Hello Ada5,
Here are the most commonly used 5FU regimens. I?ve also included
examples of some cancers and their usual regimens. Not all patients
are eligible for every regimen, but these are the most prescribed:
C.M.F
=====
?C.M.F. includes the drugs Cyclophosphamide, Methotrexate and
Fluorouracil (5-FU). You may this chemotherapy by tablet or injection
or sometimes in combination. Your treatment will be either:
? Day 1 Methotrexate, Fluorouracil (5FU) and Cyclophosphamide as a bolus injection
? Day 8 Methotrexate, Fluorouracil (5FU) and Cyclophosphamide as a bolus injectiom
This is given every 3 or 4 weeks for 4 cycles
or
? Day 1 Methotrexate, Fluorouracil (5FU) as a bolus injection
? Day 8 Methotrexate, Fluorouracil (5FU) as a bolus injection
? Days 1-14 Cyclophosphamide by tablet usually taken at night.
? Take the anti-emetic 30mins to 1 hour before.
This is given every 3 or 4 weeks for 4 cycles
C.M.F. by bolus injection can sometimes may you have a hot flush, feel
dizzy and leave a strange taste in the mouth. These sensations should
soon pass.
Extravasation is when chemotherapy leaks outside the vein. If you
develop redness, soreness or pain at the injection site at any time
please let us know straightaway.?
E.C.F.
=========
E.Carbo.F includes the drugs epirubicin, carboplatin and fluorouracil
(also called 5FU).
? Epirubicin is given by injection into a drip (red in colour)
? Carboplatin is given via a drip
? Fluorouracil (5FU) is given via a drip
The treatment is given every 3 weeks for 6 cycles.
http://www.christie.nhs.uk/patientinfo/booklets/chemocards/EcarboF.htm
E.C.F. which includes the drugs epirubicin, cisplatin and fluorouracil
(also called 5FU).
? Epirubicin is given by injection into a drip (red in colour)
? Cisplatin is given via a drip
? Fluorouracil (or 5FU) is given via a drip or a portable pump
The treatment is given every 3 weeks for 6 cycles. If you have a pump,
you will need to come to the clinic after 2 weeks to have your pump
changed and to see a doctor.
http://www.christie.nhs.uk/patientinfo/booklets/chemocards/ECF.htm
Fluorouracil, or 5FU, and calcium folinate, also known as folinic acid.
Your treatment of fluorouracil and calcium folinate will be given:
Extravasation is when chemotherapy leaks outside the vein. If you
develop redness, soreness or pain at the injection site at any time
please let us know straightaway.
http://www.christie.nhs.uk/patientinfo/booklets/chemocards/cf_5fu.htm
M.C.F.
======
M.C.F. includes the drugs Mitomycin C, Cisplatin and Fluorouracil.
? Mitomycin C is given by injection on alternate treatments
? Cisplatin is given via a drip
? Fluorouracil (5FU) is given continuously via a pump over 3 weeks
The treatment is given every 3 weeks for 6 to 8 cycles. You will need
to come to the pump clinic after 2 weeks to have your pump changed and
to see a doctor.
http://www.christie.nhs.uk/patientinfo/booklets/chemocards/mcf.html
Oxaliplatin, 5-Fluorouracil (5FU) and Folinic Acid (Calcium Folinate).
Oxaliplatin and 5-FU/Folinic acid Includes OxMdG (Oxaliplatin and
Modified deGramont) and FOLFOX-4 treatments
Oxaliplatin and Folinic Acid are given together via a drip over 2
hours. Followed by either:
5FU infusor lasting 5 minutes
5FU infusor lasting 46 hours - OxMdG
or
5FU infusor lasting 5 minutes
5FU infusor lasting 22 hours (Day 1)
Folinic Acid infusor lasting 2 hours
5FU infusor lasting 5 minutes
5FU infusor lasting 22 hours (Day 2) - FOLFOX-4
This treatment is repeated every 2 weeks.
http://www.christie.nhs.uk/patientinfo/booklets/chemocards/oxaliplatin_5FU.htm
========================================
? ?Folinic acid (a clear fluid) is given as a drip into your cannula
or central or PICC line. Oxaliplatin (a clear fluid) is also given as
a drip. Giving these drugs takes about 2 hours.
