To the Editor.—
The disagreement between Moertel (236:1935, 1976) and Li (237:872, 1977) regarding the value of fluorouracil as an adjuvant agent can be reconciled if the factors of angiogenesis and selective solubilization of fluorouracil are taken into account.It is evident that at the stage in which disseminated tumor cells are not yet vascularized; they are not accessible and, thus, largely invulnerable to such anticancer drugs as may be presented in the circulating blood. Further, in the unvascularized state, only limited growth of the tumor mass occurs.1 While angiogenesis renders the tumor accessible to anticancer drugs, at the same time it also promotes an exponential rate of malignant cell growth.2 The tumor growth rate that occurs after even a relatively short period of vascularization is such as to make it problematic whether in the individual case fluorouracil will be able to selectively overcome the kinetics of cancer cell
Ecanow B, Gold BH, Sadove M. Fluorouracil and Colorectal Cancer. JAMA. 1977;238(6):481–482. doi:10.1001/jama.1977.03280060025011
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