Paradoxical effect of capecitabine in 5-fluorouracil-induced cardiotoxicity: A case vignette and literature review

Saneeymehri, Seyyedeh; Markey, Kelly; Mahipal, Amit

doi:10.1177/1078155215579303

Cited by 13 publications

(8 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cardiac symptoms subsided after initiation of capecitabine and the patient tolerated the treatment well. [3] If chest pain occurs with capecitabine treatment, fluoropyrimidines will usually not be further considered. Golias et al reported a 46-year-old woman with gastric sarcoma who was administered cisplatin after capecitabine-induced cardiotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Rechallenge capecitabine after fluoropyrimidine-induced cardiotoxicity in rectal cancer

Peng¹,

Ouyang²,

Tong³

2019

Medicine

View full text Add to dashboard Cite

Rationale:Fluoropyrimidine-induced cardiotoxicity is a rare but potentially serious toxicity. The most common symptom is anginal chest pain.Patient concerns:A 35-year-old woman was diagnosed with rectal cancer with metastasis to the liver.Diagnosis:A computed tomography scan showed a 9.3 × 4.5-cm predominantly hypodense lesion within the left lobe of the liver and thickening of the rectum. Liver biopsy showed moderately differentiated adenocarcinoma with necrosis involving the liver parenchyma, and immunohistochemistry for mismatch repair proteins indicated that the tumor was positive for MutL Homolog 1, MutS Homolog 2, MutS Homolog 6, and Protein Homolog 2. Rectal biopsy indicated moderately differentiated adenocarcinoma.Interventions:She received chemotherapy of fluorouracil 1600 mg/m2, leucovorin 500 mg/m2, and irinotecan 100 mg/m2 every week. During the second cycle of chemotherapy, she developed severe anginal chest pain. We replaced fluorouracil with capecitabine 1500 mg (3 pills) a day every 2 weeks, with 1 week off, with irinotecan 100 mg/m2 on day 1 and bevacizumab 5 mg/kg at 200 ml/h for 30 min every 2 weeks. She was treated with chemotherapy for approximately 6 months.Outcomes:The liver lesion showed a significant response to chemotherapy, so she underwent resection of the liver tumor and rectum. After the surgery, she received radiation therapy to the rectal area, and 3 months of chemotherapy were administered prior to colostomy reversal.Lessons:Although the mechanism of fluoropyrimidine-induced cardiotoxicity is still uncertain, our case provides clinical evidence that cardiotoxicity could be a dose-related complication. Reducing the dose of fluoropyrimidine should be considered as a strategy after fluoropyrimidine-induced cardiotoxicity. However, this must be discussed with a multidisciplinary team including oncologists and cardiologists. Close monitoring of serial biomarkers and echocardiography are necessary for early diagnosis of cardiotoxicity.

show abstract

Section: Discussionmentioning

confidence: 99%

Rechallenge capecitabine after fluoropyrimidine-induced cardiotoxicity in rectal cancer

Peng¹,

Ouyang²,

Tong³

2019

Medicine

View full text Add to dashboard Cite

show abstract

“…There is little evidence describing the likely outcomes of fluoropyrimidine rechallenge following TS. Successful capecitabine administration in individuals following 5-fluorouracil-induced ACS [ 10 ] and TS [ 2 ] has been reported previously. Similarly, our patient tolerated capecitabine well, with no recurrence of cardiac symptoms, and a normal echocardiogram after one complete cycle of capecitabine therapy.…”

Section: Discussionmentioning

confidence: 99%

Successful capecitabine rechallenge following 5-fluorouracil-induced Takotsubo syndrome

et al. 2016

View full text Add to dashboard Cite

Cardiac toxicity is a widely reported complication of fluoropyrimidine chemotherapies (5-fluorouracil and capecitabine); however, Takotsubo syndrome (TS) is less widely reported. There is little data available describing the viability of fluoropyrimidine rechallenge after fluoropyrimidine-induced TS. We report the case of Ms X, a 41-year-old woman with metastatic oesophageal cancer, who developed acute onset left ventricular dysfunction, with a measured left ventricular ejection fraction of 15% on cycle 1 day 3 of FOLFOX chemotherapy, after disconnection of the fluorouracil infusion pump. Her symptoms resolved over 2 days, and an echocardiogram returned to normal within 2 weeks. 5-Fluorouracil was discontinued, and replaced with capecitabine, without recurrence of symptoms. The remainder of her treatment was uneventful. This is the second case to describe successful capecitabine retreatment following 5-fluorouracil-induced TS.

show abstract

“…There are case reports of successful treatment with capecitabine following 5FU-related cardiotoxicity, 55 , 56 but more robust evidence is lacking. Given what appears to be an equivalent risk of cardiotoxicity with capecitabine as an initial therapy described above, in the absence of more robust data supporting safety switching from 5FU to capecitabine, it cannot be recommended if there are any viable alternatives.…”

Section: Cardiotoxicity Of Alternative Agentsmentioning

confidence: 99%

Managing 5FU Cardiotoxicity in Colorectal Cancer Treatment

Anaka¹,

Abdel‐Rahman²

2022

CMAR

View full text Add to dashboard Cite

Fluorouracil (5FU) is the backbone chemotherapy agent in the treatment of colorectal cancer (CRC). Cardiotoxicity represents an uncommon but serious side effect of treatment with 5FU. Here, we review the current literature on 5FU-cardiotoxicity in the setting of CRC specifically, with a focus on data from the modern era of combination chemotherapy. Despite decades of study, there is little consensus on risk factors and biomarkers for 5FU-cardiotoxicity, nor how patients with CRC should be managed following a cardiotoxicity event. Given the elevated risk of recurrent cardiotoxicity on rechallenge, the use of alternative regimens that do not contain 5FU is a critical aspect of management. Data on the cardiotoxicity risk and efficacy of non-5FU regimens in CRC are therefore reviewed in detail.

show abstract

Paradoxical effect of capecitabine in 5-fluorouracil-induced cardiotoxicity: A case vignette and literature review

Cited by 13 publications

References 15 publications

Rechallenge capecitabine after fluoropyrimidine-induced cardiotoxicity in rectal cancer

Rechallenge capecitabine after fluoropyrimidine-induced cardiotoxicity in rectal cancer

Successful capecitabine rechallenge following 5-fluorouracil-induced Takotsubo syndrome

Managing 5FU Cardiotoxicity in Colorectal Cancer Treatment

Contact Info

Product

Resources

About