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Fluoropyrimidine-induced cardiac toxicity: challenging the current paradigm
Suparna C Clasen1, Bonnie Ky1,2, Rupal O'Quinn1
1Cardio-oncology in the Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Journal of Gastrointestinal Oncology
|January 5, 2018
Summary
Fluoropyrimidine chemotherapy can cause coronary vasospasm, but a new protocol allows patients to safely restart treatment. This approach successfully completed chemotherapy for all 11 patients without cardiac events.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- Fluoropyrimidines (5-FU, capecitabine) are vital chemotherapy agents for solid tumors.
- Cardiac toxicity, including coronary vasospasm and myocardial ischemia, limits their use.
- Patients often interrupt chemotherapy after experiencing cardiovascular side effects.
Purpose of the Study:
- To evaluate the safety and efficacy of rechallenging patients with fluoropyrimidines after suspected drug-induced coronary vasospasm.
- To assess the feasibility of completing planned chemotherapy regimens in patients with a history of fluoropyrimidine-associated cardiac events.
Main Methods:
- A case series of 11 patients with suspected fluoropyrimidine-induced coronary vasospasm was analyzed.
- Patients were rechallenged with intravenous fluoropyrimidine or oral capecitabine.
- A cardioprotective protocol involving calcium channel blockers and long-acting nitrates was administered prior to rechallenge.
Main Results:
- All 11 patients successfully completed their planned first-line chemotherapy regimens with minimal interruption.
- No cardiac events or recurrent coronary vasospasm were observed during or after therapy.
- Prophylactic cardiac medications were discontinued upon completion of chemotherapy.
Conclusions:
- Rechallenging patients with fluoropyrimidines using a protocol of careful cardiac monitoring and combined calcium channel blockers and long-acting nitrates is feasible and safe.
- This strategy allows for the continuation of potentially curative chemotherapy regimens.
- Further research is warranted to validate this approach in a broader patient population.
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