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Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 3:05 am
by plastikos
Just finished my first infusion of chemo after resection of my liver recurrence. Talked to my onc and the regimen we are giving is technically not FOLFIRI but Irinotecan followed by a long infusion (over 2 days) of high dose 5FU. No Leucovorin. According to my onc its a protocol being used at MDA with good results and less toxicity. So far in terms of side effects it seems ok. Much better than when I was on FOLFOX definitely. Anyone familiar or undergoing the same regimen? Just wondering.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 7:22 am
by Ron50
Hi,
When I was having chemo (over 16 years ago) leucovorin was the new in thing. I was told that it would help with the side effects of the 5Fu. It did not help in fact it helped get me off that regime of 5 days straight infusions of 5fu with leucovorin. It nearly killed me and I switched to 48 weeks of 5fu and levamisole(banned in 2001 for often fatal side effects). The next time I came in contact with leucovorin was when I was taking methotrexate for nephrotic syndrome of the kidneys ( probably a result of levamisole). leucovorin did not make a bit of difference to the nausea and I eventually switched to cyclosporine which is a front line immunosuppressant and is surprisingly easy to tolerate ( until I grow another head). I guess what I am saying is I would not be worried about not having leucovorin. Ron.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 7:26 am
by Ontario Guy
plastikos wrote:Anyone familiar or undergoing the same regimen?


No, but thanks to you and Ron50 for the information. Very interesting.

Best,

OG

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 4:40 pm
by sjring
I was doing FOLFOX but after a couple treatments we dropped the leucovorin and the 5FU bolus before the 46 hour infusion. Both were giving me some gastric issues. It didn't seem to make that much of a difference in my treatment.

As always your mileage may vary.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 4:58 pm
by exaussie
We were told leucovorin made chemo stay in the body longer but didn't offer that much of a difference for the bother. We dropped it after 6 rounds.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 5:09 pm
by rp1954
In a Black (no LV) and White (huge LV, 75-90-200 mg/day for continuous 5FU) world, we're gray.

I've had my doubts they know what they are doing with leucovorin, for a while. Given the MTFHR mutations, alongside various individual metabolic divergences with 5FU, the amount of LV and 5,10 methylenetetrahydrofolate build-up might be a problem for many. Yet, part of the other "half" might really need a lot of LV to work.

That would account for some of the differences in 5FU-LV performance vs toxicity. For continuous 5FU, I wouldn't be surprised if 4 - 30 mg of LV per day had an optimum point, adequate for TS binding in up to half the population. This low dose LV issue was never properly addressed by trials in my eyes, but that's how I interpret what data there is. Don't quite have a view for biweekly MTD 5FU tx.

Because of the selective R,S enantiomer uptake, I also suspect that oral LV can be superior to IV LV, more than halfway to levo-leucovorin.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 5:14 pm
by JAZZToo
When I was on Folfirinox for the last several treatments the Leucovorin and bolus 5FU were discontinued. When I asked why, I was told that it was found to be ineffective and not necessary, that the 48 hour 5FU was enough. Somewhere there must be a research study to back up this change in protocol, but I didn't think to ask.

Leslie
Lynch syndrome
2014 Pancreatic Cancer FOLFIRINOX x 23, Gemzar/Abraxane x 5
2003 Colon Cancer Stage 3. Right hemicolectomy, 6 mos. Leucovorin & Bolus 5FU
1995 Endometrial Cancer Stage 1. TAHBSO No chemo

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 6:17 pm
by fwilkins
We went trough the same ambiguity about Leucovorin and 5FU at MDA. It was on the orders at each infusion, so for months we thought that's what we were getting. It comes out later, that yes, it was on the orders each time, but they always excluded it. There had been a shortage of Leucovorin, so I was always concerned about why it was not given. Never really understood why.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 6:44 pm
by justin case
Someone correct me if I'm wrong, but leucovoren is a folonic acid substitute, that helps keep chemo in your body for a little longer, not much longer. If you are doing Folfox, you probably had some or something similar, if you are doing Folfiri, you probably had some , or something similar. If you are on a pump for day's or weeks, you probably don't need it, butt I could be wrong :roll:
Michael

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 7:24 pm
by Ron50
You are not wrong Justin. When I was on methotrexate , I was originally given folic acid with the dose. As I progressed with the methotrexate my gi problems got worse. I progressed to self injecting methotrexate combined with folic acid tablets. My gi problems subsided for a short time then increased dramatically. They tried me then on leucovorin (follonic acid) in combination with the methotrexate. It did not help and I went off MTX altogeather. In reality the real cause of the problem was most likely bile salt malabsorption after my gall bladder was removed( one of the small black stones in my gall bladder blocked off my pancreatic duct and nearly killed me ). I finally solved the problem with cholestramine ( questran lite) which binds the bile salts and takes them thru the gi tract without causing problems. I think that is why it is called medical PRACTICE. I now take cyclosporine for my nephrotic syndrome. My first nephrologist mistook the kidney disease as minimal change disease and had me on 75mg daily of prednisone for nearly two years. I now have type two diabetes . More practice. Fortunately I have a good neph now . He has done two kidney biopsies and cannot identify the problem. I was losing over 7 grams of protein a day thru my urine before he put me on cyclosporine. I am down to .7 of a gram now and holding, for how long heaven only knows. Cheers Ron.

Re: Chemo question - no leucovorin

Posted: Thu Nov 19, 2015 8:18 pm
by jhocno197
After my husband started having severe gallbladder problems while on chemo, they dropped his leucovorin.

Re: Chemo question - no leucovorin

Posted: Fri Nov 20, 2015 3:42 am
by Nik Colon
When I switched places and they cut my iri to 80% and no bolus 5fu they didn't do leucovorin then. Not sure if they meant cuz no bolus or cutting down the iri or what, but I didn't get any then. Idk

Re: Chemo question - no leucovorin

Posted: Sat Nov 21, 2015 8:30 pm
by plastikos
Thank you for all the replies. I was just worried that without leucovorin we would be veering off protocol. I've just had 1 infusion and so far, knock on wood, toxicity seems less. Hopefully response will also be good. According to my onc he used it on a patient with bone and lung mets and had a complete response, which is encouraging. In my case its adjuvant chemo post liver resection.