5fu/leucovorin bolus

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KWT
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5fu/leucovorin bolus

Postby KWT » Wed Jun 03, 2015 11:03 am

Are there studies that show the effectiveness of doing the push prior to pump install?

CLD
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Re: 5fu/leucovorin bolus

Postby CLD » Wed Jun 03, 2015 12:12 pm

Thanks for posting this question, Kenny. The Onc stopped the bolus after my husband's 4th infusion due to high liver function. I've been wondering how this would effect the long term effectiveness of the FOLFOX.
Wife to DH/ Father of 6 (age 42 at dx) diagnosed Jan 2015 stage IIIC
Tumor deposit in mesentery 13/24 lymph nodes +
CEA at dx: 5
MSS
Low Grade/Mod. Diff.
FOLFOX 6 months
N.E.D until June 2018
PET Scan 6/18
Biopsy confirms cancer in 3 Paraaortic lymph nodes
Folfiri + Avastin (6tx) and Xeloda during radiation
Cancer all over both lungs dx Jan 2019
FOLFIRI +AVASTIN presently

KWT
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Re: 5fu/leucovorin bolus

Postby KWT » Wed Jun 03, 2015 12:39 pm

Let's hope the pros chime in here.

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rwightman
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Re: 5fu/leucovorin bolus

Postby rwightman » Wed Jun 03, 2015 2:39 pm

My SD oncologist said that doing the bolus actually caused really high levels of 5FU in the system and then too low of levels afterwards and he wanted me to have a steady dose of 5FU. He told my AZ oncologist this, but my AZ oncologist had no idea how to administer that - he thought the only way to do it would be to wear the pump for a week, which didn't seem appealing. I will see my SD oncologist on the 16th and will ask him again b/c it was somewhat confusing as he didn't say how it would be done, so we have stuck to the bolus/pump. He did check my blood to make sure I wasn't getting overdosed or under dosed. That's not very helpful I know, but unless someone else chimes in, I'll ask my Dr. in a few weeks.
10/9/14 DX Age 50 - MSS
10/23/14 - Colon Resection - Stage II - 0/15 lympth nodes
12/30/14 - Stage IV - 1 liver met 2cc - Liver Resection - No lymph nodes and margins clear
3/10/15 - peri mets
3/15 - Folfox with Avastin - 7 tx
7/15 - HIPEC - 2 peri mets
10/14 - resection of abdominal met
11/12 - 5FU

justin case
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Re: 5fu/leucovorin bolus

Postby justin case » Thu Jun 04, 2015 4:27 pm

My last 12 infusions were a bolus a week of 5FU. 6 weeks every Friday, 2 weeks off, then 6 more weeks. I was also low on iron, so the longest part of my visit, was doing the iron infusion.(of course nothing until my blood work was approved)
Michael
This treatment was developed for a daily dose of 5FU, for a week, 1 week off, and a bolus every day for the next week, at Roswell Park in New York. My treatment was used by the Mayo Clinic, for those who needed to work :roll:
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

KWT
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Re: 5fu/leucovorin bolus

Postby KWT » Thu Jun 04, 2015 6:17 pm

I'm wondering if this is the cause for the mouth sore I received? I'm telling them to take Avastin and bolus and save it for someone else. The nurse said today I'll ask the dr? I said ask all you want but I'm done with those items until they can tell me the benefit. My gums bleed easily and the nose as well.

justin case
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Re: 5fu/leucovorin bolus

Postby justin case » Thu Jun 04, 2015 6:58 pm

I had no bleeding with 5FU , nor much discomfort.
7/11 diagnosed Stage 2 colon and rectal cancer
chemo/rad
lar/temp ilio
Reversal & port removal
21 round of chemo Folfox 9tx, 5fu 12 tx
Last treatment July 2012

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Bev G
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Re: 5fu/leucovorin bolus

Postby Bev G » Thu Jun 04, 2015 7:45 pm

My onc in Pittsburgh told me that the BOLUS of 5FU had not been shown to be of any benefit, so she stopped mine after a couple of bolus doses...I got all the 5FU through the pump, both pre-op liver resection and for 6 or so months of 5FU "mop-up. I would seriously doubt that any bleeding is from the 5FU, it would seem almost certainly to be due to the Avastin.

