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M Wasif Saif1, Manasi M Shah, Anuj R Shah

  • 1Yale University School of Medicine, FMP 116, CT 06520, New Haven, USA. wasif.saif@yale.edu

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Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • 5-fluorouracil (5-FU) is a widely used chemotherapy agent.
  • Cardiotoxicity associated with 5-FU is not well understood.
  • This study aims to define the syndrome of 5-FU-induced cardiotoxicity.

Purpose of the Study:

  • To review and analyze reported cases of 5-FU cardiotoxicity.
  • To identify patterns in patient demographics, tumor types, and treatment regimens.
  • To characterize the clinical presentation, management, and outcomes of 5-FU cardiotoxicity.

Main Methods:

  • A comprehensive literature review was conducted from 1969 to 2007.
  • Data from 448 reported cases of 5-FU cardiotoxicity were compiled.
  • 377 evaluable cases were analyzed for demographic, clinical, and treatment-related factors.

Main Results:

  • Cardiotoxicity occurred in patients aged 14-86, with 65% over 55 years old; the male:female ratio was 1.5:1.
  • Gastrointestinal tumors (60%) were most common; continuous infusion was the primary administration route (72%).
  • Angina (45%), myocardial infarction (22%), and arrhythmias (23%) were frequent; 69% of cardiac events occurred within 72 hours of the first 5-FU cycle. 8% of patients with cardiotoxicity died, and 13% of those re-exposed to 5-FU died.

Conclusions:

  • 5-FU cardiotoxicity is an infrequent but real complication, potentially linked to continuous infusion schedules and independent of dose.
  • Cardiac risk factors do not predict toxicity, necessitating close patient observation.
  • Discontinuation of 5-FU is recommended upon symptom development; re-challenge should be approached with extreme caution and aggressive monitoring.