Weekly simultaneous 24h infusion of high-dose 5-fluorouracil and sodium folinate as salvage therapy for recurrent ovarian cancer – a case report

Introduction: Despite any modern therapies, approximately 80% of patients with ovarian cancer relapse. Unresectable recurrent ovarian cancer is usually treated by cytotoxic chemotherapy including carboplatin combinations (for platin-sensitive disease) or monotherapy with e.g. paclitaxel, pegylated liposomal doxorubicin, gemcitabine or treosulfan (for platin-resistant disease). Response rates to chemotherapy vary between 8 to 50% depending on the number of previous therapies. Although chemotherapy in recurrent disease still failed to show prolongation of overall survival, it still seems beneficial for prolonging time of remission and PFS, if toxicity is acceptable. 5-Fluorouracil is approved for treatment of various neoplasms, including breast cancer and cancers of gastrointestinal origin. Data on efficacy in ovarian cancer are controversial, published response rates range between 5 – 50%.

Methods: We report the case of a 48-year-old woman with metastatic ovarian cancer who had already received 6 lines of chemotherapy and aromatase inhibitor treatment. Disease was regressive under docetaxel/gemcitabine, but treatment was ceased due to toxicity after 6 cycles. Patient was switched to weekly 24h simultaneous infusions of 2000 mg/m² 5-Fluorouracil and 500 mg/m² sodium folinate for 6 weeks, followed by 2 weeks pause.

Results: Between 09/2009 and 10/2010 the patient received 5 cycles of 5-Fluorouracil/sodium folinate, achieving stable disease. The patient received one further cycle between 11/2010 and 01/2011. CT-scan in 01/2011 revealed progression of hepatic metastasis.

Conclusion: Weekly 24h infusion of high-dose 5-Fluorouracil/sodium folinate may be effective as salvage therapy in ovarian cancer.