ํ๋ฃจ์ค๋ก์ฐ๋ผ์ค
ํ๋ฃจ์ค๋ก์ฐ๋ผ์ค(5-FU)์ ์์ํ์์ ํน์ ์ ํ์ ์์ ์น๋ฃํ๋ ๋ฐ ์ฌ์ฉ๋๋ ํผ๋ฆฌ๋ฏธ๋ ์ ์ฌ์ฒด ํญ์ข ์์ ์ ๋๋ค. * **๊ฐ**: ์ ์ ์(์ข ์ข ๋ ์๋ฃจ๋น์ ๋ฐ ์ํด๋กํฌ์คํ๋ฏธ๋์ ํจ๊ป FAC ํ๋กํ ์ฝ์ ์ผ๋ถ๋ก ์ฌ์ฉ๋จ), ํผ๋ถ ํธํ์ธํฌ์ ๋ฐ ์์ฅ๊ด ์ข ์์ ์ ์ ์ ์ผ๋ก ์ฌ์ฉ๋ฉ๋๋ค. * **๋ง**: ํธํ์ธํฌ์, ํ์์ข , ๋ง ์ฌ์ฝ์ด๋์ ๊ฐ์ ํผ๋ถ ์ข ์์ ์น๋ฃํ๊ธฐ ์ํด ๊ตญ์์ ์ผ๋ก ๋๋ ๋ณ๋ณ ๋ด ์ฃผ์ฌ(์ข ์ข ์ํผ๋คํ๋ฆฐ๊ณผ ๋ณ์ฉ)๋ก ์ฌ์ฉ๋ฉ๋๋ค. > **๋งค์ฐ ์ค์ํ ์ข ๊ฐ ์ฐจ์ด**: 5-FU๋ **๊ณ ์์ด์๊ฒ ์ ๋ ๊ธ๊ธฐ**์ ๋๋ค. ๊ณ ์์ด๋ ์ด ์ฝ๋ฌผ์ ์์ ํ๊ฒ ๋์ฌํ๋ ๋ฐ ํ์ํ ๊ฒฝ๋ก๊ฐ ๋ถ์กฑํ์ฌ, ์์ฃผ ๋ฏธ๋(์: ์ฌ๋์ฉ ์ฐ๊ณ ์ ์ฐ๋ฐ์ ์ญ์ทจ)์๋ ์ฌ๊ฐํ๊ณ ๋น ๋ฅด๊ฒ ์งํ๋๋ฉฐ ์ข ์ข ์น๋ช ์ ์ธ ์ ๊ฒฝ๋ ์ฑ์ ์ ๋ฐํฉ๋๋ค.
์์ฉ ๊ธฐ์ : Fluorouracil is a prodrug that acts as a cell-cycle phase-specific (S-phase) antimetabolite. It enters the cell and is converted into two primary active metabolites: * **FUMP (fluorouridine monophosphate)** โ Inhibits the enzyme **thymidylate synthase**, which blocks the synthesis of deoxythymidine triphosphate (dTTP). This severely disrupts **DNA synthesis** and repair. * **FUTP (fluorouridine triphosphate)** โ Falsely incorporates into **RNA**, disrupting RNA processing, function, and subsequent protein synthesis. By halting both DNA and RNA functions, the drug induces apoptosis in rapidly dividing cancer cells.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- ALL ยท CONTRAINDICATED ยท ALL ยท Do NOT use in any form on cats
- All indications ยท DO NOT USE ยท PO/IM/IV/SC/topical ยท null ยท null ยท Strictly contraindicated. Causes potentially fatal neurotoxicity.
- Intratumoral injection with epinephrine into certain skin neoplasms (squamous cell carcinoma, melanoma, sarcoid) ยท 0.3 mL of 1:1000 epinephrine is added to each mL of 5-FU solution up to a maximum of 3 mL of epinephrine per total volume of 5-FU injected. ยท Intratumoral ยท Epinephrine may result in white hair growth and can cause transient excitation, tachycardia, and shaking if absorbed systemically in sufficient quantities.
- Canine mammary carcinoma (in combination with doxorubicin and cyclophosphamide-FAC protocol), dermal squamous cell carcinoma and GI tract tumors ยท 150 mg/m2 IV weekly, or 5-10 mg/kg IV weekly ยท IV ยท weekly
- Systemic carcinomas ยท 150 mg/m2 ยท IV ยท once weekly OR once every 3 weeks when combined with carboplatin ยท 6 weeks (if used weekly) ยท Reduce dose by half in patients with liver, renal, or bone marrow impairment.
