Impressions on 5-Fluorouracil in Bangladesh

The controversies on 5-fluorouracil (5-FU) appear to be gradually culminating in two divergent groups of workers. One group uses low doses of the drug administered weekly and the other group prefers high doses, the so-called standard loading dose system or its modification. The present study reports impressions with a modified repeated protracted high dose schedule of 5-FU in 325 patients with far-advanced solid malignancies treated in Bangladesh with 20% objective and 40% subjective responses. The morbidity rate was high but the protraction and the vigilance perhaps have kept the mortality rate at 1.5%. About 14% of 120 patients with gastrointestinal metastatic cancers have survived more than 1 year and 8% beyond 2 years. Review of the literature on 5-FU reveal a tendency towards better response rates with higher drug concentrations particularly in the tumor-bearing area. It is noted that some prolonged survivors are always recorded by workers using high dose schedules but not yet by those using weekly schedules. It is imperative to wait for both short- and long-term results of the controlled trials before valid conclusions can be made.