Rechallenging Fluoropyrimidine-Induced Cardiotoxicity and Neurotoxicity: A Report of Two Cases

Abstract

Fluoropyrimidines (FP's) such as fluorouracil (5-FU) and capecitabine are antimetabolites widely used in many solid tumors. FPs side effects are caused mainly by a lack of dihydropyrimidine dehydrogenase (DPD) enzyme. It has been noticed that treatment with infusional regimens of 5-FU is associated with more adverse events (AE) compared to bolus forms. Here, we report two cases of unusual side effects seen with infusional 5-FU and capecitabine and how early intervention by withholding ongoing treatment can help in preventing progression and mortality.

Coronary atherosclerosis and chemotherapy: From bench to bedside

“…In the early and late stages of arteriosclerosis, a variety of procoagulants and antithrombin proteases are immunohistochemically labeled at different locations on the arteriosclerotic vessel wall, whereas the procoagulant state of early plaques are enhanced (55). An earlier single-center study of 1083 cancer patients who underwent 5-FU chemotherapy showed cardiotoxicity in 17 patients, angina in 15 patients, and definitive myocardial infarction in 1 patient (56). Another prospective clinical trial of 367 patients treated with high-dose 5-FU showed 28 cardiac events induced by 5-FU, with 18 patients experiencing angina at the beginning of treatment and 21 patients developing unstable angina after the withdrawal of 5-FU (57).…”