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The 1957 chemotherapy that remains the backbone of treatment for bowel, stomach, pancreatic, anal, head and neck and breast cancers, and as a cream for skin precancers.
Answer a few questions from a report and read the guideline statement that applies, quoted word for word with its source. Educational aids to prepare for an appointment, not advice.
Heidelberger (1957). Infusional 5-FU with leucovorin is the core of FOLFOX/FOLFIRI/FOLFIRINOX, chemoradiation (rectal, anal, oesophageal, pancreatic, head and neck), and adjuvant colon therapy; capecitabine is its oral prodrug. DPYD genotyping before use is now recommended (EMA 2020; FDA label 2024). Topical 5-FU treats actinic keratosis and superficial BCC.
Converted to FdUMP (thymidylate synthase inhibition) and FUTP (RNA incorporation); potentiated by leucovorin; DPD deficiency causes severe toxicity.
1.Fluorouracil (5-FU) slips into a pocket on its target.
Given by infusion or injection in a clinic or hospital outpatient department, so it is a Part B drug: Medicare pays 80% after the Part B deductible and the patient owes 20% coinsurance, uncapped in Original Medicare unless a Medigap policy applies. HCPCS J9190. When 5-FU is infused over 46 hours through an ambulatory pump at home, the drug and pump are paid under the Part B durable medical equipment benefit. Topical fluorouracil (Efudex) for skin lesions is Part D.
Multi-source generic; covered under the medical benefit without prior authorisation in most plans, as part of standard regimens.
Sources: Medicare.gov: Chemotherapy · Medicare.gov: Prescription drugs (outpatient, Part B). Not medical or financial advice; verify with your plan.
Sources: NICE search: fluorouracil. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Compare all products across the US, EU, UK, Japan, China and Australia →
| Region | Year | Indication |
|---|---|---|
| US | 1962 | Colorectal, breast, gastric and pancreatic adenocarcinoma |
| US | 1970 | Topical: actinic keratosis and superficial basal cell carcinoma |
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People living with HIV who have anal HSIL should be offered treatment rather than observation, and screening programmes to find those lesions are now justified. High-resolution anoscopy capacity is the limiting step.
Organ preservation became a plan rather than an accident: consolidation chemotherapy after chemoradiotherapy gives the best chance of keeping the rectum, and salvage surgery after regrowth does not appear to cost survival.
Complete cytoreductive surgery with modern systemic chemotherapy gives a median survival over 40 months in selected patients with peritoneal metastases, and the heated intraperitoneal oxaliplatin adds only late complications.
A positive randomised phase 2 that the German NALIRICC trial failed to reproduce; guidelines list the regimen as an option, and the disagreement is a reminder that single-country phase 2 results in biliary cancer need replication.
Carboplatin plus weekly paclitaxel is the chemotherapy backbone for advanced anal cancer and the base on which retifanlimab was added in POD1UM-303.
This is the evidence behind the December 2015 US approval of Vistogard, the only antidote for fluorouracil or capecitabine overdose and early life-threatening toxicity. Its main practical message is the 96-hour window: the drug must be started before toxicity is fully established.
Gemcitabine and cisplatin is the first-line chemotherapy for recurrent or metastatic nasopharyngeal carcinoma and the backbone of the toripalimab, camrelizumab and tislelizumab combinations.
The first approved second-line regimen and the basis of NALIRIFOX, which NAPOLI 3 later moved to first line; it fixed the sequence (gemcitabine-based first, then liposomal irinotecan with fluorouracil) written into the 2018 ASCO guideline.
Query for this drug: (TITLE:"Fluorouracil" OR ABSTRACT:"Fluorouracil" OR TITLE:"5-FU" OR ABSTRACT:"5-FU" OR TITLE:"Adrucil" OR ABSTRACT:"Adrucil" OR TITLE:"Efudex" OR ABSTRACT:"Efudex") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Fluorouracil (5-FU), not a curated reading list.
Shares FUDR/Oxaliplatin HAI Plus Irinotecan vs. FOLFOXIRI Chemotherapy in Treating Initially Unresectable CRCLM, BALLAD, A Study to Evaluate Efficacy and Safety of Tislelizumab Plus Chemotherapy for Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Adenocarcinoma and Esophageal Squamous Cell Carcinoma in Racial and Ethnic Minority Patients in the United States, Cediranib (AZD2171, RECENTIN™) in Addition to Chemotherapy in Patients With Untreated Metastatic Colorectal Cancer and the tags generic, who-essential.
Shares A Study of Aflibercept in Combination With FOLFIRI in Patients With Second-Line Metastatic Colorectal Cancer in Japan, Combination Chemotherapy and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer, FUDR/Oxaliplatin HAI Plus Irinotecan vs. FOLFOXIRI Chemotherapy in Treating Initially Unresectable CRCLM, G-CSF in Preventing Neutropenia During First-Line Treatment With Chemotherapy and Bevacizumab in Patients With Metastatic Colorectal Cancer and the tags generic, who-essential.
Shares Glufosfamide Versus 5-FU in Second Line Metastatic Pancreatic Cancer, CPI-613 (Devimistat) in Combination With Hydroxychloroquine and 5-fluorouracil or Gemcitabine in Treating Patients With Advanced Chemorefractory Solid Tumors, ESPAC-3: adjuvant fluorouracil plus folinic acid versus gemcitabine after pancreatic cancer resection, Efficacy and Safety of Pembrolizumab (MK-3475) in Combination With Chemoradiotherapy (CRT) Versus CRT Alone in Muscle-invasive Bladder Cancer (MIBC) (MK-3475-992/KEYNOTE-992) and the tags generic, who-essential.
Shares DBCG 82b and 82c, Alkylating agents and antimetabolites, Small-molecule API synthesis, Buccal mucosa and gingivobuccal cancer (oral cancer in India) and the tags generic, who-essential.
Shares Safety and Efficacy Comparison of Docetaxel and Ixabepilone in Non Metastatic Poor Prognosis Breast Cancer, Sequential Administration of FE75C and Docetaxel Versus Docetaxel/Cyclophosphamide in HER-2 Negative, Node Positive Breast Cancer, Randomized Phase III Trial Comparing Sequential Administration of FE75C Followed by Docetaxel Versus Paclitaxel as Adjuvant Chemotherapy in Axillary Lymph Node (+) Breast Cancer, Six vs 12 Months of Trastuzumab With Docetaxel Following FEC as Adjuvant Treatment in N+ Breast Cancer and the tags generic, who-essential.
Shares Small-molecule API synthesis, Hepatoblastoma, Generic sterile injectables (the 2023 platinum shortage), Cytotoxic chemotherapy and the tags generic, who-essential.
Shares Generic sterile injectables (the 2023 platinum shortage), Cytotoxic chemotherapy and the tags generic, who-essential.
Shares Cytotoxic chemotherapy and the tags generic, who-essential.