Continuous Infusional Chemotherapy for Early Breast Cancer: The Royal Marsden Hospital Experience

摘要

Continuous infusional chemotherapy is not a new concept. The clinical use of long-term infusional fluorinated pyrimidines was first described in the 1960s (Sullivan et al. 1960), but interest has been renewed in recent years as the limitations of conventional chemotherapy in common solid tumours have become increasingly clear. 5-FU has been the major drug studied.5-FU is a cycle-specific S-phase-dependent drug with a short half-life of 10-20 min (Ensminger et al. 1978) and is therefore appropriate for use in long-term continuous infusional chemotherapy. Lokich et al. (1981) showed that surprisingly large doses of up to 300 mg/m2 per day could be delivered by ambulatory pump and long-term indwelling central venous lines for prolonged periods. This represents a greater than five-fold increase in dose intensity over many standard conventional schedules (e.g. CMF), with plantar-palmar syndrome and mucositis replacing myelosuppression as the dose-limiting toxicity. Subsequently Lokich et al. (1989) went on to demonstrate in a randomised trial that continuous infusional 5-FU for 10 weeks or more achieved a significantly higher response rate than 5-day conventional bolus treatment (30% vs 7%)sin patients with advanced colorectal cancer, with less myelosuppression.