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Biomedical subjects

N Renée

Publications and source records attributed to N Renée.

At least 19 recordsLinked to original sources
PubMed2003

Molecular mechanisms underlying the interaction between ZD1839 ('Iressa') and cisplatin/5-fluorouracil.

ZD1839 ('Iressa'), an orally active, selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is currently being investigated in clinical trials as a treatment for cancer. 'Iressa' is a trademark of the AstraZeneca group of companies. We have previously demonstrated a synergistic interaction between ZD1839 and cisplatin/5-fluorouracil (5FU) in CAL33, a human head and neck cancer cell line that markedly expresses EGFR. This study examined the effects of this drug combination on the cell cycle, cell cycle regulators, apoptosis-related factors, EGFR-related signalling and DNA repair in CAL33 cells. The cells were incubated with ZD1839 alone for 48 h, then cisplatin and 5FU were added. Exposure to the drug combination continued for a further 48 h. ZD1839 alone induced accumulation of cells in the G0/G1 phase of the cell cycle at 24 h accompanied by a concomitant increase in p21, p27 and Bax, a significant decrease in Bcl2 and a decrease in Akt phosphorylation. A decrease in DNA-PK was observed at 48 h. ZD1839 alone had no effect on caspase-3 activity, but addition of ZD1839 to cisplatin-5FU led to a significant increase in caspase-3 activity at 96 h. Thus, ZD1839 affects key cellular pathways controlling cell proliferation, apoptosis and DNA repair. These data provide a rationale to support clinical trials combining ZD1839 and cisplatin-5FU and other protocols that combine EGFR-targeting agents with chemotherapy or radiotherapy.

Antineoplastic Agents↗
PubMed2003

[Circadian variations of dihydropyrimidine dehydrogenase (DPD) activity in oral mucosa of healthy volunteers].

UNLABELLED: Dihydropyrimidine dehydrogenase (DPD) is the rate limiting enzyme of 5-fluoro-uracil (5-FU) catabolism. DPD rhythmicity, peak at 1:00 is an important determinant of 5-FU tolerability and has practical implications for the pattern of chronomodulated delivery of the drug. Maximal tolerated doses have been highed and anti-tumour activity also. But 30% patients have toxicities expressed by mucositis in oral mucosa. PURPOSE: Titrate DPD activity in oral mucosa in healthy subjects, in oral mucosa which is the target of 5-FU, at 10:00 and midnight could help to understand toxicities in patients. SUBJECTS AND METHODS: Eight healthy subjects participated (information note signed by patients). One oral mucosa sample was drawn at 10:00 and an other at midnight. DPD activity was analyzed by a H.P.L.C. method. RESULTS: DPD activity in oral mucosa varied from 0.004 to 0.13 nmol x min(-1) x mg(-1) prot at 10:00 and from 0.07 to 0.16 nmol x min(-1) x mg(-1) prot at midnight, with a 30% average relative increase from morning to midnight (range: -20% to +100%; statistical significant difference with P <0.073). CONCLUSION: DPD circadian changes in healthy oral mucosa subjects remained to agree to mononuclear cell, with increase at midnight.

Adult↗
PubMed2003

Dihydropyrimidine dehydrogenase circadian rhythm in mouse liver: comparison between enzyme activity and gene expression.

Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme of 5-fluorouracil (FU) catabolism. The relevance of the measurement of DPD activity for identifying DPD-deficient patients is lessened by circadian variability in DPD activity. Our purpose was to determine whether or not DPD mRNA is sustained by a circadian rhythm. Synchronised mice (male B6D2F1) were sacrificed at 3, 7, 11, 15, 19 or 23 Hours After Light Onset (HALO; eight mice per time-point). Liver DPD activity was determined by a radio-enzymatic assay and liver DPD expression by a reverse transcriptase-polymerase chain reaction (RT-PCR) enzyme-linked immunosorbent assay (ELISA) method. Mice synchronisation was controlled by leucocyte and neutrophil counts. Individual DPD activity ranged from 555 to 1575 pmol/min/mg prot; mean DPD activity was highest at 3 HALO (mean+/-standard error of the mean (S.E.M.); 1105+/-70) and lowest at 15 HALO (889+/-71). Individual liver DPD expression varied from 761 to 3481 units (DPD/beta actin ratio); the mean was lowest at 3 HALO (1406+/-112) and highest at 15 HALO (2067+/-214). Cosinor analysis indicated that respective double amplitudes of DPD activity and expression were 21 and 30% of the 24-h mean. The acrophases for activity and expression were 6:40 and 14:10 HALO, respectively, meaning that maximum activity occurred 16 h after the maximum observed expression. These results, revealing the existence of a circadian rhythm in DPD expression, should stimulate further studies to enhance our understanding of the molecular mechanisms involved in the circadian regulation of the DPD enzyme.