? FOLFOX: You will then have an injection of 5FU (a clear fluid) into
your cannula or line followed by a drip of 5FU over 22 hours. The next
day the folinic acid drip and the 5FU injection are repeated. This is
followed by another 22 hour infusion of 5FU.
? OxMdG: You will then have an injection of 5FU (a clear fluid) into
your cannula or line followed by a drip of 5FU over 46 hours.
As the 5FU drips last for between 44 and 46 hours you will need to
stay in hospital unless you have a central or PICC line. If you have a
line, this part of the treatment can be given to you through a small
portable pump. The pump is used to give a controlled amount of the
drug into your bloodstream over a set period of time. It is small
enough to be carried in a belt or holster. This means that once the
pump is connected to your central line and the treatment is started
you can go home with it. There are different sorts of pumps available,
and some are electronic. Your nurse or pharmacist will explain how
your pump works and how to look after it.?
http://www.cancerbacup.org.uk/Treatments/Chemotherapy/Combinationregimes/Oxaliplatin5FU
?The BCCA recommends consideration of one of the following two
regimens in the first line therapy of metastatic colorectal cancer in
patients with good performance status: GIFOLFIRI (bolus and infusional
5FU/FA/Irinotecan) and (U)GIFOLFOX (bolus and infusional
5FU/FA/Oxaliplatin). The UGIIRFUFA regimen (also known as "Saltz"
regimen or "IFL", bolus 5FU/FA/Irinotecan.) while effective in
metastatic colorectal cancer, was associated with significantly
increased (toxic) mortality in clinical trials (J Clin Oncol 2001; 18:
3801-07) and is no longer routinely recommended.
It may be used cautiously in patients in whom infusional therapies
are not appropriate. Given the concerns of toxicity with this regimen,
it requires "undesignated" approval. Combinations of the oral 5FU drug
Capecitabine with oxaliplatin ("CAPOX") or Irinotecan ("CAPIRI") may
be considered in patients ineligible for the corresponding infusional
5FU protocols. These protocols ("UGICAPOX", "UGICAPIRI") are currently
(October 2003) under development and will also require "undesignated"
approval.
There is considerable interest in substituting oral 5FU drugs (eg,
Capecitabine) for the infusional 5FU component within the above
combinations to reduce the inconvenience and potential risks of
indwelling central venous catheters. Trials are still ongoing.
Requests for approval of the substitution of Capecitabine for
infusional 5FU are reviewed on an individual basis. The intravenous
continuous infusion protocols are, for now, the BCCA accepted
standard.
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Gastrointestinal/05.Colon/Management/Palliative.htm
?Current standard therapy following resection of high-risk colon
cancer is intravenous bolus 5-fluorouracil (5-FU) with leucovorin
(LV), but there is no consensus on the optimum regimen of these drugs:
practice ranges from the high toxicity Mayo Clinic schedule to the
very low toxicity weekly QUASAR schedule.?
?Currently, the best-recognised reference regimen in adjuvant colon
cancer treatment is the Mayo Clinic schedule: 5-FU bolus 425 mg/m2
plus LV 20 mg/m2 daily for 5 days, repeated every 4?5 weeks for six
cycles. This was superior to control in NCCTG Trial 87-46-51 [4], and
at least equivalent to three other regimens in the large US Intergroup
trial INT-0089 [5]. It was also, when combined with levamisole,
superior to 6 months of 5-FU and levamisole alone in NCCTG trial
89-46-51 [6]. The Mayo Clinic schedule is recognised by licensing
authorities as a reference regimen in adjuvant studies. The Machover
regimen has, likewise, been validated against a non-treatment control
[7]; like the Mayo regimen it is given for five consecutive days each
month, but uses a lower dose of 5-FU (370?400 mg/m2) with higher dose
LV (200 mg/m2). The weekly Roswell Park regimen was superior to a
previous regimen, MOF, in NSABP trial C-03; it involves 6 weekly
treatments of 5-FU at 500 mg/m2 with high-dose LV (500 mg/m2),
followed by 2 weeks without treatment, for six cycles (48 weeks) [8].?
