Prospective Observational Study Comparing Calcium and Sodium Levofolinate in Combination with 5-Fluorouracil in the FOLFIRI Regimen

Alessandro Passardi, Manlio Monti, Caterina Donati, Flavia Foca, Flavia Pagan, Ilario Rapposelli, Silvia Ruscelli, Giulia Bartolini, Martina Valgiusti, Laura Matteucci, Francesco Sullo, Stefania Sbaffi, Laura Crudi, Giovanni Luca Frassineti, Carla Masini

Research output: Contribution to journalArticlepeer-review


Lessons Learned: The use of sodium levofolinate (Na-Lev) is safe in combination with continuous infusion 5-fluorouracil in patients with gastrointestinal tumors treated with the FOLFIRI regimen. A comparison with calcium levofolinate (Ca-Lev) showed a similar toxicity profile. The advantages of Na-Lev over Ca-Lev might be the faster drug preparation and the shorter time of drug administration. Background: The objectives of this study were to compare the safety profiles of sodium levofolinate (Na-Lev) and calcium levofolinate (Ca-Lev) in combination with 5-fluorouracil (5-FU) in the FOLFIRI regimen and to measure the organizational impact of the introduction of Na-Lev on drug production and administration. Methods: The study opened in November 2015 and closed in August 2019. Patients with gastrointestinal cancers who were candidates for treatment with the FOLFIRI regimen were included in this nonrandomized study. Age ≥18 years, life expectancy >3 months, adequate bone marrow reserve, adequate hepatic and renal function, and an ECOG performance status of 0–2 were required. Patients in the Ca-Lev arm received a 2-hour infusion of Ca-Lev followed by 5-FU, whereas those in the Na-Lev arm received Na-Lev and 5-FU administered in a single 48-hour pump. Results: Sixty patients were enrolled, 30 in each arm. Patient characteristics were balanced. Grade (G)1–2 adverse events occurred in 18 (60.0%) and 19 (63.4%) patients of Na-Lev and Ca-Lev cohorts, respectively, whereas G3–4 adverse events occurred in 12 (40.0%) and 11 (36.6%) patients, respectively. The use of Na-Lev enabled us to save approximately 13 minutes for drug preparation and 2 hours for treatment administration, per patient per cycle. Conclusion: Na-Lev showed a reassuring toxicity profile and a favorable impact on drug preparation and administration.

Original languageEnglish
Pages (from-to)e1314-e1319
Issue number8
Publication statusPublished - Aug 2021


  • Calcium levofolinate
  • Sodium levofolinate

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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