Best wishes,

Bev
58 yo Type1 DM 48 years
12/09 Stage IV 2/22 nodes + liver met, colon resec
3 tx FOLFIRI, liver resec 4/10
9/10 6 mos off chemo, Neg PET&CTC CEA nl
2/11 finished total 10 rounds chemo

9/13 ^17th clean PET/CT NED for now

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CRguy
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Re: 5fu/leucovorin bolus

Postby CRguy » Thu Jun 04, 2015 7:55 pm

I tossed the bolus at cycle 8 of 12 FOLFOX due to low hematology counts.
Kept up FOLFOX with the 2 day bottle, still had stable/low blood counts
and do not recall any actual clinical difference as a patient without it ?????

If it ain't working FOR you ... it's working against you ... JMO = toss it !

Agree 100% with Bev on the bleeding ... Avastin !
unless your platelets are totally tanked from 5FU which would show on pre-chemo blood tests.

Cheers bro'
CR
Caregiver x 4
Stage IV A rectal cancer/lung met
14 Year survivor
my life is an ongoing totally randomized UNcontrolled experiment with N=1 !
Review of my Journey so far

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Sleen
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Re: 5fu/leucovorin bolus

Postby Sleen » Thu Jun 04, 2015 8:18 pm

I'm wondering why a bolus at all? The half-life of 5FU is really short...I thought the reason for the 46-hr. pump was to keep a continuous stream of the drug going, since it disappears pretty quickly (16 min. half-life if wikipedia is accurate). Seems like getting it all at once would be a problem.

Just thinking out loud. I am not a doctor. at all. not even a pretend one.

Celine
Last edited by Sleen on Fri Jun 05, 2015 9:25 am, edited 1 time in total.
my blog: Cancer Riot

NED since April 2016!
April 2016: lower left lung lobectomy. NED
8 mo. f/u: 1 of 7 tumors progressed.
6 mo. f/u PR confirmed (Jan 2016)
Jul 2015: NIH TIL trial NCT01174121 NCI/NIH Surgery Branch FAQ
Dec 2014 confirmed stage IV w/bilateral lung mets
FOLFOX + Radiation (bladder)
KRAS G12D :: MSS
dx Sep 2013 @47yo: IIIc T4b N2b MX [bladder invasion, 17/21 lymph nodes]

Married 28 yrs. kids: 24, 21, 17, 12, 10
SE Michigan home schooler, unemployed mechanical engineer, and programmer.

kpjpmom
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Re: 5fu/leucovorin bolus

Postby kpjpmom » Thu Jun 04, 2015 9:21 pm

My oncologist said the bolus was not that effective and removed it after first treatment. I had mouth sores after first infusion. They have now had to take away the 5 fu because they said that was causing the uncontrollable diarrhea that I was having. Last treatment 2 was ago I had no d just nausea. Hope that helps you.

Kpjpmom
DX March 2011 stg 3 cc
Kidney cancer May 2011
Folfox 6months (12 rnds)
It's Back! October 2012 colon resection, kidney removed.FOLFIRI/Erbitux starts Jan.2013
Completed FOLFIRI June 2013, Erbitux continues
March 2015 Met to spine. Radiation 15 treatments
Folfri, 5fu dropped after 3x, Erbitux and Iri continued CEA rising. Moved to
Folfox, Xeloda,Avastin until Feb. 2016 oxilap. Neuropathy returns.
Xeloda,Avastin continues.

