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JOSEP AISNER, M.D., is Professor of Medicine, the University of Medicine and Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School, and Chief, Medical Oncology, the Cancer Institute of New Jersey, 195 Little Albany Street, Room 2012, New Brunswick, NJ 08903-2681 (desouzbe{at}umdnj.edu).

Purpose. Several new oral chemotherapeutic agents have recently been introduced. Many possess novel mechanisms of action and specific targets that result in different adverse effect profiles from those associated with traditional chemotherapies and hormonal therapies. The potential advantages and challenges associated with oral chemotherapy are discussed. Summary. Use of the oral route is convenient and allows administration to take place at home or in non-traditional settings. However, nausea, difficulty swallowing, patient nonadherence, interactions with drugs and food, other pharmacokinetic factors, and the high cost of treatment can present problems in using these agents by the oral route. Awareness by clinicians of the potential problems with oral chemotherapy can help to avoid or minimize problems that might affect patient outcomes. Conclusion. While bioavailability studies are often an integral part of developing oral agents, their comparisons with parenteral forms are less well documented. However, studies comparing intravenous 5-fluorouracil (5-FU) with oral 5-FU prodrugs have demonstrated that efficacy, safety, and quality of life are not compromised by the use of oral therapy. Finally, these studies, as well as others, reveal patients prefer the oral route of administration. Index terms: Antineoplastic agents; Compliance; Costs; Drug administration routes; Drug interactions; Drugs; Drugs, availability; Fluorouracil; Food; Mechanism of action; Neoplasms; Patients; Pharmacokinetics; Quality of life; Site of action; Toxicity

 

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