CONTINUOUS-INFUSION OF 5-FLUOROURACIL IN METASTATIC COLORECTAL-CANCERPATIENTS

Response to chemotherapy in metastatic colorectal cancer is still disa ppointingly low. The most widely used agent is 5-fluorouracil (5-FU), which has a response rate of 10-20%. In view of its short plasma half- life and its S-phase specificity, continuous infusion seems more ratio nal than the conventional bolus injections. We treated 50 patients wit h recurrent or metastatic colorectal cancer with continuous infusion o f 5-FU (300mg/m2/day) using a portable infusion pump connected to a su bcutaneously implanted venous catheter (Port-a-Cath). Treatment was gi ven on an outpatient basis. Twenty-three patients had received prior c hemotherapy. A partial remission was achieved in 4 patients (response rate 8%) with a median duration of 52 weeks. There was a significant n umber of patients with stable disease for more than 3 months in the gr oup which had not received prior chemotherapy. Progressive disease occ urred more frequently in the pretreated patients. There was no clear r elationship between response to continuous infusion of 5-FU and respon se to previous or subsequent chemotherapy. Median survival was 33 week s. Toxicity consisted mostly of the hand-foot syndrome, stomatitis, mi ld nausea and diarrhoea. Dose reductions were necessary in 21 patients . Continuous infusion of 5-FU is a feasible treatment. The response ra te of 8% is lower than the response rate reported in previous series. It should not be considered as standard chemotherapy for metastatic co lorectal cancer. Combination with modulators of 5-FU or with other cyt otoxic agents might be considered.