Managing life-threatening 5-fluorouracil cardiotoxicity

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• 5-Fluorouracil (5-FU) is a cornerstone chemotherapy for colorectal cancer.
• 5-FU is associated with significant cardiotoxicity, including coronary vasospasm, arrhythmias, myocardial infarction, and sudden cardiac death.
• Direct toxic effects on vascular endothelium are the common mechanism for 5-FU-induced coronary vasospasm.

Observation:

• A patient with metastatic colon cancer experienced intolerable chest pain during 5-FU infusion chemotherapy.
• Transitioning to bolus 5-FU led to disease progression.
• A multidisciplinary team decided to re-challenge with 5-FU infusion, incorporating pre-treatment with diltiazem.

Findings:

• The patient tolerated the 5-FU infusion with diltiazem pre-treatment without cardiotoxic adverse events.
• This case demonstrates the potential for managing 5-FU-associated cardiotoxicity.
• Multidisciplinary discussion is crucial for co-managing reversible 5-FU-induced cardiotoxicity.

Implications:

• Empiric treatment with calcium channel blockers and/or nitrates may enable patients to continue 5-FU chemotherapy after coronary artery disease risk stratification.
• This approach could preserve a vital treatment option for patients with colorectal cancer.
• Further research into proactive management strategies for 5-FU cardiotoxicity is warranted.