Animals↗
PubMed2003

Pharmacokinetics of low-dose carboplatin and applicability of a method of calculation for estimating individual drug clearance.

BACKGROUND: Carboplatin is the only cancer drug for which conventional doses are individually adjusted according to estimated clearance and target area under the curve (AUC). The aim of this prospective study was (i) to evaluate intra- and interpatient variability of ultrafilterable (UF) carboplatin AUC(0-)(infinity) and (ii) to test whether the prediction of carboplatin clearance according to the Chatelut formula established for conventional carboplatin doses was accurate for low carboplatin doses. MATERIALS AND METHODS: Thirty-one head and neck cancer patients (29 men, two women, mean age 55.9 years) received concomitant radiotherapy (Rgamma 2 Gy/day) and chemotherapy (carboplatin 50 mg/m(2)/day i.v.) for 7 weeks: Rgamma was administered 5 days/week (days 1-5) and carboplatin 2 days/week (days 1 and 4). Pharmacokinetics was performed once per week. A limited sample strategy based on Bayesian analysis was first validated and blood was subsequently taken 1 and 4 h after the end of carboplatin administration. RESULTS: A total of 143 cycles was analyzed. Ultrafilterable carboplatin AUC(0-)(infinity) ranged from 0.360 to 4.200 mg.min/ml (mean 0.830, median 0.670). As a corollary, UF carboplatin clearance ranged from 19.1 to 244.7 ml/min. Ultrafilterable carboplatin concentrations were very stable over time: AUC(0-)(infinity) variability due to treatment duration contributed to <1% of the total variance, while interpatient variability contributed to 68.6%. Accordingly, intrasubject effect was not significant (P = 0.38) whereas intersubject effect was highly significant (P <0.001). These results suggest that optimal dosage for targeting a given AUC may vary within a 13-fold range between patients. The Chatelut formula, based on creatininemia, body weight, age and sex, over estimates carboplatin clearance by 40% on average (bias 95% CI 29.6% to 51.1%). No significant relationship was observed between either bone marrow toxicity or creatinine clearance decrease and carboplatin pharmacokinetics. CONCLUSIONS: The Chatelut carboplatin clearance model established for conventional carboplatin dosages (>100 mg/m(2)) is not applicable for targeting low AUC (<1 mg x min/ml).

Adult↗
PubMed2001

High-performance liquid chromatographic assay with ultraviolet detection for quantification of dihydrofluorouracil in human lymphocytes: application to measurement of dihydropyrimidine dehydrogenase activity.

The anticancer drug 5-fluorouracil (5FU) undergoes extensive biotransformation to 5-dihydrofluorouracil (5FUH2) by the enzyme dihydropyrimidine deshydrogenase (DPD). A new HPLC method with direct UV detection for the determination of 5FUH2 in peripheral lymphocytes has been developed to detect DPD deficiency in patients treated with 5FU-based therapy. The method has been shown to be valid over the 5FUH2 concentration range of 1.14-37.88 nmol/ml. Optimal enzymatic conditions for DPD activity measurement were studied: incubation time, protein and 5FU concentrations. The assay was successfully cross-validated with the existing method using HPLC with radiochemical detection.

Chromatography, High Pressure Liquid↗
PubMed2000

An analysis of potential factors allowing an individual prediction of cisplatin-induced anaemia.

