New study in JNCCN supports chemotherapy option that reduces side effects for people with gastrointestinal cancers

PLYMOUTH MEETING, PA [September 5, 2024] — New research just-published online by JNCCN—Journal of the National Comprehensive Cancer Network finds that for many commonly used treatment regimens targeting metastatic gastrointestinal (GI) cancers, such as FOLFOX, FOLFIRI, or FOLFIRINOX, it is possible to administer 5-FU solely through continuous infusion, minus the bolus (quick-delivery via intravenous push) component, without negatively affecting patient outcomes.

The study reviewed results from 11,765 patients across 280 cancer clinics who were diagnosed with advanced colorectal, gastroesophageal, and pancreatic cancers between January 2011 and May 2022. According to the findings, there was no decrease in overall survival for the 13.7% of patients who did not receive a 5-FU bolus component as part of their treatment regimen. However, those patients did see a notable reduction in cytopenias, such as neutropenia (compromised immune system) or thrombocytopenia (bleeding problems).

“The true value of our findings lies in the empirical evidence they provide, which supports what many of us have long suspected,” said lead researcher Shun Yu, MD, NYU Langone Health. “The most significant benefit of this adjustment is that it makes the treatment more tolerable, potentially easing the chemotherapy experience for patients. For decades, the most effective treatment for gastrointestinal cancers was a combination of two forms of 5-fluorouracil: the 5-FU bolus injection, followed by the 5-FU continuous infusion. However, in the early 2000s, the standard of care evolved into multi-drug regimens after it was discovered that adding to the two-component 5-FU backbone significantly improved patient outcomes. While the value of the 5-FU bolus was well established in the older single drug regimens, its role in these newer multi-drug combinations was never thoroughly tested and was largely just assumed.”

The study points out that many practicing oncologists—particularly those who have been in practice longer or who specialize in GI cancers—have already begun to omit the bolus. Recent shortages of 5-FU have also highlighted the potential for reducing this bolus portion.

“This study offers solid evidence for not using a 5-FU bolus with FOLFOX/FOLFIRI/FOLFIRINOX regimens in advanced GI cancers,” commented Elena Gabriela Chiorean, MD, Fred Hutch Cancer Center, who was not involved in this research. “5-FU is a core component of treatment regimens for many gastrointestinal cancers and has traditionally been included as a bolus in addition to a 46-hour infusion in many multiagent chemotherapy regimens. However, there have been no clear evidence showing that bolus 5-FU confers additional efficacy when retained with 5-FU infusion in multi-agent regimens. The authors conducted a large retrospective cohort study to determine the safety and survival rates for patients with advanced colorectal, gastroesophageal and pancreatic cancers after multiagent 5-FU based chemotherapy with and without the 5-FU bolus from the start, adjusting for clinical factors such as age and comorbidities. This large study shows that omitting the bolus 5-FU has no detrimental effect on survival but reduces side effects and healthcare costs.”

A more detailed response from Dr. Chiorean, who is also a Member of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) Panel for Pancreatic Adenocarcinoma, will be publishing in the upcoming October 2024 issue of JNCCN.

Complimentary access is available to “Omission of 5-Fluorouracil Bolus from Multidrug Regimens for Advanced Gastrointestinal Cancers: A Multicenter Cohort Study.” To read the entire article, visit JNCCN.org.

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More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN at x.com/JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network^® (NCCN^®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients^® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation^®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.