Cardiotoxicity of 5-fluorouracil

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• 5-fluorouracil (5-FU) is a widely used chemotherapy agent.
• Continuous infusion protocols are common for 5-FU administration.
• Cardiac toxicity is a known, albeit uncommon, side effect of 5-FU.

Observation:

• Three patients receiving continuous 5-FU infusions developed anterior substernal chest pain.
• These symptoms were associated with electrocardiographic changes indicative of ischemia.
• Two patients experienced myocardial infarctions, and one patient died.

Findings:

• The observed cardiac events were temporally related to 5-FU administration.
• Cardiac toxicity appears more probable with continuous infusion 5-FU, particularly in patients with pre-existing cardiac conditions.
• The clinical presentation suggests cardiac ischemia, likely due to coronary artery vasospasm.

Implications:

• Continuous infusion 5-FU may pose a significant risk for patients with underlying coronary artery disease.
• Healthcare providers should carefully assess cardiac risk before initiating 5-FU infusion therapy.
• Discontinuation of 5-FU is recommended if patients develop chest pain during treatment, especially with ischemic changes.