Individual 5-fluorouracile dose optimization in folfiri treatment
The present invention belongs to the field of improved personalized medicine. More precisely, the present invention relates to a method for progressively optimizing the 5-FU dose administered by continuous infusion in patients treated by a FOLFIRI regimen or a similar regimen, based on the 5-FU plasmatic concentration measured during the previous 5-FU continuous infusion and on a herein described decision algorithm. The present invention also relates to a method for treating a cancer patient in which the 5-FU dose administered in continuous infusion in each FOLFIRI or similar treatment cycle is optimized using the decision algorithm according to the invention.
1. A method for treating a cancer patient in need thereof, said method comprising the steps of:
a. determining from a blood sample of a patient suffering from cancer the dose D(n+1) of 5-fluorouracile (5-FU) for the next cycle of treatment (n+1), wherein
each treatment cycle n comprises:
0-500 mg/m2 of 5-FU administered in a bolus,
0-600 mg/m2 of folinic acid or a salt thereof,
a dose D(n) (in mg/m 2 ) of 5-FU administered in a continuous infusion of 43 to 49 hours, and
0-500 mg/m 2 of irinotecan; and
said blood sample has been taken from said patient in previous treatment cycle n at least 1 hour after the beginning of the 5-FU perfusion and before the end of said perfusion,
said method comprising:
measuring in vitro the 5-FU plasmatic concentration in the blood sample
calculating D(n+1) depending on D(n) using the following decision scheme:
if [5-FU]<100 μg/L, then D(n+1)=D(n)×1.40,
if 100<[5-FU]<200 μg/L, then D(n+1)=D(n)×1.30,
if 200<[5-FU]<300 μg/L, then D(n+1)=D(n)×1.20,
if 300<[5-FU]<400 μg/L, then D(n+1)=D(n)×1.10,
if 400<[5-FU]<500 μg/L, then D(n+1)=D(n)×1.05,
if 500<[5-FU]<600 μg/L, then D(n+1)=D(n)×1.025,
if 600<[5-FU]<650 μg/L, then D(n+1)=D(n),
if 650<[5-FU]<700 μg/L, then D(n+1)=D(n)×0.975,
if 700<[5-FU]<800 μg/L, then D(n+1)=D(n)×0.95,
if 800<[5-FU]<900 μg/L, then D(n+1)=D(n)×0.90,
if >900 [5-FU], then D(n+1)=D(n)×0.80, and
b. administering the dose D(n+1) calculated in step a) to the patient.
2. The method according to claim 1 , wherein the duration of the continuous infusion of 5-FU in each cycle n is about 46 hours.
3. The method according to claim 1 , wherein the dose of 5-FU administered in a bolus in each cycle n is about 400 mg/m 2 .
4. The method according to claim 1 , wherein the dose of folinic acid or salt thereof administered to the patient in each cycle n is about 100 mg/m 2 .
5. The method according to claim 1 , wherein the dose of irinotecan administered to the patient in each cycle n is comprised between 120 and 300 mg/m 2 .
6. The method according to claim 1 , wherein the treatment further comprises the administration to the patient in each cycle n of an anticancer monoclonal antibody.
7. The method according to claim 6 , wherein said anticancer monoclonal antibody is cetuximab, panitumumab or bevacizumab.
8. The method according to claim 1 , wherein the blood sample has been taken in cycle n 15 minutes to 22 hours before the end of the 5-FU continuous infusion.
9. The method according to claim 8 , wherein the blood sample has been taken in cycle n 2 to 3 hours before the end of the 5-FU continuous infusion.
10. The method according to claim 1 , wherein the blood sample has been taken in cycle n between 1 hour and 5 hours after the beginning of the 5-FU continuous infusion.
11. The method according to claim 1 , comprising pre-treatment diagnosis of a possible increased sensitivity of said patient to 5-FU, and wherein the 5-FU dose D(n) administered in a continuous infusion in cycle n is at most about 2500 mg/m 2 and has been determined based on the pre-treatment diagnosis.
12. The method according to claim 11 , wherein the diagnosis of a possible hypersensitivity of said patient to 5-FU is performed from at least one biological sample of said patient by combining at least two of the following in vitro tests:
a) the analysis of the presence of a significant mutation in DPD gene,
b) the measure of uracil plasmatic concentration, and
c) the measure of the ratio dihydrouracil plasmatic concentrations/uracil plasmatic concentration (UH 2 /U ratio).
13. The method according to claim 12 , wherein the three in vitro test have been performed and the initial dose D(n) has been determined using the following decision algorithm:
a) If
no significant mutation in DPD gene has been detected and uracil plasmatic concentration is less than 15 gg/L, or
no significant mutation in DPD gene has been detected and uracil plasmatic concentration is at least 15 p.g/L but the UH2/U ratio is at least 6,
then a standard dose D(n) of 2500 mg/m2 is administered to the patient in cycle n;
b) In all other cases,
if 6<UH2/U ratio, then D(n) is 1750 mg/m 2
if 3<UH2/U ratio<6, then D(n) is 1250 mg/m 2
if 1<UH2/U ratio<3, then D(n) is 750 mg/m 2
if UH 2 /U ratio<1 then the patient is preferably not treated with 5-FU.
14. The method according to claim 1 , wherein said patient is suffering from colorectal cancer, stomach cancer, hepatic ducts cancer, pancreas cancer, oesophagus cancer, or breast cancer.