Key Terms: Catheter, Hepatic intra-arterial infusion, Intraperitoneal.
Definition
Floxuridine is an anti-cancer drug that is injected directly into the artery that carries blood to the liver or the abdominal cavity. The brand names of floxuridine are Fluorodeoxyuridine, FUDR, and Floxuridine For Injection USP. The generic name product may be available in the United States.
Purpose
Floxuridine is used to treat gastrointestinal cancers that have metastasized, or spread, to the liver. These cancers include rectal cancer and Stage IV colon cancer. Floxuridine also has been used to treat cancerous gastrointestinal tumors; however the response rate is poor and usually the drug is used only to relieve symptoms.
Description
Floxuridine is approved by the United States Food and Drug Administration.
Floxuridine is a type of medicine called an antimetabolite because it interferes with the metabolism and growth of cells. Floxuridine prevents the production of DNA in cells. The cells cannot reproduce and eventually they die.
Floxuridine sometimes is used in conjunction with the drugs fluorouracil (5-FU), cisplatin, and/or leucovorin. Leucovorin increases the activity of floxuridine. In general, floxuridine is more effective than other chemotherapies against liver metastases, but its use does not improve overall survival rates. Ongoing studies are comparing floxuridine with other chemotherapies. The drug may be used in conjunction with surgery. Its use in conjunction with radiation therapy is being evaluated.
Recommended Dosage
Floxuridine is injected directly into the liver. This is called hepatic intra-arterial infusion, or hepatic arterial infusion. A special pump delivers the drug through an implanted infusion port or catheter into an artery that goes to the liver. Injection of floxuridine into a vein is being evaluated. Floxuridine also may be injected into the abdominal cavity (intraperitoneal therapy). The dosage of floxuridine depends on a number of factors including body weight, type of cancer, and any other medicines that are being used.
Precautions
Floxuridine may lower the number of white blood cells and, therefore, reduce the body's ability to fight infection. Immunizations (vaccinations) should be avoided during or after treatment with floxuridine because of the risk of infection. It also is important to avoid contact with individuals who have recently taken an oral polio vaccine. Treatment with floxuridine may cause chicken pox or shingles (Herpes zoster)to become very severe and spread to other parts of the body.
Kidney or liver diseases may increase the effects of floxuridine, since the drug may be removed from the body at a slower rate. Floxuridine also may put an individual at an increased risk for hepatitis.
Floxuridine can cause birth defects in animals. Therefore this drug should not be taken by pregnant women or by either the man or the woman at the time of conception. Women usually are advised against breast-feeding while receiving this drug.
Side Effects
Since floxuridine may affect the growth of normal cells as well as cancer cells, side effects may occur during or after drug treatment. Some effects may occur months or even years after the drug is administered. Floxuridine increases the risk of later developing certain types of cancer, such as leukemia.
The more common side effects of floxuridine include:
- diarrhea
- loss of appetite (anorexia)
- sores in the mouth or on the lips
- stomach pain or cramps
- numbness or tingling in the hands and feet
Less common side effects of floxuridine include:
- nausea and vomiting
- black, tar-like stools
- heartburn
- redness or scaling of the hands or feet
- sore, swollen tongue
- skin rash or itching
- temporary thinning of hair (alopecia)
- bleeding at the site of the catheter
- infection from the catheter
- closing off of the catheter
Other, rare side effects of floxuridine include:
- blood in urine or stools
- hiccups
- hoarseness or coughing
- fever or chills
- sore throat
- difficulty swallowing
- blurred vision
- lower back or side pain
- painful or difficult urination
- small red skin spots
- difficulty walking
- bleeding or bruising
- yellow eyes or skin
- seizures
- depression
In addition to lowering the white blood cell count, increasing the risk of infection, floxuridine may reduce the level of blood platelets that are necessary for normal blood clotting. This can increase the risk of bleeding. The drug also may lead to abnormalities in liver function. Intraperitoneal floxuridine therapy has been associated with the development of fibrous masses in the abdomen.
Interactions
Previous treatment with radiation or other anti-cancer drugs can increase the effects of floxuridine on the blood.
Drugs that may interact with floxuridine include:
- amphotericin B (Fungizone)
- antithyroid drugs that are used to treat an overactive thyroid
- azathioprine (Imuran)
- chloramphenicol (Chloromycetin)
- colchicine
- flucytosine (Ancobon)
- ganciclovir (Cytovene)
- interferon (Intron A, Roferon-A)
- plicamycin (Mithracin)
- zidovudine (AZT, Retrovir)
—Margaret Alic, Ph.D.
