A Rare Case of Reversible Cardiac Dysfunction Associated with Tegafur/Gimeracil/Oteracil (S-1) Therapy

Abstract

For the past 20 years, S-1 has been used in the treatment of many types of cancer. However, the clinical importance of myocardial dysfunction attributed to S-1 remains to be unclear. Thus, in this study, we report on a patient with myocardial dysfunction associated with S-1.S-1 postoperative chemotherapy for gastric cancer was included as a treatment for a 65-year-old man. On day 8, S-1 treatment was discontinued after the patient developed an oral ulcer. He was then admitted to the hospital because of diarrhea caused by S-1. At approximately the same time, he developed dyspnea, and his chest X-rays revealed perihilar vascular engorgement and cardiac enlargement. Although his brain natriuretic peptide was 595.8 pg/mL, troponin I and creatine phosphokinase were unremarkable. Electrocardiograms showed no change in atrial fibrillations or new ST-T wave change. As per his transthoracic echocardiogram, noted were expansion of the left ventricle, global hypokinesis, and reduced left ventricular ejection fraction (approximately 40%). The patient was then diagnosed with S-1-related myocardial dysfunction. Furosemide, human atrial natriuretic peptide, dobutamine, enalapril, spironolactone, and bisoprolol were administered. Thirteen days after being diagnosed with heart failure, his symptoms disappeared, his echocardiogram showed that the left ventricular ejection fraction had increased to 65%, and the cardiothoracic ratio improved to 47% according to his chest X-rays.S-1-related myocardial dysfunction may be reversible, as it can improve after approximately 2 weeks.

Dihydropyrimidine Dehydrogenase-Mediated Resistance to 5-Fluorouracil: Mechanistic Investigation and Solution

“…Other combinations are also being trialed, for instance, S-1 in combination with docetaxel among patients with stage III gastric cancer and S-1 with oxaliplatin in locally advanced adenocarcinoma of the gastric cancer. , Recently, a rare case of reversible cardiac dysfunction associated with S-1 therapy has been studied by Oyakawa and associates in a 65-year old patient with gastric cancer. The clinicians reported S-1-related myocardial dysfunction in the patient which they found to be reversible with the administration of furosemide, human atrial natriuretic peptide, dobutamine, enalapril, spironolactone, and bisoprolol . S-1 is still a combination of interest for most of the researchers around the globe as evident from the frequency of published reports associated with it.…”

“…The clinicians reported S-1-related myocardial dysfunction in the patient which they found to be reversible with the administration of furosemide, human atrial natriuretic peptide, dobutamine, enalapril, spironolactone, and bisoprolol. 83 S-1 is still a combination of interest for most of the researchers around the globe as evident from the frequency of published reports associated with it.…”