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Lookup NU author(s): Dr Martin Highley
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Aims Oral administration of 5-fluorouracil (FUra), an important cytotoxic agent, is limited by a wide variation in bioavailability. 5'-deoxy-5-fluorouridine (dFUrd), a masked form of FUra, has shown promise clinically when given intravenously or orally as a solution or tablet. This study investigates the efficacy of an oral capsule formulation of dFUrd in generating continuous systemic levels of this compound in cancer patients. Methods Six patients with advanced intestinal or ovarian malignancies were given three cycles of dFUrd, days 1-5, at intervals of 4 weeks. The doses of dFUrd were 600 mg m(-2) three times daily, 800 mg m(-2) three times daily, and 1000 mg m(-2) three times daily, on cycles one, two and three, respectively (total dose 36 g m(-2)). The initial dose in each cycle was given as a slow intravenous injection over 10 min, and the remainder orally. Plasma and urine levels of dFUrd and two of its metabolites, FUra and 5,6-dihydro-5-fluorouracil (FUraH(2)), were monitored in six patients at each dose level. Results AU six patients completed the study, receiving three different doses over a 3 month period, following which one had achieved a partial response, one had stable disease, and four had developed progressive disease. Side-effects were negligible, and only two instances of transient diarrhoea WHO grade 1 were seen. Total body clearance (CLtot) of intravenous dFUrd decreased with increasing dose; 2.7, 2.0 and 1.3 1 min(-1) m(-2), following doses of 600, 800 and 1000 mg m(-2) respectively. The mean elimination half-life of intravenous dFUrd increased with the dose from 15 to 22 min. Oral dFUrd was rapidly absorbed with a lag time of less than 20 min. The mean elimination half-life (t(1/2, z)) Of Oral dFUrd was 32-45 min in the dose range 600-1000 mg m(-2) The AUC of FUra and FUraH(2) increased overproportionally with increasing intravenous doses of dFUrd. The mean systemic bioavailability of oral dFUrd was 34-47%. Conclusions dFUrd, which selectively releases the antimetabolite FUra in tumour cells, can be,given orally at doses of 600-1000 mg m(-2) three times daily for 5 days. The systemic levels achieved are equivalent to those seen following continuous infusions of dFUrd or FUra. Toxicity is tolerable, and further clinical investigation of oral dFUrd is warranted.
Author(s): Van Der Heyden SAM, Highley MS, De Bruijn EA, Tjaden UR, Reeuwijk HJEM, Van Slooten H, Van Oosterom AT, Maes RAA
Publication type: Article
Publication status: Published
Journal: British Journal of Clinical Pharmacology
Print publication date: 01/04/1999
ISSN (print): 0306-5251
ISSN (electronic): 1365-2125
Publisher: Wiley-Blackwell Publishing Ltd.