Capecitabine-Induced Cardiotoxicity: Case Report and Review of the Literature

Abstract

Capecitabine, an oral prodrug of 5-fluorouracil (5fu), has been integrated into the management of multiple cancer types because of convenience of administration and efficacy comparable with 5fu. Cardiotoxicity induced by 5fu—in particular angina—has been well described in the literature, but reports of adverse cardiac events with capecitabine are also emerging. The mechanism underlying 5fu cardiotoxicity has long been thought to result from coronary vasospasm, but animal-model studies and patient echocardiographic findings both suggest a cardiomyopathic picture. Although 5fu cardiotoxicity is often reversible and can be managed supportively, presentations that are more severe—including arrhythmias, acute ischemic events, and cardiogenic shock—have been documented. In this report, we describe the case of a patient who ultimately required a pacemaker after developing symptomatic bradycardia and sinus arrest while receiving capecitabine for colon cancer.

Simultaneous neoadjuvant radiochemotherapy with capecitabine and oxaliplatin for locally advanced rectal cancer

“…The mechanism of cardiac toxicity either with 5-FU infusion or with capecitabine was closely investigated. It is believed to be primarily based on coronary vasospasm [1,18]. Whether the addition of oxaliplatin to capecitabine increases the risk for cardiovascular toxicity remains to be elucidated.…”

Digital Ischemia in Patients with Solid Tumors: a Case Report and Review of the Literature

“…Moreover, it is known that the capecitabine cardiotoxicity is frequently due to coronary vasospasm [18]. Can we postulate a vasospastic activity of capecitabine on peripheral microcirculation?…”

Antineoplastic drug-induced bradyarrhythmias

“…Among all, the best known mechanism is ischemic myocardial damage, due also to coronary artery thrombosis, arteritis, activation of the coagulation system with microthrombosis and autoimmune damage [1-3, [51][52][53]. Genetic polymorphisms may explain individual variability in fluoropirimidine-related cardiotoxicity [54]. Bradyrrhythmias were reported during or independently from ischemic injury.…”