Why is leucovorin given along with 5-FU for colonic cancer treatment?

  

39.1 A patient with colonic cancer is being treated with 5-FU as
well as leucovorin (N5,N10-methylene tetrahydrofolate).
The rationale for administering the coenzyme depends on it being essential
for:
A. Conversion of 5-FU to fluorodeoxyuridylic acid
(FdUMP).
B. Protection against the anemia caused by 5-FU
treatment.
C. The inhibition of thymidylate synthase by FdUMP.
D. Prolongation of the antitumor effect of 5-FU
39.2 Neutropenia develops in a patient undergoing cancer
chemotherapy. Administration of which one of the following agents would
accelerate recovery of neutrophil counts?
A. Leucovorin.
B. Filgrastim.
C. Prednisone.
D. Vitamin B12.
39.3 Hydration and/or diuresis can prevent the renal toxicity
associated with:
A. Cisplatin.
B. Chlorambucil.
C. Tamoxifen.
D. Gemcitabine.
E. MTX.
39.4 A patient is being treated with allopurinol to control
hyperuricemia resulting from chemotherapy. Which of the following would have to
have its dose reduced to prevent toxicity?
A. 5-FU.
B. 6-MP.
C. 6-TG.
D. Fludarabine.
E. Cytarabine.

Introduction:
Cancer chemotherapy involves the use of drugs that destroy cancer cells or inhibit their growth, but these drugs may also cause severe side effects to patients. Therefore, it is important to manage these side effects to ensure that the treatment is effective and safe. In this article, we will discuss several issues that oncologists and cancer patients need to be aware of when undergoing chemotherapy.

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Why is leucovorin given along with 5-FU for colonic cancer treatment?
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Description:
In section 1, we will look at the rationale for administering leucovorin to a patient with colonic cancer receiving 5-FU treatment. We will explain the essential roles of leucovorin in the conversion of 5-FU to its active metabolite, inhibition of thymidylate synthase, and prolongation of 5-FU’s antitumor effect. In section 2, we will address the issue of neutropenia, which is a common side effect of chemotherapy, and discuss the use of filgrastim to accelerate the recovery of neutrophil counts. In section 3, we will examine the critical role of hydration and diuresis in preventing renal toxicity associated with different chemotherapy agents. Finally, in section 4, we will discuss the potential interactions between allopurinol and chemotherapy agents such as 5-FU, 6-MP, 6-TG, fludarabine, and cytarabine, which may require a dose reduction to prevent toxicity. Understanding these issues can enable oncologists to manage chemotherapy side effects more effectively, improve patient outcomes, and enhance cancer care.

Objectives:

– Understand the rationale for administering leucovorin in combination with 5-FU in the treatment of colonic cancer.
– Identify the agent that can accelerate the recovery of neutrophil counts in a patient undergoing cancer chemotherapy.
– Recognize the drugs that can cause renal toxicity and the potential role of hydration and/or diuresis in preventing it.
– Understand the concept of hyperuricemia resulting from chemotherapy and the use of allopurinol to control it.

Learning Outcomes:

Upon completion of this learning module, the learner will be able to:

Rationale for administering coenzyme in colon cancer treatment:
– Explain the rationale for administering leucovorin in combination with 5-FU in the treatment of colonic cancer.
– Compare the modes of action of 5-FU and leucovorin in the treatment of colonic cancer.
– Determine the potential side effects associated with the use of leucovorin in combination with 5-FU.

Acceleration of neutrophil counts:
– Identify the agent that can accelerate the recovery of neutrophil counts in a patient undergoing cancer chemotherapy.
– Explain the mechanism of action of the identified agent and how it affects neutrophil count.
– Assess the potential side effects and risks associated with the use of this agent.

Prevention of renal toxicity:
– Describe the concept of renal toxicity associated with chemotherapy.
– Recognize the drugs that can cause renal toxicity and the potential role of hydration and/or diuresis in preventing it.
– Explain the mechanism of renal toxicity and the precautions that need to be taken to prevent it.

Hyperuricemia resulting from chemotherapy:
– Understand the concept of hyperuricemia resulting from chemotherapy and its potential complications.
– Describe the mechanism of action of allopurinol and how it can help control hyperuricemia.
– Recognize the drugs that can cause hyperuricemia and need to have their dose reduced to prevent toxicity.

Solution 1: Administering Leucovorin alongside 5-FU for the treatment of Colonic Cancer

When treating patients with colonic cancer, administering 5-FU alongside Leucovorin has shown to be beneficial in prolonging the antitumor effect of the drug. The rationale behind administering the coenzyme depends on it being essential for the conversion of 5-FU to fluorodeoxyuridylic acid (FdUMP) and the inhibition of thymidylate synthase by FdUMP. Leucovorin also provides protection against the anemia caused by 5-FU treatment. Administering Leucovorin with 5-FU can, therefore, result in better efficacy of the medication in treating colonic cancer.

Solution 2: Treating Neutropenia in a patient undergoing cancer chemotherapy with Filgrastim

Neutropenia is a common side effect of cancer chemotherapy, which occurs due to the low number of neutrophils in the body. Administering Filgrastim to the patient can accelerate the recovery of neutrophil counts. Filgrastim is a type of medication that stimulates the production and release of neutrophils from the bone marrow, thus reducing the side effects of chemotherapy. Therefore, Filgrastim is a recommended treatment option to treat neutropenia in cancer patients undergoing chemotherapy.

Suggested Resources/Books:
1. “Chemotherapy and You: Support for People with Cancer” by National Cancer Institute
2. “Chemotherapy and Biotherapy Guidelines and Recommendations for Practice” by Martha Polovich, Julie M. Whitford, and MiKaela Olsen
3. “Chemotherapy and Immunotherapy for Hematologic Malignancies: A Nursing Perspective” by Gwen H. Nichols and Kristin B. Reding
4. “Chemotherapy-induced Neuropathic Pain” by S. Parkitny and N.K. Mehta

Similar asked questions:
1. What are the most common side effects of chemotherapy?
2. What medications can help prevent nausea and vomiting during chemotherapy?
3. Are there any alternative therapies for cancer treatment besides chemotherapy?
4. How does chemotherapy differ for different types of cancer?
5. How can caregivers support a patient undergoing chemotherapy treatment?

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