New face for a familiar friend: the deGramont regimen in the treatment of metastatic colorectal cancer given as an outpatient: a feasibility study

Abstract

The use of elastomeric infusional devices to administer chemotherapy is becoming established in a number of malignancies. Historically, hospitals have admitted patients for treatments such as the deGramont regimen, used in advanced colorectal cancer. This consists of intermittent infusional 5-fluorouracil (5-FU) and folinic acid and usually requires two to three inpatient days, every two weeks. We performed a prospective, single-center, study to assess the feasibility of administering the deGramont regimen on an outpatient basis using elastomeric infusional devices. In addition, we assessed patient acceptability of this mode of administration and the effects on quality of life (using the self-completed EORTC QLQ-C30 questionnaire). Crude cost-benefit analysis was performed and we attempted to define the group of patients for whom this is a viable option. Twenty-six patients, all receiving the same regimen, were recruited into the study. Two cohorts were (nonrandomly) allocated to receive either standard inpatient (n=13) or novel out-patient (n=13) chemotherapy. Administration of the deGramont regimen using elastomeric infusional devices through an indwelling central venous catheter was found to be both feasible and highly acceptable to patients. Those patients receiving this modality of administration reported marked benefits, improved morale and did not suffer from impaired quality of life. Taking into account the costs of inpatient hospital stay, the outpatient regimen conferred considerable cost savings. Given the continued use of this popular regimen, either alone or in combination with newer, more active agents such as irinotecan and oxaliplatin, these findings have potential implications for a large number of patients and institutions. It also raises possibility of exploring this approach for other types of ambulatory infusion device chemo-therapy and may hasten the advent of home-based chemotherapy.