5FU remains the most widely used chemotherapeutic agent for CRC. Cape is a 5FU pro-drug developed to mimic the continuous infusion of 5FU while avoiding complications and inconvenience of intravenous administration.1 This study presents an assessment of prescribing patterns and causes of toxicity for 104 CRC inpatients at the PAH during the 2020-2021 financial year. Data was collected using electronic medical records and prescribing software, and includes patient demographics, mutation status, treatment and reason for hospital admission.
In the study cohort of 104 patients (pts), 63 were males and 41 were females, with a median age of 59 years. Of these, 80 pts had metastatic disease and 24 received adjuvant chemotherapy. The majority of pts were prescribed 5FU, of which 66 were on 5FU-Oxaliplatin, 19 were on 5FU-Irinotecan and 9 were on 5FU-Oxaliplatin-Irinotecan. In the Cape cohort, 8 undertook Cape-monotherapy and 2 were on Cape-Oxaliplatin. 37 patients exhibited KRAS mutations, while 4 presented BRAF mutations. Additionally, 11 were receiving Anti-VEGF therapy and 4 were receiving Anti-EGFR therapy. 20% of the CRC pts were admitted due to 5FU related toxicity and 2.8% were due to Cape related toxicity. The most common side effects with 5FU were cytopenia, fevers and colitis (33%), with 1 coronary vasospasm. In Cape pts, hand foot syndrome was frequently reported and colitis was not a predominate cause of admission.
The findings of this analysis mirror current literature in reporting that pts on 5FU are more likely to be hospitalised due to 5FU related toxicities such as colitis and neutropenic fevers.1 This retrospective audit is limited by the institutional practice of preferring 5FU over Cape. While the sample size of this study is limited, it is reassuring to see the low incidence of admissions with Cape and it should be considered a reasonable option in suitable circumstances.