http://annonc.oxfordjournals.org/cgi/content/full/15/4/568
?No regimens appear to be significantly superior to 5-FU, with or
without leucovorin. With either regimen, average survival rates are
between three and six months.12 Combination regimens include FAM-S
(5-FU, doxorubicin, mitomycin, streptozocin), FAC (5-FU, doxorubicin,
cisplatin), FAP (5-FU, doxorubicin, cisplatin), and SMF (streptozocin,
mitomycin, 5-FU).? ?Attempts to improve clinical response rates
include investigating new chemotherapy agents, such as CPT-11 and
pirarubacin, and remodulating 5-FU with a variety of agents.?
http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf2fc4.htm
Bowel Cancer
-------------
?5-FU may be used alone, or in combination for its palliative (pain
killing) action in the management of bowel cancer, either as a single
agent or in combination with other cytotoxic agents. It is usually
combined with leucovorin (LV) and this treatment course is known as
5-FU/LV , or 5FU/FA
How is the treatment administered?
5-FU is given as an infusion or injection. Infusions are given through
a central line which is a rubber tube inserted under the skin of your
chest into a vein. This line is known as a Hickman or Groshong line .
Alternatively the drug may be given through a PICC line which is
inserted into
one of the large veins of the arm near the bend of the elbow.?
http://www.bowelcancer.org/treatments/chemotherapy.htm#5fu
?The chemotherapy regimen known as FOLFOX ? oxaliplatin plus
fluorouracil (5-FU) plus leucovorin ? produced higher response rates
and a significant delay in tumor progression in patients with
metastatic colorectal cancer, compared to other therapy.?
http://www.cancer.gov/clinicaltrials/results/oxaliplatin-as-second-line0603
??The most common chemotherapy drug for colorectal cancer is called
5-fluorouracil or 5-FU for short. You may have 5-FU with a vitamin
called folinic acid which makes the 5-FU more active against cancer
cells.?
Irinotecan (Campto)
?Irinotecan is also called CPT-11. You may have this drug as a first
treatment (1st line chemotherapy) for advanced bowel cancer. It has
been approved as a first treatment option since August 2005. Or you
may have it as a second type of treatment (2nd line chemotherapy) if
earlier chemotherapy hasn't controlled your bowel cancer. Depending
on treatment you've had before, you may have irinotecan on its own or
in combination with 5FU.?
http://www.cancerhelp.org.uk/help/default.asp?page=2929
?These benefits are most pronounced with regimens containing
irinotecan or oxaliplatin in combination with 5-FU; median OS
durations consistently approach 20 months, some as high as 24 months.
Timing ? Many patients with metastatic CRC are asymptomatic. The value
of early chemotherapy versus treatment deferral until symptoms develop
is controversial. In one trial in which 182 patients with asymptomatic
metastatic CRC were randomly assigned to initial or deferred
chemotherapy with sequential methotrexate, 5-FU and leucovorin,
earlier treatment was associated with a improvement in median OS (14
versus 9 months), symptom-free interval, and PFS [4].?
http://patients.uptodate.com/topic.asp?file=gicancer/10963&title=Gilbert's+syndrome
?Metastatic colorectal cancer has traditionally been treated with i.v.
5-fluorouracil (5-FU), with or without leucovorin (LV). 5-FU is
administered as either an i.v. bolus or a protracted infusion.
Although schedules using the latter method offer efficacy benefits
(objective response rate, time to disease progression), protracted
infusion schedules are often associated with medical complications,
inconvenience, high costs, and poor quality of life. Issues such as
quality of life and convenience have influenced treatment decisions,
but the availability of oral fluoropyrimidines represents a new
development in this domain.