Severe cisplatin (CP)-induced anaemia significantly impairs the patient's quality of life. Prevention based on erythropoietin (EPO) administration would be cost-effective providing that individual predictive factors of anaemia are identified. The aim of the present study was to identify parameters able to predict the occurrence of CP-related anaemia. This prospective study was conducted on 40 head and neck cancer patients receiving a CP (100 mg/m(2), intravenous (i. v.) on day 1) - 5-fluorouracil (5-FU, 1 g/m(2)/dx5 days by continuous infusion) induction chemotherapy. Three cycles were given at 3-weekly intervals. Platinum pharmacokinetics (total and ultrafilterable plasma platinum concentration measured 16 h after CP administration) and 5-FU pharmacokinetics (full-cycle plasma area under the curve, (AUC(0-105h)30 g/l) occurred in 15 patients (38%) and 3 of them also received a blood transfusion. Patient age, 5-FU AUC(0-105h) and total platinum concentration were unrelated to Hb loss. In contrast, ultrafilterable (UF) platinum concentration was significantly correlated to Hb loss: the higher the UF platinum concentration, the greater the Hb loss (P=0.015). A discriminant analysis allowed a cut-off value for UF platinum to be proposed to identify patients developing significant loss of Hb: 91% of patients exhibiting a UF platinum concentration above 50 ng/ml developed significant loss of Hb in contrast to 18% in the group of patients with a UF platinum concentration below 50 ng/ml (odds ratio (95% confidence interval, CI) of 46 (4.7-446)). In conclusion, the present platinum pharmacokinetic survey may be proposed as a valuable approach to identify patients at risk for developing severe anaemia.

Adult↗
PubMed2000

A limited sampling strategy for determining carboplatin AUC and monitoring drug dosage.

There are several convincing reports showing relationships between the area under the curve of ultrafilterable concentration versus time (AUC) and pharmacodynamics of carboplatin. It is advisable, in treated patients, to check the AUC that is effectively delivered as compared with the prescribed AUC. To this end, limited sampling strategy seems to be an adequate approach since it limits the constraints of repeated blood sampling for both patients and nursing staff. A flexible limited sampling method for assessing ultrafilterable carboplatin AUC was developed. This method was based on a Bayesian estimation of carboplatin clearance using the NON linear Mixed Effect Model (NONMEN) program and a large pharmacokinetic and covariates database (103 patients). The optimal sampling design was a two-sample schedule (1 and 4 h after the end of infusion). During a prospective evaluation, it allowed an adequate estimation of carboplatin clearance with a non-significant bias (-4.5%) and a good precision (9%). In a second stage, this method was clinically applied to monitor carboplatin AUC in a group of 5 patients with metastatic germ cell tumours treated with intensified high dose carboplatin-based chemotherapy for 4 days. Dosage adjustments were performed according to daily controls of their AUC in order to obtain a total AUC of 20 mg/ml x min. By using this strategy all patients effectively received a total AUC very close to this targeted AUC, thus proving the clinical usefulness of this limited sampling method.

Antineoplastic Agents↗
PubMed2000

Impact of UFT on tumoral TS and DPD levels in colorectal cancer.

This was an open lable, pilot translational clinical pharmacology study of a brief (7 day) course of UFT, 300 mg/m2/day, in combination with leucovorin, 90 mg/day, in six patients with newly diagnosed advanced colorectal cancer. The primary objectives of the study were to examine the impact of this treatment course on the UFT targets which are thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD). The rate of tumoral TS inhibition after the 7-day UFT treatment sequence varied from 5% up to 31%. UFT treatment induced a constant and variable decrease in tumor DPD activity ranging from 13% to 60%. UFT treatment induced a constant increase in uracil concentrations both in plasma and tumors. FT, 5-FU and the metabolite fluoro-beta-alanine (FBAL) were found in plasma and tumors at variable concentrations; the highest drug concentrations were those of FBAL in plasma. The present translational clinical study provides data related to the in vivo pharmacological effects of UFT with a description of its impact on cellular targets.

Administration, Oral↗
PubMed1999

Dihydropyrimidine dehydrogenase deficiency and fluorouracil-related toxicity.

