Phase I and pharmacologic evaluation of intraperitoneal 5-fluoro-2'-deoxyuridine

Intraperitoneal (i.p.) 5-fluoro-2'-deoxyuridine (Floxuridine, FUdR, FdUrd) was evaluated in a phase I study at a starting level of 500 mg given on 1 day in 2 I 1.5% dialysate. Escalations within patients were allowed every other cycle. A total of 23 patients (age, 32-78 years) received 108 treatment courses. Local tolerance at all dose levels was excellent, with no cases of drug-related peritonitis being observed. Nausea and vomiting increased in severity in relation to dose and was universal at greater than 3,000 mg x 3 days. One patient each developed grade 1 mucositis as well as diarrhea at a dose of 3,000 mg x 3 days and leukopenia and thrombocytopenia at 5,000 mg x 3 days. Peritoneal fluid (PF) and plasma (PL) FdUrd profiles were monitored by an HPLC method in 13 subjects, with 7 being studied serially at 2-4 increment doses for up to 6 h. Profiles that exhibited apparent linear pharmacokinetics gave PF drug levels 2-4 logs higher than the PL counterparts, with the latter essentially declining in parallel to the former, indicating that the disposition of FdUrd from the peritoneal compartment is rate-determining. The mean terminal half-life for PF FdUrd was found to be 115 min and mean peritoneal clearance was 25 ml/min. The vast differences in drug levels and AUC found between the PF and the PL profiles suggests a high systemic clearance of FdUrd, which was confirmed in two patients receiving 2 g FdUrd by short i.v. infusion. A disproportionate increase in the plasma FdUrd levels and the corresponding AUC values was found with increasing dose, suggesting a disproportionate increase in the systemic partitioning of FdUrd when doses were escalated within a patient. Substantial levels of peritoneal 5-fluorouracil (FUra) were also detected in most of the subjects. Thus, FdUrd was found to have several desirable properties for i.p. administration: (1) a 2- to 4-log pharmacologic advantage. (2) the absence of local toxicities, and (3) a favorable antitumor spectrum and some evidence of antitumor effects in this phase I and pharmacology study. A 3,000-mg dose given in 2 1 1.5% dialysate for 3 consecutive days exhibited antitumor activity and produced no systemic toxicity except nausea and vomiting, which was controlled by antiemetics. This dose schedule is therefore recommended for phase II trials directed against small-volume disease in the peritoneal cavity, such as may be found in some stages of ovarian and gastrointestinal cancers.(ABSTRACT TRUNCATED AT 400 WORDS)

Path model of multidimensional compliance with cancer therapy

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.