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GrouseMan
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Re: 5fu/leucovorin bolus

Postby GrouseMan » Thu Jun 04, 2015 10:20 pm

Sleen wrote:I'm wondering why a bolus at all? The half-life of 5FU is really short...I thought the reason for the 46-hr. pump was to keep a continuous stream of the drug going, since it disappears pretty quickly (16 min. if wikipedia is accurate). Seems like getting it all at once would be a problem.

Just thinking out loud. I am not a doctor. at all. not even a pretend one.

Celine


Ya don't need to be a doctor to understand the pharmacodynamics of the drug. I think they use to give it bolus, thinking that after the Oxaliplatin infusion, the Bolus would be more synergistic with it, than its turned out to be. There is a synergy between the two drugs, just not on that fast of a time scale I think. Now most oncologist just added the amount in the Bolus to the pump so you end up with the same amount only spread out more. I think this also reduces some of its side effects by spreading it out.

GrouseMan
DW 53 dx Jun 2013
CT mets Liver Spleen lung. IVb CEA~110
Jul 2013 Sig Resct
8/13 FolFox,Avastin 12Tx mild sfx, Ongoing 5-FU Avastin every 3 wks.
CEA: good marker
7/7/14 CT Can't see the spleen Mets.
8/16/15 CEA Up, CT new abdominal mets. Iri, 5-FU, Avastin every 2 wks.
1/16 Iri, Erbitux and likely Avastin (Trial) CEA going >.
1/17 CEA up again dropped from Trial, Mets growth 4-6 mm in abdomen
5/2/17 Failed second trial, Hospitalized 15 days 5/11. Home Hospice 5/26, at peace 6/4/2017

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DH2Sleen
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Re: 5fu/leucovorin bolus

Postby DH2Sleen » Fri Jun 05, 2015 9:13 am

Being a mathy kind of engineering geek, I can't resist commenting on this.

Maybe GrouseMan or DK37 can comment on this, but I assume that the intent of the pump is to keep the concentration of 5FU in your blood at a constant level for the entire 46 hours. It pumps enough 5 FU every 2 minutes to make up for the exponential biological decay that is a result of your body trying to remove this poison. If you start at 100% of the intended concentration using the bolus and the pump keeps the concentration level up, then you get the full effect for the entire 46 hours. But if you start at 0% (no bolus), it takes about 8 hours to get up to the full concentration.

So, have there been studies on having the pump + bolus for 38 hours? Or pump (higher delivery rate) without bolus for 46 hours? Either way, even if you get the same mass of the drug, you do not get the same concentration for the intended period of time. Does it make a difference? I have no idea, and I wonder if your onc does.
DW, Sleen dx 9/2013 @47yo: IIIc T4b N2b MX
9/2013 colectomy
10/2013 - 3/2014 FOLFOX
4/2014 - 6/2014 Rad to bladder
12/2014 +'ve for lung mets, MX becomes M1
3/2015 enter TIL trial @ NIH
7/1/15 Receive 148E9 cells to target K-ras G12D mutation
8/11/15 Reduction=18%, no new tumors
9/15/15 25%
10/20/15 27%; PET -> one hot met
11/24/15 30% all mets shrinking
1/26/16 46% but one suspicious met
3/24/16 46% but one growing
4/7/16 Lung lobectomy NED for the first time
3/3/20 Still NED "cured"

KWT
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Re: 5fu/leucovorin bolus

Postby KWT » Fri Jun 05, 2015 10:48 am

I'm going to drop the pump next time. I let him bullshit me into the diareah thing. I'm constipated anyhow. I still believe oncs like the pump for profit reasons alone.

peanut_8
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Re: 5fu/leucovorin bolus

Postby peanut_8 » Fri Jun 05, 2015 11:41 am

Can you sub Xeloda for 5fu? Just curious.
female, diagnosed Jan 14, RC stage 2a, age 56
MSS
April 14, 28 chemo/rad with Xeloda
June 14 adjuvant Xeloda 6 rounds
currently NED


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