Dihydropyrimidine dehydrogenase (DPD) is the initial and rate-limiting enzyme of 5-fluorouracil (5-FU) catabolism. We report lymphocytic DPD data concerning a group of 53 patients (23 men, 30 women, mean age 58, range 36-73), treated by 5-FU-based chemotherapy in different French institutions and who developed unanticipated 5-FU-related toxicity. Lymphocyte samples (standard collection procedure) were sent to us for DPD determination (biochemical method). Among the whole group of 53 patients, 19 had a significant DPD deficiency (DD; below 150 fmol min(-1) mg(-1) protein, i.e. less than 70% of the mean value observed from previous population study). There was a greater majority of women in the DD group (15 out of 19, 79%) compared with the remaining 34 patients (15 out of 34, 44%, P<0.014). Toxicity was often severe, leading to patient death in two cases (both women). The toxicity score (sum of WHO grading, theoretical range 0-20) was twice as high in patients with marked DD (below 100 pmol min(-1) mg(-1) protein, n = 11, mean score = 13.2) compared with patients with moderate DD (between 150 and 100 pmol min(-1) mg(-1) protein, n = 8, mean score = 6.8), P = 0.008. In the DD group, there was a high frequency of neurotoxic syndromes (7 out of 19, 37%). The two deceased patients both had severe neurotoxicity. The occurrence of cardiac toxicity was relatively rare (1 out of 19, 5%). These data suggest that women are particularly prone to DPD deficiency and allow a more precise definition of the DD toxicity profile.

Adult↗
PubMed1999

Variable intrinsic sensitivity of human tumor cell lines to raltitrexed (Tomudex) and folylpolyglutamate synthetase activity.

The cytotoxic effects of Tomudex (TX) were investigated on a panel of 15 human tumor cell lines expressing a spontaneous sensitivity to the tested agent. We determined the basal cellular amount of relevant cellular factors potentially related to the cytotoxic efficacy of or resistance to TX. We selected thymidylate synthase (TS) as the target for TX, basal reduced folates (RF), because RF may compete with TX for a common site on the TS molecule. We also tested folylpolyglutamate synthetase (FPGS) because this is the enzyme which transforms the drug into its active polyglutamated form. Results were as follows. There was a wide inter-cell line variability in IC50 values for TX and there were marked differences between cell lines for all tested biochemical parameters. No link was observed between basal cellular TS activity and TX cytotoxic efficacy. There was an inverse relationship between reduced folate cellular content and TX IC50 values; this relationship did not, however, reach statistical significance. The only significant relationship was found between basal cellular FPGS activity and TX IC50r = -0.56, p = 0.03. Tumor cells with a relatively high FPGS activity were more sensitive to TX cytotoxic effects and vice versa. Along with previous results which showed that acquired resistance to TX is accompanied by a decrease in FPGS activity, the present data are strongly indicative of a prominent role played by FPGS activity in the intrinsic sensitivity to TX. Means to up-regulate FPGS activity with pharmacological or tumor-specific genetic approaches are recommended so as to optimize TX antitumor activity.

Animals↗
PubMed1997

Dual modulation of 5-fluorouracil cytotoxicity using folinic acid with a dihydropyrimidine dehydrogenase inhibitor.

Dihydropyrimidine dehydrogenase (DPD) is the key enzyme of the fluorouracil (FU) catabolic pathway. We have shown that tumor cells expressing a high DPD activity are resistant to FU (Eur J Cancer 30: 1517, 1994), and that 5-ethynyluracil (776C), a very potent DPD inactivator, markedly enhances the FU cytotoxic effect (Clin Cancer Res 1: 991, 1995). Both experimental background and clinical experience have demonstrated the role of folinic acid (FA) in increasing FU efficacy. The aim of the present study was to investigate the dual FU pharmacomodulation based on the combination of FU with 776C and/or FA on 7 human cancer cell lines (2 head and neck, 3 breast, 1 colon, 1 duodenum) expressing a spontaneous FU sensitivity. These cell lines were chosen according to their ability to respond to FU modulation by FA and/or 776C. The potency of FU modulation was evaluated by the ratio between FU IC50 and FU IC50 in the presence of the tested biomodulator(s), defined as factor F. In cell lines sensitive to FU modulation by 776C only (median F value with 1 microM of 776C = 2.5), the addition of FA did not enhance FU-776C cytotoxicity. In contrast, for cell lines resistant to FU modulation by 776C, the FU-FA-776C combination led to a significant cytotoxicity enhancement as compared to FU-FA (median F values were 3.6 and 2.6 respectively). In cell lines responsive to FU modulation by FA and 776C, the median F values were 2.3 and 1.8 with FA and 776C, respectively. Interestingly, the dual modulation by FA + 776C led to a median F value at 6.3, suggesting more than the additive effects of FA and 776C. This synergistic interaction was statistically confirmed by multivariate ANOVA (FA x 776C interaction). The present study points out that FA plus 776C could prove to be a very attractive combination for future strategies in FU biomodulation.

