Gastrointestinal cancer. Treatment with fluorouracil-nitrosourea combinations

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Abstract
Combination chemotherapy with fluorouracil and the nitrosoureas was evaluated in several hundred gastrointestinal cancer patients. Semustine seems to be the most favorable nitrosourea for such combination treatment, particularly for colorectal carcinoma. Objective responses to combinations of carmustine and semustine ranged from 25 to > 50% in stomach, pancreatic and liver cancers. Three controlled studies showed superior objective response rates in comparison to constituent drugs used alone, and 2 studies showed substantially extended survival for the gastric cancer patient. Two controlled studies on colorectal cancer showed a statistically significant improvement in objective response rate for the fluorouracil-semustine combination when compared to treatment with fluorouracil alone, but improved survival time was not noted. Combined fluorouracil-nitrosourea therapy represents a meaningful advance in the management of advanced gastrointestinal cancer, the 1st substantiated advanced in almost 20 yr. Such treatment is still only capable of inducing transient tumor shrinkage in half of the afflicted patients. Evidence of improved survival is fragmentary and exists, if at all, for gastric cancer only. This treatment was not shown to be effective, or even tested, in the surgical adjuvant circumstance. Although combined fluorouracil-nitrosourea therapy of gastrointestinal cancer produced some hopeful results, it should be regarded only as a small step forward, not a stopping point.

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