title: Efficacy and Safety of Bolus 5-Fluorouracil and L-Leucovorin as Salvage Chemotherapy for Oral Fluoropyrimidine-Resistant Unresectable or Recurrent Gastric Cancer: A Single Center Experience.
abstract: OBJECTIVE
  The International Organization for Standardization-5fluorouracil (FU) 10 trial found that bolus 5-FU and l-leucovorin was not inferior to S-1 in the treatment of gastric cancer (GC). Continuous 5-FU and the rapid injection of 5-FU have different anti-cancer effects. Thus, bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC.
  
  
  METHODS
  We retrospectively analyzed the medical records of all patients with S-1 or capecitabine-resistant, unresectable, or recurrent GC treated with bolus 5-FU and l-leucovorin between January 2010 and December 2015 at Hokkaido University Hospital. The bolus 5-FU and l-leucovorin regimen consisted of intravenous l-leucovorin (250 mg/m2/2 h) and bolus 5-FU (600 mg/m2) administered once weekly followed by a 2-week rest period; each cycle was repeated every 8 weeks.
  
  
  RESULTS
  A total of 14 patients were identified. The disease control rate was 35.7%. The median progression-free survival was 1.6 months (95% confidence interval [CI], 1.3~2.0 months), and the median overall survival was 6.3 months (95% CI, 4.7~7.9 months). No patient died from treatment-related causes. The most common severe adverse event associated with bolus 5-FU and l-leucovorin was neutropenia, which occurred in 21.4% of patients.
  
  
  CONCLUSIONS
  Bolus 5-FU and l-leucovorin treatment might be useful for oral FU-resistant GC. We are planning a multi-center prospective phase II trial to evaluate the efficacy and safety of bolus 5-FU and l-leucovorin treatment for pre-treated unresectable or recurrent GC to confirm the results of this limited, retrospective study.
authors.affiliation: Cancer Center, Hokkaido University Hospital, Sapporo, Japan.; Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Tetsuhito
authors.initials: T
authors.lastname: Muranaka
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yuki
authors.affiliation: Cancer Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sawada
authors.affiliation: Cancer Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Harada
authors.affiliation: Cancer Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kawamoto
authors.affiliation: Cancer Center, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakatsumi
authors.affiliation: Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
keywords: 5-fluorouracil; Drug therapy; Leucovorin; Stomach neoplasms