Cell Survival↗
PubMed1996

Tumoral platinum concentrations in patients treated with repeated low-dose cisplatin as a radiosensitizer.

The aim of the present study was to check whether platinum (Pt) concentrations achieved in tumors with a daily low-dose schedule were close to those promoting radiosensitization. Fifteen previously untreated patients with histologically proven advanced uterine cervix tumors were studied. They received a daily irradiation 30 min after a short infusion of 5 mg cisplatin for 5 consecutive days every week. A biopsy was taken from the accessible tumor mass, 4 to 6 hr after the daily injection. Blood samples were obtained once a week, just before the daily injection (H0) and 30 min after (H30). Quantificative analysis of Pt concentrations was performed by atomic absorption spectrophotometry. Plasma and tumoral Pt concentrations exhibited a marked intersubject variability. The median tumoral Pt concentration was 1,710 mg/g. Median total and ultrafiltrable Pt concentrations in plasma taken at H0 and H30 were 231 and 360 ng/ml, and 7 and 90 ng/ml respectively. Tumoral and total plasma Pt concentrations significantly increased during the course of treatment. Present data show that tumoral Pt concentrations achieved with this CDDP schedule are in the range of tumoral Pt concentrations previously shown to promote radiosensitization (2,000 ng/g). These results suggest that this CDDP radiosensitization regimen might be started with higher CDDP doses in order to reach earlier radiosensitizing Pt tumoral concentrations.

Aged↗
PubMed1996

Impact of different fluorouracil biochemical modulators on cellular dihydropyrimidine dehydrogenase.

In attempts to increase fluorouracil (FU) activity by pharmacomodulation, most attention has been paid to FU activation pathways without consideration of the presence and possible role of FU catabolism in the target tumoral cell itself. The first step in the catabolism of FU is hydrogenation by the enzyme dihydropyrimidine dehydrogenase (DPD). The purpose of the present study was to test the DPD-inhibitory effects of several agents whose use as FU biomodulators has been clinically established: cisplatin, hydroxyurea, dipyridamole, and allopurino. Five cancer cell lines of human origin were used. Dipyridamole and hydroxyurea were the only modulators for which an augmentation in FU cell-growth inhibition (MTT test) was clearly evident for the whole panel of cell lines investigated (P<1.10(-4) and P=0.005, respectively). With dipyridamole the efficacy of FU was multiplied by a factor of around 5. Allopurinol and cisplatin had no obvious effect on cellular DPD activity (biochemical method). For dipyridomole and hydroxyurea, DPD activity showed a more or less marked concentration-related inhibition according to the cell line tested. Only dipyridamole produced reductions in FU IC50 values (50% growth-inhibitory concentrations), i.e., potentiation of FU cytotoxicity, that were significantly related to inhibition of cellular DPD activity. This DPD-mediated interaction between dipyridamole and FU is a new finding that could be important for a better understanding of FU-dipyridamole combination chemotherapy.

Allopurinol↗
PubMed1996

Link between dihydropyrimidine dehydrogenase activity in peripheral blood mononuclear cells and liver.

Dihydropyrimidine dehydrogenase (DPD) is the rate-limiting enzyme of 5-fluorouracil (FU) catabolism, which occurs mainly in the liver. Several cases of severe FU-related toxicity have been reported in patients exhibiting a marked DPD deficiency measured in peripheral blood mononuclear cells (PBMCs). In addition, it has been shown that PBMC-DPD activity correlates to systemic FU clearance. The purpose of the present study was to closely evaluate the link between DPD activity measured in PBMCs and in liver samples obtained from the same patients. This prospective study was conducted on 27 patients (18 men and 9 women) who underwent laparotomy for various pathologies. Liver biopsies were performed in normal liver and immediately stored in liquid nitrogen. Biological liver function tests were within normal values for all patients. Concomitantly to the liver biopsy, a blood sample was taken and PBMCs were immediately isolated and stored at -80 degreesC. Liver-DPD and PBMC-DPD activities were measured by a radioenzymatic assay using 14C-FU as substrate (sensitivity limit, 5 pmol/min/mg protein; interassay reproducibility, 10%). Liver-DPD (mean, 178; median, 186; range, 54-290 pmol/min/mg protein) and PBMC-DPD (mean, 196; median, 205; range, 80-275 pmol/min/mg protein) exhibited the same pattern of distribution. Neither liver-DPD nor PBMC-DPD was significantly different between men and women. A significant linear correlation was demonstrated between liver- and PBMC-DPD activity (liver-DPD = 0.6 x PBMC-DPD + 59, r = 0.56, P = 0.002). Interestingly, the patient who exhibited the lowest PBMC-DPD activity (80 pmol/min/mg protein, at risk value for developing FU-related side effects) also had very low liver-DPD activity (98 pmol/min/mg protein). In conclusion, in patients with normal liver function, DPD activity measured in PBMCs reflects DPD activity expressed in the liver. The demonstrated link between liver- and PBMC-DPD activity reinforces the interest in DPD investigation in PBMCs for selecting, before FU-containing chemotherapy, patients at risk of developing severe toxicities due to impairment of FU clearance.

Adult↗
PubMed1995

Response to fluorouracil therapy in cancer patients: the role of tumoral dihydropyrimidine dehydrogenase activity.

PURPOSE: The aim of the present study was to analyze the role of thymidylate synthase (TS; main cellular target of fluorouracil [FU]) and dihydropyrimidine dehydrogenase (DPD; rate-limiting enzyme of FU catabolism) in tumoral biopsies with respect to FU responsiveness. PATIENTS AND METHODS: This prospective study was conducted on 62 head and neck cancer patients (six stage II, 16 stage III, and 40 stage IV). All received first-line chemotherapy with biomodulated FU (5-day continuous infusion). Before treatment, a tumor biopsy and control biopsy (symmetrical nontumoral area) were obtained. Cytosolic TS and DPD activities were measured using radioenzymatic assays. RESULTS: DPD activity was detectable in all samples, without a significant difference between tumoral (median, 60 pmol/min/mg protein; range, 13 to 193) and nontumoral samples (median, 68 pmol/min/mg protein; range, 12 to 150). Tumoral TS and tumoral DPD were not significantly influenced by tumor localization or tumor staging. Among 52 tumors assessable for clinical response, we observed 46% complete responses (CRs), 33% partial responses (PRs), and 21% no responses (NRs). No relationship was demonstrated between TS activity and response to FU therapy. The comparison of tumoral DPD between complete responders and partial or nonresponders showed a trend toward significance (P = .06). In an attempt to reduce variability, we analyzed the tumoral/nontumoral DPD activity ratio; complete responders exhibited a significantly lower normalized DPD than partial or nonresponding patients (median, 0.86, 1.18, and 1.42 for CR, PR, and NR, respectively; CR v PR plus NR, P = .03). CONCLUSION: Although resistance to FU is multifactorial, the present clinical study suggests that FU catabolism in target cells is probably a determinant factor for FU responsiveness in cancer patients and justifies the clinical use of specific DPD inhibitors as FU biomodulators.

Adult↗
PubMed1995

[Physicochemical compatibility of 5-fluorouracil (new french preparation) and folinic acid].

The potentiation of 5-fluorouracil (5FU) cytotoxicity by folinic acid (FA) is based on strong experimental basis. This experimental concept has been prolonged in the clinical setting where 5FU-FA combination has demonstrated its superiority in comparison to 5FU alone for the chemotherapeutic treatment of advanced colorectal cancer. A justified question concerns the stability for 5FU (new French preparation, with sodium hydroxyde, by Roche)-FA admixtures studied in clinically compatible conditions. We have presently undertaken this study. Based on drug concentrations corresponding to current 5FU-FA chemotherapeutic protocols, we have tested the influence of various factors like the vials, diluents and the type of FA preparation (Lederfoline versus Elvorine). The mixture between 5FU and FA leads to the formation of a precipitate which is influenced by the contact time between 5FU and FA (threshold at 24 hr), by the relative concentration of each drug in mixture and its seems necessary to avoid the mixture between undiluted 5FU and FA (d,1 preparation, Lederfoline). Cassettes or plastic bags are preferable to glass recipients. Finally and above all, the use of pure lFA form (Elvorine) does not lead to the formation of a precipitate seen with the d'1 FA form (Lederfoline) at equal concentration of active folate (1 form). These data carry practical importance for the security and the quality of 5FU-FA protocols and particularly when using portable pumps during prolonged periods necessitating the use of small volume of injectable drug solutions.

Drug Combinations↗