[MOL] The study of hepatic arterial infusion of chemotherapy after resec [00816] Medicine On Line

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[MOL] The study of hepatic arterial infusion of chemotherapy after resection.....

The study of hepatic arterial infusion of chemotherapy after resection of hepatic metastases in patients with colorectal cancer, reported by Kemeny et al. (Dec. 30 issue), (1) represents a positive development in the management of colorectal cancer. However, clinicians planning to use this therapy may be confused by the dosages reported in the article. By convention, the dosage for hepatic intraarterial chemotherapy is based on the amount of drug delivered to the patient. Since infusion devices have variable flow rates and deliver only part of their contents in 14 days, the total dose of floxuridine placed in the device is much more than the dose the patient receives.
> Kemeny et al. state that the infusion pump was filled with "0.25 mg of floxuridine per kilogram of body weight per day for 14 days in combination with 20 mg of dexamethasone; 50,000 U of heparin, and enough normal saline to result in a volume of 50 ml." This does not mean that the dose delivered to patients was 0.25 mg per kilogram per day for 14 days. Because the average flow rate for these devices is approximately 2.0 ml per day, the dose of floxuridine that each patient received was about 0.14 mg per kilogram per day.
> Given the risk of hepatobiliary toxicity and the narrow therapeutic index for this treatment, (2) the dose of hepatic intraarterial floxuridine is a critical factor in the safe administration of regional chemotherapy. The dose of floxuridine should be based on the flow rate of the pump used to deliver the drug.
> Alan P. Venook, M.D.
> Betsy Althaus, Pharm.D.
> Robert S. Warren, M.D.
> University of California, San Francisco
> San Francisco, CA 94143
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