Pharmacokinetics of bolus 5-fluorouracil: Relationship between dose, plasma concentrations, area-under-the-curve and toxicity

The pharmacokinetics of 5-fluorouracil (5FU) have been related to toxicity and antitumor activity, in particular for continuous infusion schedules, but to a lesser extent for frequently used bolus injections. The use of intensive sampling schedules limits the application of pharmacokinetics to optimize individual dosing or to define the ideal combination with other drugs. We therefore reanalyzed a pharmacokinetic study in order to develop a limited sampling schedule. Patients received escalating doses of 5FU at 500, 600 and 720 mg/m² as a bolus until toxicity developed. Blood samples were analyzed until 24 h after administration. The area under the concentration time curve from 0-90 min (AUC_0-90) was strongly correlated with dose and also with toxicity (p = 0.0009). The 5FU concentrations at 30 and 60 min were correlated to the AUC_30-240 and to that of the AUC_0-90 (r² = 0.970). The use of limited sampling (30, 60, 90 min) in a patient given 353 mg/m² 5FU with severe toxicity at initial dosing at 500 mg/m² revealed that the AUC_0-90 at 353 mg/m ² was higher than the normal AUC_0-90 for 500 mg/m ². This patient appeared to have an 8-fold lower activity of the 5FU degradation enzyme dihydropyrimidine dehydrogenase. Limited sampling will allow us to define potential aberrant kinetics of pharmacokinetic interaction of 5FU with other drugs being developed for treatment of colorectal cancer.