title: A possible cause and remedy for the clinical failure of 5-fluorouracil plus eniluracil.
abstract: BACKGROUND
  Eniluracil is a potent inactivator of dihydropyrimidine dehydrogenase (uracil reductase), the enzyme that rapidly catabolizes 5-fluorouracil (5-FU). Although eniluracil in combination with 5-FU was promising in phase I and II studies, in 2 multicenter phase III colorectal cancer studies, eniluracil dosed in a 10-to-1 ratio to 5-FU produced less antitumor benefit than the standard regimen of 5-FU/leucovorin without eniluracil. The current study tested whether the high eniluracil doses caused the clinical failure. The effect of excess eniluracil versus adequate eniluracil on 5-FU antitumor activity was studied in rats bearing large transplanted colon tumors.
  
  
  METHODS
  The rats were divided into 3 groups: group A received no treatment, group B was treated with eniluracil 1 mg/kg (adequate) 1 hour before 5 mg/kg 5-FU, and group C was treated identically to group B but also received eniluracil 25 mg/kg (excess) 5 minutes before 5-FU administration.
  
  
  RESULTS
  The rate of complete tumor regression (cure) was 0% in group A (no treatment), 88% in group B (adequate eniluracil), and 25% in group C (excess eniluracil). Toxicity was minimal. Only slight weight loss occurred in all groups.
  
  
  CONCLUSIONS
  When the eniluracil dose is in 5-fold excess to 5-FU (as in the phase III clinical trials), the antitumor activity of 5-FU was significantly diminished. Moreover, to maximize the antitumor activity of 5-FU, eniluracil must not be present in excess over 5-FU in rats bearing tumors. Simple strategies to achieve optimal antitumor efficacy are presented.
authors.affiliation: Spector Consulting Services, Durham, NC, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spector
authors.forename: Shousong
authors.initials: S
authors.lastname: Cao
mesh_terms: D000818:Animals; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005472:Fluorouracil / Q000008:administration & dosage; D009374:Neoplasms, Experimental / Q000188:drug therapy; D051381:Rats; D011916:Rats, Inbred F344; D014498:Uracil / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: C073482:eniluracil; D014498:Uracil; D005472:Fluorouracil