Measurement of 5-fluorouracil in scalp hair: a possible index of patient compliance with oral adjuvant chemotherapy.
OBJECTIVE
Little is known about patient compliance with oral adjuvant chemotherapy. It is estimated to be poor especially in Japan, where it is still unusual for patients to be directly informed of their diagnosis of malignancy. 5-Fluorouracil (5-FU) was measured in hair samples to assess patient exposure to 5-FU, and its potential usefulness is discussed as an index of compliance with postoperative adjuvant chemotherapy.


METHODS
Hair samples obtained from 55 patients, who had received oral 5-FU (total dose 27-41 g) as postoperative adjuvant chemotherapy over a 6-month period, were used for the analysis of 5-FU. The drug was extracted from the hair using ethyl acetate, and its fluorescence derivatization was employed for measurement with HPLC. The detection limit of 5-FU in hair was 0.01 ppm.


RESULTS
In 22 out of 55 samples 5-FU content was under the detection limit, whereas in the remaining 33 samples the drug was detected in a range of 0.006-2.125 ng per hair strand; in addition, drug content showed a lognormal distribution. 5-FU was detected in the hair collected from those patients who were possibly compliant with the postoperative oral adjuvant chemotherapy.


CONCLUSIONS
As many as 40% of the patients analysed were supposed to be much less compliant. Even in the possibly compliant patients, the degree of compliance with the therapy varied according to a log-normal distribution.
Uematsu
T
T
Department of Pharmacology, Gifu University School of Medicine, Japan.
Nakashima
M
M
Fujii
M
M
Hamano
K
K
Yasutomi
M
M
Kodaira
S
S
Kato
T
T
Kotake
K
K
Oka
H
H
Masuike
T
T
D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000032:analysis* / Q000493:pharmacokinetics / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000601:surgery; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005472:Fluorouracil / Q000032:analysis* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006197:Hair / Q000737:chemistry*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D051381:Rats; D013050:Spectrometry, Fluorescence
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil