Title |
Is monitoring of plasma 5-fluorouracil levels in metastatic / advanced colorectal cancer clinically effective? A systematic review
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Published in |
BMC Cancer, July 2016
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DOI | 10.1186/s12885-016-2581-x |
Pubmed ID | |
Authors |
Karoline Freeman, Mark P. Saunders, Olalekan A. Uthman, Sian Taylor-Phillips, Martin Connock, Rachel Court, Tara Gurung, Paul Sutcliffe, Aileen Clarke |
Abstract |
Pharmacokinetic guided dosing of 5-fluorouracil chemotherapies to bring plasma 5-fluorouracil into a desired therapeutic range may lead to fewer side effects and better patient outcomes. High performance liquid chromatography and a high throughput nanoparticle immunoassay (My5-FU) have been used in conjunction with treatment algorithms to guide dosing. The objective of this study was to assess accuracy, clinical effectiveness and safety of plasma 5-fluorouracil guided dose regimen(s) versus standard regimens based on body surface area in colorectal cancer. We undertook a systematic review. MEDLINE; MEDLINE In-Process & Other Non-Indexed Citations; EMBASE; Cochrane Library; Science Citation Index and Conference Proceedings (Web of Science); and NIHR Health Technology Assessment Programme were searched from inception to January 2014. We reviewed evidence on accuracy of My5-FU for estimating plasma 5-fluorouracil and on the clinical effectiveness of pharmacokinetic dosing compared to body surface area dosing. Estimates of individual patient data for overall survival and progression-free survival were reconstructed from published studies. Survival and adverse events data were synthesised and examined for consistency across studies. My5-FU assays were found to be consistent with reference liquid chromatography tandem mass spectrometry. Comparative studies pointed to gains in overall survival and in progression-free survival with pharmacokinetic dosing, and were consistent across multiple studies. Although our analyses are encouraging, uncertainties remain because evidence is mainly from outmoded 5-fluorouracil regimens; a randomised controlled trial is urgently needed to investigate new dose adjustment methods in modern treatment regimens. |
X Demographics
Geographical breakdown
Country | Count | As % |
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United Kingdom | 1 | 100% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 1 | 100% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 58 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 10 | 17% |
Student > Ph. D. Student | 6 | 10% |
Student > Master | 6 | 10% |
Student > Doctoral Student | 4 | 7% |
Other | 4 | 7% |
Other | 10 | 17% |
Unknown | 18 | 31% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 16 | 28% |
Pharmacology, Toxicology and Pharmaceutical Science | 5 | 9% |
Biochemistry, Genetics and Molecular Biology | 5 | 9% |
Nursing and Health Professions | 3 | 5% |
Business, Management and Accounting | 2 | 3% |
Other | 8 | 14% |
Unknown | 19 | 33% |