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Effect of Chemotherapy with 5-Fluorouracil on Intestinal Permeability and Absorption in Patients with Advanced Colorectal Cancer

Daniele, Bruno M.D., Ph.D.; Secondulfo, Mario M.D.; De Vivo, Rocco M.D.; Pignata, Sandro M.D., Ph.D.; De Magistris, Laura M.D.; Delrio, Paolo M.D.; Palaia, Raffaele M.D.; Barletta, Emiddio M.D.; Tambaro, Rosa M.D.; Carratù, Romano M.D.

Journal of Clinical Gastroenterology: March 2001 - Volume 32 - Issue 3 - p 228-230
Clinical Research

5-Fluorouracil (5-FU), in association with leucovorin (LV), is the most used chemotherapy agent in the treatment of colorectal cancer. Response rate, as well as side-effect incidence, increases with the dose intensity of regimens that are used. The most common dose-limiting toxicity for 5-FU/LV modulation is diarrhea. To assess the modification of small intestinal function, we investigated the changes in intestinal permeability (IP) and intestinal absorption (IA) in 41 chemo-naive patients (21 men and 22 women; mean age, 61 ± 9 years) with advanced colorectal cancer after treatment with the association of folinic acid and 5-FU. After chemotherapy administration, we found a marked increase in IP and a reduction in IA, measured as cellobiose–mannitol (CE–MA) ratio (p < 0.0001) and D-xylose absorption (p = 0.0001), respectively. Patients who experienced diarrhea have an increase in CE–MA ratio and a reduction in D-xylose absorption values, both statistically significant. Cellobiose–mannitol ratio and D-xylose absorption tests can be used for the assessment of toxic effect of 5-FU on mature intestinal epithelium and also for evaluating the role of cytoprotective agents.

From the Divisions of Medical Oncology B (B.D., R.D., S.P., E.B., R.T.) and Surgical Oncology C (P.D., R.P.), National Cancer Institute, Napoli, Italy; and the Gastroenterology Unit (M.S., L.D., R.C.), Second University of Naples, Naples, Italy.

Submitted January 12, 2000.

Accepted May 30, 2000.

Address correspondence and reprint requests to Dr. Bruno Daniele, Medical Oncology, National Cancer Institute, Via M. Semmola, 80131 Napoli, Italy. E-mail:

Presented in part at the European Cancer Conference, Hamburg, Germany, September 14–18, 1997, and published in abstract form in Eur J Cancer 1997;33(suppl 8):S169.

© 2001 Lippincott Williams & Wilkins, Inc.