- Basal cell and squamous cell carcinoma ยท Apply to affected area ยท topical ยท q24h ยท As directed by oncologist ยท Wear gloves when applying. Prevent the dog from licking the area.
์ฉ๋์ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์ฐธ๊ณ ์๋ฃ์ ๋๋ค. ํญ์ ์ต์ ๋ผ๋ฒจ๊ณผ ๊ฐ๋ณ ํ์์ ๋ํด ํ์ธํ์ญ์์ค.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- CATS (Do NOT use in any form, including topical)
- Patients with known hypersensitivity to the drug
- Patients in poor nutritional states
- Patients with depressed or reduced bone marrow function
- Patients with concurrent serious infections
- Pregnancy (Known teratogen - FDA Category D)
- Cats (strictly contraindicated due to fatal neurotoxicity)
- Patients with severe bone marrow suppression
- Patients with severe hepatic or renal impairment (unless dose is adjusted)
- Pregnancy and lactation
์ด์๋ฐ์
- Dose-dependent myelosuppression (leukopenia, thrombocytopenia)
- Gastrointestinal toxicity (nausea, vomiting, hemorrhagic diarrhea, GI ulceration/sloughing, stomatitis)
- Neurotoxicity (ataxia, disorientation, seizures)
- Fatal neurotoxicity in cats (even with topical exposure)
- Anorexia
- Vomiting
- Stomatitis
- Diarrhoea
- Leucopenia (nadir between 7 and 14 days)
- Thrombocytopenia
- Anaemia
- Alopecia
- Hyperpigmentation
- Dermatitis
- Cerebellar ataxia
- Seizures
์ฝ๋ฌผ ์ํธ์์ฉ
- Leucovorin ยท May increase the gastrointestinal toxic effects of 5-FU
- Cimetidine ยท Inhibits the metabolism of 5-FU, potentially increasing toxicity ยท major
- Carboplatin ยท Synergism in human oncology, but combination may be more toxic in small animals ยท major
- Methotrexate ยท Synergistic if administered before 5-FU; antagonistic if administered afterwards ยท major
- Vincristine ยท Increases the cytotoxicity of 5-FU ยท major
๋ชจ๋ํฐ๋ง
- CBCs (nadirs usually occur between days 9-14 with recovery by day 30)
- Gastrointestinal adverse effects (vomiting, diarrhea, anorexia)
- Central nervous system adverse effects (ataxia, seizures)
- Liver enzymes (alkaline phosphatase, serum transaminase), serum bilirubin, and lactic dehydrogenase (may increase)
- Tumor response/Efficacy
- Complete Blood Count (CBC) to monitor for leucopenia and thrombocytopenia (nadir 7-14 days)
- Renal function parameters
- Hepatic function parameters
- Gastrointestinal signs (vomiting, diarrhea, stomatitis)
- Neurological signs
๊ณผ์ฉ๋
Overdoses are extremely serious and potentially fatal. * **Dogs**: The lowest reported toxic dose is 8.6 mg/kg (mild GI irritation/vomiting). Seizures and death have been reported at doses as low as 10.3 mg/kg, with survival rates potentially as low as 25%. * **Cats**: Very small ingestions (such as licking human topical creams) can cause death. **Clinical Signs**: Onset is rapid (30 minutes to 6 hours). Signs include acute nausea, vomiting, hemorrhagic diarrhea, abdominal pain, GI sloughing, ataxia, severe nonresponsive seizures, severe dose-dependent myelosuppression affecting all cell lines, metabolic acidosis, and multi-organ failure. **Treatment**: * Aggressive GI decontamination and protection if ingestion was very recent (though rapid onset may render this ineffective). * Intensive supportive care: antiemetics, fluid support, pain control, and temperature regulation. * Seizure control: Diazepam is often unrewarding; barbiturates or general anesthesia are frequently required. * Broad-spectrum antibiotics to prevent secondary infections. * Filgrastim (Neupogenยฎ) can be considered to stimulate bone marrow stem cell proliferation in dogs. * Intensive hematologic monitoring (CBCs every 3-4 days) for at least 3-4 weeks.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.