The increasing complexity of cancer chemotherapy makes it mandatory that pharmacists be familiar with these highly toxic agents. This column reviews various issues related to the preparation, dispensing, and administration of cancer chemotherapy, both commercially available and investigational.
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References
1.
HeidelbergerC., ChaudhuriN.K., DannebergP.Fluorinated pyrimidines, a new class of tumour-inhibitory compounds. Nature.1957; 179: 663–6.
2.
VaughnD.J., HallerD.G.The role of adjuvant chemotherapy in the treatment of colorectal cancer. Hematol Oncol Clin North Am.1997; 11: 699–719.
3.
MoertelC.G., FlemingT.R., MacdonaldJ.S.Levamisole and fluorouracil for adjuvant therapy of resected colon carcinoma. N Engl J Med.1990; 322: 352–8.
4.
MoertelC.G., FlemingT.R., MacdonaldJ.S.Fluorouracil plus levamisole as effective adjuvant therapy after resection of stage III colon carcinoma: A final report. Ann Intern Med.1995; 122: 321–6.
5.
HallerD.G., CatalanoP.J., MacdonaldJ.S.Fluorouracil (FU), leucovorin (LV) and levamisole (LEV) adjuvant therapy for colon cancer: Five-year final report of INT-0089. Proc Am Soc Clin Oncol.1998; 17: 256a.
6.
WolmarkN., RocketteH., MamounasE.Clinical trial to assess the relative efficacy of fluorouracil and leucovorin, fluo-rouracil and levamisole, and fluorouracil, leucovorin, and lev-amisole in patients with Dukes' B and C carcinoma of the colon: Results from National Surgical Adjuvant Breast and Bowel Project C-04. J Clin Oncol.1999; 17: 3553–9.
7.
MooreH.C., HallerD.G.Adjuvant therapy of colon cancer. Semin Oncol.1999; 26: 545–55.
8.
ArdalanB., ChuaL., TianE.A phase II study of weekly 24-hour infusion with high-dose fluorouracil with leucovorin in col-orectal cancer. J Clin Oncol.1991; 9(4): 625–30.
9.
HartmannJ.T., KohneC.H., SchmollH.J.Is continuous 24-hour infusion of 5-fluorouracil plus high-dose folinic acid effective in patients with progressive or recurrent colorectal cancer? A phase II study. Oncology.1998; 55(4): 320–5.
10.
YehK.H., ChengA.L., LinM.T.A phase II study of weekly 24-hour infusion of high-dose 5-fluorouracil and leucovorin (HDFL) in the treatment of recurrent or metastatic colorectal cancers. Anticancer Res.1997; 17(5B): 3867–72.
11.
JägerE; KleinO; WachterB. Second-line treatment with high-dose 5-fluorouracil and folinic acid in advanced colorectal cancer refractory to standard-dose 5-fluorouracil treatment. Oncology.1995; 52(6): 470–3.
12.
HaasN.B., SchilderR.J., NashS.A phase II trial of weekly infusional 5-fluorouracil in combination with low-dose leucovorin in patients with advanced colorectal cancer. Invest New Drugs.1995; 13(3): 229–33.
13.
Diaz-RubioE., ArandaE., CampsC.A phase II study of weekly 48-hour infusions with high-dose fluorouracil in advanced colorectal cancer: An alternative to biochemical modulation. J Infuse Chemother.1994; 4(1): 58–61.
14.
ArandaE., CervantesA., CarratoA.The Spanish experience with high-dose infusional 5-fluorouracil (5-FU) in colorectal cancer. The Spanish Cooperative Group For Gastrointestinal Tumor Therapy (TTD). J Infus Chemother.1996; 6(3): 118–22.
15.
ArandaE., Diaz-RubioE., CervantesA.Randomized trial comparing monthly low-dose leucovorin and fluorouracil bolus with weekly high-dose 48-hour continuous-infusion fluorouracil for advanced colorectal cancer: A Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD) study. Ann Oncol.1998; 9(7): 727–31.
16.
WarrenH.W., AndersonJ.H., O'GormanP.A phase II study of regional 5-fluorouracil infusion with intravenous folinic acid for colorectal liver metastases. Br J Cancer.1994; 70(4): 677–80.
17.
KerrD.J., LedermannJ.A., McArdleC.S.Phase I clinical and pharmacokinetic study of leucovorin and infusional hepatic arterial fluorouracil. J Clin Onocl.1995; 13(12): 2968–72.
18.