Studies have confirmed that the majority of patients prefer oral to
i.v. chemotherapy. Questionnaire-based studies have also demonstrated
a preference for home-based rather than hospital-/clinicbased therapy.
This preference was one of the driving forces behind the development
of the oral fluoropyrimidines capecitabine (Xeloda®) and uracil plus
tegafur (UFT). Oral agents offer patients a more convenient treatment
option that can be administered at home, providing patients with a
greater sense of control over their therapy, while avoiding the
medical complications and psychological distress associated with
venous access.?
http://theoncologist.alphamedpress.org/cgi/content/full/6/suppl_4/12
?When comparing 5-FU/cisplatin-containing combination therapy regimens
with anthracyclines versus those without anthracyclines (HR 0.77; 95%
CI 0.62 to 0.95 based on 501 participants) and
5-FU/anthracycline-containing combinations with cisplatin versus those
without cisplatin (HR 0.83; 95% CI 0.76 to 0.91 based on 1147
participants), there was a significant survival benefit for regimens
including 5-FU, anthracyclines and cisplatin.?
http://www.cochrane.org/reviews/en/ab004064.html
Insulinoma
----------
?We achieved control of serum glucose levels with fluocortolone in
a patient with malignant insulinoma and hypoglycemia. We then
administered high-dose folinic acid and 5-fluorouracil (5-FU) bolus,
then 5-FU by continuous infusion for 2 consecutive days every 2 weeks
(this method is abbreviated as HDLV5FU). The plasma insulin and
C-peptide levels remained unchanged and the neoplasm was stable for 4
months with this therapy. According to the authors' literature review,
this is the first malignant insulinoma case treated with both
fluocortolone and HDLV5FU. Prospective studies are needed to determine
more effective treatment modalities for malignant insulinoma.?
http://www.theendocrinologist.org/pt/re/endocrinologist/abstract.00019616-200203000-00003.htm;jsessionid=D98oCfIDQGkW8pz0vOWuA42tGbosciv9UrA2ZRrxOnur5HVAE6vc!600736187!-949856144!9001!-1
Breast Cancer
-------------
?In women with a higher risk of disease recurrence, such as those
who have positive axillary lymph nodes or other unfavorable features,
the most commonly prescribed regimens include FAC, CEF (Cytoxan,
Ellence® [epirubicin] and 5-FU), AC followed by Taxol® (paclitaxel),
or TAC (Taxotere® [docetaxel], Adriamycin, and Cytoxan).?
http://www.curetoday.com/backissues/v2n3/features/early_stage/
?Chemotherapy combinations for non-metastatic breast cancer
? AC ± T ? Adriamycin (chemical name: doxorubicin) with
cyclophosphamide (brand name: Cytoxan), with or without Taxol
(chemical name: paclitaxel) or Taxotere (chemical name: docetaxol)
? CMF ? cyclophosphamide, methotrexate, and fluorouracil ("5-FU" or 5-fluorouracil)
? CAF ? cyclophosphamide, Adriamycin, and fluorouracil ("5-FU" or 5-fluorouracil)
? CEF ? cyclophosphamide, Epirubicin (similar to Adriamycin), and
fluorouracil ("5-FU" or 5-fluorouracil)
? FAC ? fluorouracil ("5-FU" or 5-fluorouracil), Adriamycin, and cyclophosphamide.
http://www.breastcancer.org/tre_sys_chemo_whydrugs.html
Additional 5FU information:
===========================
http://www.cancerbacup.org.uk/Treatments/Chemotherapy/Individualdrugs/Fluorouracil#3210
FOLFOX
http://www.mayoclinic.org/news2003-rst/2050.html
FOLFIRI
http://www.esmo.org/reference/abstracts00/cc/187.htm
Here is a chart that outlines FOLFOX and FOLFIRI, along with modifications:
http://patients.uptodate.com/image.asp?file=onco_pix/chemo_2.gif
I hope this has helped, along with Blah526?s useful comment. If any
part of my answer is unclear, please request an Answer Clarification.
I will be happy to assist you before you rate my answer.
Regards, Crabcakes
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