Mount Sinai clinical experience with leucovorin and 5-fluorouracil

Fluorouracil Plus Leucovorin Induces Submandibular Salivary Gland Enlargement in Rats

The administration of 5-fluorouracil (FU) and leucovorin (LV) to rats induced a previously unreported sialoadenitis-like toxicity. Four different treatment regimens were used: daily-times-5 iv or ip injections of LV (200 mg/kg) followed 30 minutes later by FU (27.5 mg/kg or 35 mg/kg). These treatments resulted in 3 severity levels of systemic toxicity indicated by changes in body weight. In addition to the well known FU+LV-induced diarrhea, myelosuppression, and stomatitis, facial edema, and enlargement of the submandibular salivary gland were consistently seen. Facial edema occurred almost exclusively in rats that subsequently underwent excessive weight loss and were euthanized. The submandibular, but not parotid or sublingual, salivary gland was enlarged and the severity of this effect changed in a bell-shaped relationship with respect to increasing FU+LV induced loss of body weight. Histologic examination of affected glands established the occurrence of bacterial infection, sialoadenitis and destruction of gland tissue. This paper provides the first known documentation of FU+LV treatment-induced selective pathology of the submandibular salivary gland. The selectivity of this toxicity, apparently not normally seen in humans, to the submandibular salivary gland of the rat is of interest and its mechanism warrants further investigation.

Effective chemotherapy for gastrointestinal tumors. 21st Symposium on Recent results in chemotherapy of malignant diseases (Chairmen: J. van de Loo, V. Diehl) of the Gesellschaft zur Bekämpfung der Krebskrankheiten Nordrhein-Westfalen (GBK), Düsseldorf, June 1989

Chemotherapy can achieve approximately 50% rates of response, survival advantage or both for every type of gastrointestinal tumor. Findings favor adjuvant therapy for all high-risk tumors. Test-worthy candidate regimens possibly increase safety and efficacy, and challenge traditional choices of treatment for patients with either unresectable or metastatic disease. They create many new options and an unprecedented order of complexity. Treatments remain to be compared and integrated. Efforts to assess the impact of patient characteristics, cost and safety are preliminary at best, and critical to rational usage. There are as yet no perfect regimens, only a series of options supported by incomplete but clearly more promising findings than heretofore. These include: biochemical modulation for gastric and colonic cancer; chemotherapy as a radiotherapy adjuvant for esophageal, rectal, anal, and pancreatic cancer; and immunotherapy for gastric and colorectal cancer. Selective application of endocrine therapy, circadian time schedules or regional therapy may augment safety and quality of life. While response rates have probably improved, their exact frequency, quality and effect on survival are incompletely characterized. Investigations, offer the best way to deal with the options and speed progress, in the context of building upon apparent best therapies.

Clinical trials with 5-fluorouracil, folinic acid and cisplatin in patients with gastrointestinal malignancies

Combination chemotherapy for advanced gastrointestinal malignancies remains unsatisfactory. Studies show a definite therapeutic advantage for folinic acid/5-fluorouracil (5-FU) regimen compared with single agent 5-FU given intravenously in the management of advanced colorectal cancer. Data on survival benefits vary. A definitive conclusion regarding this question must outweigh the maturation of the present studies and possibly generate further extensive investigations. The currently available data are insufficient from which to draw any conclusion on the effect of the attempt to modulate 5-FU activity further by the addition of cisplatin to the combination. Nevertheless, the combination appears to elicit some therapeutic advantage in patients with pancreatic carcinoma and rectal carcinoma. The paucity of data in gastric carcinoma is disappointing in light of sensitivity to both cisplatin and 5-FU.