Acute presentation of vasospastic angina induced by oral capecitabine: a case report

Abstract

IntroductionOral capecitabine is an oral prodrug of 5-fluorouracil that has been integrated into the management of multiple cancer types because of the convenience of administration and its efficacy compared with 5-fluorouracil. Capecitabine mimics the pharmacokinetics of intravenous 5-fluorouracil. While cardiac events associated with the use of 5-fluorouracil are a well-known side effect, capecitabine-induced cardiotoxicity has only been rarely reported.Case presentationWe present a case of a 46-year-old woman of Greek ethnicity who presented to our institution with an operated gastric sarcoma who experienced capecitabine-induced vasospastic angina. Primarily a clinical diagnosis of a possible acute coronary syndrome was proposed and the patient was admitted to the hospital for further investigation which was proved between normal limits. After a witnessed episode of angina, her prior history of capecitabine intake and an undertaken further imaging investigation we associated anginal symptoms and signs with vasospastic angina induced by capecitabine 36 hours prior to hospital admission.ConclusionCardiologists should be aware of the potential cardiac hazards of capecitabine, especially in patients with cardiovascular risk factors. Due to the increasing usage of capecitabine during the last years, patients should be warned for the possibility of chest pain, particularly during the first few days of capecitabine treatment. Specifically, patients developing acute coronary syndrome should not be retreated with capecitabine. On the other hand, due to its promising antitumoral efficacy, its use should not be discouraged.

Rechallenge capecitabine after fluoropyrimidine-induced cardiotoxicity in rectal cancer

“…Golias et al reported a 46-year-old woman with gastric sarcoma who was administered cisplatin after capecitabine-induced cardiotoxicity. [2] In our case, we rechallenged capecitabine after 5-FU-induced cardiotoxicity. However, our patient still experienced chest pain with a high dose of capecitabine.…”

“…In addition, fluoropyrimidine-induced cardiotoxicity is a rare but potentially serious toxicity. [2][3][4][5] The most common symptom of cardiotoxicity is anginal chest pain, and other symptoms include dyspnea and hypertension. Severe heart failure due to 5-FUinduced cardiotoxicity has also been reported.…”

Capecitabine-induced cardiotoxicity: more evidence or clinical approaches to protect the patients' heart?

“… 17 , 18 As demonstrated in animal models and in human studies, 19 , 20 arterial vasospasm is one of the possible mechanisms of 5-FU related angina. During a capecitabine-related coronary spasm, patients may experience angina-like chest pain 21 , 22 and ventricular fibrillation. 23 , 24 Moreover, the diagnosis of vasospastic angina could be consistent with the hypothesis of an acute coronary syndrome also in the first cardiac event presented during neoadjuvant treatment.…”

Capecitabine-induced vasospasm: a case report

“…Pre-existing cardiac and renal diseases are reported risk factors for cardiotoxicity [11]. Capecitabine is enzymatically metabolized in the liver to 5-FU, which in turn plays a major role in inhibiting DNA and RNA syntheses in tumor cells by blocking the synthesis of precursor nucleotides [12]. In contrast to the direct myocardial toxicity of anthracyclines, capecitabine and its active metabolite 5-FU are thought to exert their cardiac effects by causing reversible coronary spasms [2].…”