Fluorouracil

So nearly all treated lesions resolved or flattened, even in patients on EGFR inhibitors and other immune-modulating drugs.

With the understanding that this is a small four-patient case series, the authors position it as a cheaper, more accessible alternative to intralesional 5-FU or methotrexate and may be a reasonable treatment option for patients.

So I have utilized intralesional triamcinolone for eruptive keratoacanthomas, eruptive keratoacanthomatous type squames on the lower legs.

I sometimes will even alternate it with 5-FU or combine it with 5-FU.

So I do think a multi-modality approach, almost oftentimes non-surgical approach for these patients who have multiple squamous cells on the lower legs is something to consider.

What are your thoughts?

And those patients I'll kind of log is my first go to if I really feel like it's inflammatory and reactive and that's helpful.

Right.

Mm.

And so, uh, found that the azelaic acid not only was very potent for anti-inflammatory, but it was also broad-spectrum anti-inflammatory, also broad-spectrum antimicrobial, was also prevented metaplasia that occurred, and even as a drug delivery agent for 5-FU.

We were able to turn down the incidence of contact reactions and improve the killing of actinic keratoses, particularly hypertrophic actinic keratoses, uh, using the azelaic acid as a carrier for 5-FU.

So I had a number of patents with, uh, azelaic acid, including the original patents for rosacea, seborrheic dermatitis, and actinic keratoses.

Wow.

what are your thoughts on get root canal so

i think car noise and like all that other stuff is the older kind of things right the 5fu i've done that so you just take some new gauze right and you 5fu is like an ointment It looks like, you know, something you put on your jock or something, right? You just squeeze it out and like, just on your gloved hand and just like coat the new guys and you just pack it in there and leave a little tail and make sure it's radio opaque.

Right.

And you take it out the next day.

Yeah.

I had a patient, I did that too.

And they're like, They didn't show up for like three days because they missed some appointment and like the kid was somewhere else and like, all right.

So he was like three days out.

So what do we do with systemic therapy? The first real progress, other than sort of single-agent therapies and other sort of platinum combinations, was the EXTREME regimen, the EXTREME trial published in the England Journal of Medicine 2008.

And this added cetuximab to a platinum and 5-FU.

If you remember our induction episode, that TAX324 study that looked at dosataxol, platinum, 5-FU for induction, and that beat platinum 5-FU.

When you remember that in a prior randomized trial, but then further studies really showed that induction didn't improve overall survival, which is why you don't really see that.

That's how this backbone was created.

That platinum 5-FU was used in induction, also used in the metastatic setting.

And the idea was let's add that EGFR inhibitor cetuximab to that.

And there was an improved overall survival.

Not the full Fearnox.

I guess just the full Fox, because now I'm just on 5FU.

I'm saying chemo terms.

All those are names of chemo.

And you think back, this is gonna make perfect sense to you.

So I was going along eating gluten, didn't know I have silent celiac, and then ga- cancer, and three of the drugs, Cytoxan, 5-FU, and Doxorubicin.

And the Cytoxan literally works by creating a more permeable gut.

Right.

Well, tell us more.

So mitomycin 5-FU, BC 2001 regime.

You've got Beacon, carbidine, nicotinamide.

But the most widely used regime actually is based on the Christie Phase 2 data, which is weekly gemcitabine.

We don't have the weekly gem at the moment.

Yeah, but it'd be easy to give.

For some reason, we've stuck with mitomycin and 5-FU and with carbogen and nicotinamide for those who are not eligible.

I wouldn't be afraid of giving gemcitabine.

Mm-hmm.

And the primary power tool mentioned in the literature is a drug called 5-fluorouracil or 5-FU.

Wait a minute, 5-FU.

I recognize that name.

Isn't that a chemotherapy drug?

Okay, so the fibroblasts are the bricklayers.

Right.

5-FU is an antimetabolic agent, which means it interrupts cell division.