115 The influence of 5-fluorouracil on the appearance of endothelium in small arteries. A scanning and transmission electron microscopic study in rabbits

Cwikiel, Magdalena; Albertsson, Maria; Zhang, B.; Wieslander, Jörgen

doi:10.1016/0959-8049(95)95370-l

Cited by 41 publications

(54 citation statements)

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Section: Endothelial Dysfunctionmentioning

confidence: 99%

“…Several animal studies examined the direct effects of 5-FU on vascular endothelial cells and noted direct en- dothelial damage and platelet and fibrin accumulation with increased thrombus formation on both gross examination and electron microscopic evaluation [20,26]. With exposure to 5-FU, damage to endothelial cells followed by platelet accumulation and fibrin formation was observed [26]. Kuzel et al [27] demonstrated an increase in the quantity of fibrinopeptide A and a decrease in the amount of protein C activity in the presence of 5-FU, which together make a blood vessel more susceptible to thrombus formation.…”

Section: Endothelial Dysfunctionmentioning

confidence: 99%

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5-fluorouracil induced cardiotoxicity: Review of the literature

Sorrentino

Kim²,

Foderaro³

et al. 2012

Cardiol J

180

138

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Section: Endothelial Dysfunctionmentioning

confidence: 99%

Section: Endothelial Dysfunctionmentioning

confidence: 99%

5-fluorouracil induced cardiotoxicity: Review of the literature

Sorrentino

Kim²,

Foderaro³

et al. 2012

Cardiol J

180

138

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show abstract

“…Furthermore, it has been demonstrated that 5-FU may cause damage to endothelial cells with consequent thrombus formation. In our experience, 5-FUassociated effects on vascular endothelium reached their peak about 3 days from initiation of treatment, which corresponds to the clinical course of 5-FU cardiotoxicity (Cwikiel et al, 1995(Cwikiel et al, , 1996.…”

Section: Discussionmentioning

confidence: 64%

Prophylactic options in patients with 5-fluorouracil-associated cardiotoxicity

et al. 2003

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At present, the various mechanisms involved in 5-fluorouracil (5-FU)-correlated cardiotoxicity remain to be elucidated and a universally accepted prophylaxis or treatment for this specific toxicity is not available. Although it may improve time to progression, survival and clinical benefit, a 5-FU-based regimen usually has to be discontinued if a patient experiences cardiotoxicity. Here, we describe our experience with three cases of 5-FU-associated cardiotoxicity. The angina-like pain that appeared approximately 95 h after beginning 5-FU therapy was apparently independent of the drug's administration modality. In the two patients receiving 5-FU 12-h flat continuous infusion from 22.00 to 10.00 h (5-FU 12-h c.i.) in combination with other drugs, the dose of 5-FU was reduced by 10 -20% and patients received prophylactic transepidermal nitroglycerin. In the third patient, 5-FU administration modality was changed and prophylactic therapy was not given. By taking these precautions, the patients no longer complained of anginal pain and none of them discontinued chemotherapy. (Kohne et al, 1998). The spectrum of toxicities associated with 5-FU involves the gastrointestinal tract, the bone marrow, the skin and the central nervous system. Last, but not the least, 5-FU may give cardiac toxicity that is less familiar to physicians and this may present as precordial pain, atrial arrhythmias, electrocardiogram (EKG) ST-T wave changes, ventricular dysfunction and cardiogenic shock.The overall incidence of 5-FU cardiotoxicity varies from 1.2 to 18% of patients and is usually underestimated, since silent EKG alterations often occur (Klaus Becker et al, 1999). The different mechanisms involved in 5-FU-associated cardiotoxicity are not yet fully understood and no unequivocally effective prophylaxis or treatment for this specific toxicity exists. Here, we describe three cases of 5-FU-associated cardiotoxicity, its clinical management and the prophylactic treatment used. PATIENTS AND METHODS Case 1A 57-year-old male, with positive family history for acute myocardial infarction (AMI) but with no history of cardiovascular disease, came to our observation after undergoing an anterior resection of the rectum for a stage III rectal -sigmoid adenocarcinoma (RSA) ( Table 1). Physical examination, chest X-rays, blood pressure and EKG were all within normal limits. The patient received four cycles of adjuvant chemotherapy with 5-FU (370 mg m À2 day À1 ) and folinic acid (FA) (50 mg tot À1 ) i.v. for 5 days, every 3 weeks.During adjuvant chemotherapy, disease progressed with liver metastasis and the patient's therapy was changed to irinotecan (180 mg m À2 ) day 1 and 5-Fu 12-h flat continuous infusion from 22.00 to 10.00 h (5-FU 12-h c.i.) (900 mg m À2 day À1 ) for 4 days, every 2 weeks. Approximately 93 h after starting the first cycle of the second 5-FU regimen, the patient presented angina-like pain that lasted a few minutes and disappeared with oral nitroglycerin. The blood pressure was 160/115 mmHg and the heart rate was 105 beats min...

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“…One is that 5-FU may have deleterious effects on the endothelium. Many studies and case reports have been published about vasospasm due to toxic effects on the coronary endothelial intima [3,4]. Kosmas et al reported that the toxicity becomes more pronounced about three days after the start of 5-FU administration by increased prostacyclin release [2].…”

Section: Discussionmentioning

confidence: 99%

Successful Resuscitation from Cardiopulmonary Arrest: 5-FU Cardiotoxicity

Nakamura¹,

Kuwabara²,

Mitani³

et al. 2017

J Cardiovasc Dis Diagn

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A 61-year-old man with 5-fluorouracil (5-FU) chemotherapy suffered a cardiopulmonary arrest (CPA). The electrocardiogram showed changes consistent with myocardial infarction only during CPA that was normalized 30 minutes after cardiopulmonary resuscitation. Coronary angiography showed no significant stenosis. We suspected the cause of CPA to be vasospastic angina due to 5-FU and administered Benidipine, Diltiazem, and Isosorbide mononitrate to prevent recurrence of vasospasm.

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115 The influence of 5-fluorouracil on the appearance of endothelium in small arteries. A scanning and transmission electron microscopic study in rabbits

Cited by 41 publications

References 0 publications

5-fluorouracil induced cardiotoxicity: Review of the literature

5-fluorouracil induced cardiotoxicity: Review of the literature

Prophylactic options in patients with 5-fluorouracil-associated cardiotoxicity

Successful Resuscitation from Cardiopulmonary Arrest: 5-FU Cardiotoxicity

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