LorenzM., Staib-SeblerE., GogC.A pilot study on intensive weekly 24-hour intra-arterial infusion with 5-fluorouracil and folin-ic acid for colorectal liver metastases. Oncology.1998; 55(1): 53–8.
19.
ArandaE., CervantesA., DortaJ.A phase II trial of weekly high dose continuous infusion 5-fluorouracil plus oral leucovorin in patients with advanced colorectal cancer. The Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD). Cancer.1995; 76(4): 559–63.
20.
ArandaE., CervantesA., CarratoA.Outpatient weekly highdose Continuous-infusion 5-fluorouracil plus oral leucovorin in advanced colorectal cancer. A phase II trial. Spanish Cooperative Group for Gastrointestinal Tumor Therapy (TTD). Ann Oncol.1996; 7(6): 581–5.
21.
NobileM.T., BarzacchM.C., SanguinetiO.Activity of high dose 24 hour 5-fluorouracil infusion plus L-leucovorin in advanced colorectal cancer. Anticancer Res.1998; 18(1B): 517–21.
22.
GremJ.L., McAteeN., BalisF.A phase II study of continuous-infusion 5-fluorouracil and leucovorin with weekly cisplatin in metastatic colorectal carcinoma. Cancer.1993; 72(3): 663–8.
23.
HausmaningerH., MoserR., SamoniggH., MlineritschB., SchmidtH.Biochemical modulation of 5-fluorouracil by leucovorin with or without interferon-alpha-2c in patients with advanced col-orectal cancer: Final results of a randomised phase III study. Eur J Cancer.1999; 35(3): 380–5.
24.
LoefflerT.M., HausamenT.U.High-dose infusional 5-fluorouracil combination therapy of metastatic gastric and colorectal cancer. J Infus Chemother.1996; 6(3): 137–40.
25.
VanhoeferU., HarstrickA., KohneC.H.Phase I study of a weekly schedule of irinotecan, high-dose leucovorin, and infusion-al fluorouracil as first-line chemotherapy in patients with advanced colorectal cancer. J Clin Oncol.1999; 17(3): 907–13.
26.
TrisselL.A., MartinezJ.F., XuQ.A.Incompatibility of fluorouracil with leucovorin calcium or levoleucovorin. Am J Health Syst Pharm.1995; 52: 710–5.
27.
TrisselL.A.Handbook on Injectable Drugs.11th ed.Bethesda, MD: American Society of Health-System Pharmacists; 2001, 588.
28.
HeskethP.J., KrisM.G., GrunbergS.M.Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol.1997; 15(1): 103–9.
29.
American Society of Health-System Pharmacists. ASHP therapeutic guidelines on the pharmacologic management of nausea and vomiting in adult and pediatric patients receiving chemotherapy or radiation therapy or undergoing surgery. Am J Health Syst Pharm.1999; 56(8): 729–64.
30.
National Comprehensive Cancer Network.NCCN antiemesis practice guidelines. Oncology.1997; 11(11A): 57–89.
31.
GrallaR.J., OsobaD., KrisM.G.Recommendations for the use of antiemetics: Evidence-based, clinical practice guidelines. J Clin Oncol.1999; 17: 2971–94.
OzerH., ArmitageJ.O., BennettC.L.2000 update of recommendations for the use of hematopoietic colony-stimulating factors: Evidence-based, clinical practice guidelines. J Clin Oncol.2000; 18: 3558–85.
LymanG.H., KudererN., GreeneJ.The economics of febrile neutropenia: Implications for the use of colony-stimulating factors. Eur J Cancer.1998; 34: 1857–64.
36.
LarsonD.L.Treatment of tissue extravasation by antitumor agents. Cancer.1982; 49: 1796–9.
37.
LarsonD.L.What is the appropriate management of tissue extravasation by antitumor agents?Plast Reconstr Surgery.1985; 75: 397–402.
38.
PattersonW.P., ReamsG.P.Renal and electrolyte abnormalities due to chemotherapy. In: PerryM.C., ed. The Chemotherapy Source Book.2nd ed.Baltimore, MD: Williams and Wilkins; 1996, 727–44.
39.
KintzelP.E., DorrR.T.Anticancer drug renal toxicity and elimination: Dosing guidelines for altered renal function. Cancer Treat Rev.1995; 21: 33–64.
40.
KingP.D., PerryM.C.Hepatotoxicity of chemotherapeutic and oncologic agents. Gastroenterol Clin North Am.1995; 24(4): 969–90.
