Influence of inflammatory bowel disease on the ability of patients to tolerate systemic fluorouracil-based chemotherapy

Purpose: To evaluate the safety of administering fluorouracil (5FU)- based chemotherapy to cancer patients with inflammatory bowel disease (IBD). Patients and Methods: We retrospectively reviewed all patients entered into the Memorial Sloan-Kettering Cancer Center clinical data base from 1985 through 1995 who had a diagnosis of IBD, had a gastrointestinal malignancy, and were treated with systemic 5FU-based chemotherapy. A total of 19 patient charts were identified and reviewed. Results: Fifty-three percent of patients reviewed experienced severe (grade III/IV) diarrhea on treatment. Sixty percent of patients with a history of active IBD and 40% of patients with a history of inactive IBD experienced severe diarrhea on treatment. The incidence of severe diarrhea did not appear to he substantially influenced by age, schedule of 5FU administration, concurrent radiation, or type of IBD. Conclusion: While there does appear to be an increased risk of diarrhea exacerbation in IBD patients treated with 5FU, a substantial number of patients tolerate chemotherapy without increased difficulty. The degree of IBD activity or other clinical parameters can not be used to predict accurately the likelihood of toxicity.