Cardiotoxicity of fluoropyrimidines in different schedules of administration: a prospective study

• Published in: Journal of cancer research and clinical oncology 2008-01, Vol.134 (1), p.75-82
• Main Authors: Kosmas, Christos, Kallistratos, Manolis S., Kopterides, Petros, Syrios, John, Skopelitis, Helias, Mylonakis, Nicolaos, Karabelis, Athanasios, Tsavaris, Nicolas
• Format: Article
• Language: English
• Subjects: 5-Fluorouracil; Administration, Oral; Aged; Antimetabolites, Antineoplastic - administration & dosage; Antimetabolites, Antineoplastic - adverse effects; Antineoplastic agents; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Cancer Research; Capecitabine; Cardiotoxicity; Cardiovascular disease; Chemotherapy; Colorectal carcinoma; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Deoxycytidine - administration & dosage; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Drug Administration Schedule; Drug dosages; Electrocardiography - drug effects; Endothelium; Female; Fluorouracil - administration & dosage; Fluorouracil - adverse effects; Fluorouracil - analogs & derivatives; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - pathology; Heart; Heart - drug effects; Heart attacks; Heart Diseases - chemically induced; Heart Diseases - drug therapy; Hematology; Humans; Infusions, Intravenous; Internal Medicine; Ischemia; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Myocardium; Oncology; Original Paper; Patients; Pharmacology; Pharmacology. Drug treatments; Prognosis; Prospective Studies; Side effects; Vasoconstriction
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-007-0250-9

Background Cardiotoxicity associated with 5-Fluorouracil (5FU) administration has been infrequently reported in literature, albeit various series of acute coronary syndromes have recorded a low but definite incidence of the above toxicity. In the present study, patients undergoing 5FU-based and oral capecitabine (Xeloda ® )-based chemotherapy were tested for the potential development of cardiac-related symptoms during their administration. Patients and methods Six hundred and forty-four patients entered the study. Those experiencing any cardiac-related symptoms during 5FU infusion or oral capecitabine were subjected to ECG and serum cardiac enzymes determination. If cardiotoxicity was confirmed, 5FU infusion or oral capecitabine were interrupted, sublingual nitrates administered and cardiac monitoring initiated, while patients with >two-fold enzyme elevation were followed in a coronary care unit for at least 72 h. Cases with acute myocardial infarction were excluded from further 5FU or oral capecitabine treatment. Results Overall 26 patients (4.03%) developed symptoms and/or ECG abnormalities due to 5FU and capecitabine. Patients with continuous 5FU infusion presented a higher incidence of cardiotoxicity [14/209; 6.7%, 95% confidence interval (CI) = 3.3–10.1%] than the remaining (7/317; 2.3%, 95% CI = 0.8–3.3%) ( P