Vysoká vs. nízká dávka lekovorinu v režimech s fluorouracilem v terapii kolorektálního karcinomu v souvislosti s výpadky v dodávkách leukovorinu
| Title in English | High vs. low dose leucovorin in fluorouracil-based regimens for colorectal cancer therapy in the context of leucovorin supply shortages |
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| Year of publication | 2023 |
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| Citation | |
| Description | The problem of unavailability of drugs and shortages is a common problem of recent years. Shortages may threaten some treatment regimens for oncological patients. This article presents a systematic review of studies evaluating the efficacy and safety of chemotherapy regimens combining fluorouracil and standard or low-dose leucovorin in the treatment of colorectal cancer. A total of 13 prospective and retrospective studies were included in the review. Meta-analyses and review papers were excluded. It is apparent from the systematic review, that a lower dose of leucovorin does not fundamentally affect the efficacy of regimens combining 5-fluorouracil with leucovorin in the therapy of patients with colorectal cancer. Similarly, even in the case of safety, reducing the dose of leucovorin did not influences the frequency and severity of observed adverse effects. Surprisingly, in 3 studies, some of adverse effects occurred more often with the higher dose of leucovorin. Furthermore, the article presents the results of a questionnaire survey of the management of leucovorin shortages at the departments of preparation of cytostatics (N=46) within the Czech Republic. In total, 35 workplaces provided feedback. In 17 cases, the departments for the preparation of cytostatics in the Czech Republic had to accept restrictions on the administration of the full dose of leucovorin. These restrictions consisted of reducing the dose of the injectable form of leucovorin, changing the chemotherapy regimen, administering the oral form of calcium folinate, forcing a therapeutic break, or a combination of these approaches. |
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