5-FU induced cardiotoxicity: case series and review of the literature

Abstract

Background: 5-Fluorouracil (5-FU) is an antimetabolite chemotherapy used for a variety of solid tumors. It has the potential to cause a wide spectrum of cardiotoxicity, ranging from asymptomatic electrocardiographic changes to cardiomyopathy and subsequent cardiac failure. Main body of the abstract: We present two descriptive cases of new-onset severe cardiomyopathy induced by 5-FU followed by a review of the literature. Conclusion: Our case series emphasizes the importance of early recognition of this rare complication and prompt cessation of 5-FU, as cardiac dysfunction in this context is potentially reversible.

Diretriz Brasileira de Cardio-oncologia – 2020

“…101 O mecanismo pelo qual esses fármacos causam toxicidade não está completamente estabelecido e várias hipóteses foram geradas para explicar esses quadros, tais como vasoespasmo agudo, toxicidade direta aos miócitos, disfunção endotelial e estado de hipercoagulabilidade causando trombose. 101,102 O vasoespasmo agudo é frequentemente observado e estudos experimentais sugerem que a vasoconstricção causada pelo 5-fluorouracil esteja relacionada a proteína quinase C e endotelina-1. 103,104 De modo semelhante ao 5-fluorouracil, os taxanos são outra classe de fármacos que induzem quadros de angina secundários a espasmos coronarianos.…”

Fluoropyrimidine-induced cardiotoxicity

“…Fluoropyrimidines produce type II, reversible cardiotoxicity. The incidence of fluoropyrimidine-induced cardiotoxicity ranges from 1% to 18%[ 16 , 17 ]. The most common symptom of fluoropyrimidine cardiotoxicity is chest pain[ 16 , 17 ].…”

“…The incidence of fluoropyrimidine-induced cardiotoxicity ranges from 1% to 18%[ 16 , 17 ]. The most common symptom of fluoropyrimidine cardiotoxicity is chest pain[ 16 , 17 ]. Other symptoms that may occur are palpitations, dyspnea, hypertension, or hypotension, while less common manifestations include myocardial infarction, reversible cardiomyopathy, myopericarditis, congestive heart failure, tachyarrhythmias, coronary dissection, cardiogenic shock, and sudden death[ 18 ].…”

Rare Presentation of Cardiotoxicity Related to 5-Fluorouracil

“…5-Fluorouracil (5-FU) is a chemotherapeutic agent that is frequently used in the treatment of solid tumors. Despite proven therapeutic efficiency, 5-FU can have some undesired side effects, and, in a few cases, it was found to be associated with cardiotoxicity [ 1 – 3 ]. The incidence is rare and according to different sources, it varies from 1 to 19% [ 4 , 5 ].…”