5fu/leucovorin bolus

[KWT]

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

[CLD]

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.

[KWT]

Let's hope the pros chime in here.

[rwightman]

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.

[justin case]

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

[KWT]

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]

I had no bleeding with 5FU , nor much discomfort.

[Bev G]

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

[CRguy]

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

[Sleen]

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

[kpjpmom]

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

[GrouseMan]

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

[DH2Sleen]

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.

[KWT]

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]

Can you sub Xeloda for 5fu? Just curious.