Cardiac Toxicity with Capecitabine, Vinorelbine and Trastuzumab Therapy: Case Report and Review of Fluoropyrimidine-Related Cardiotoxicity

Abstract

A 45-year-old woman presented with a metastatic breast carcinoma and was treated with capecitabine, oral vinorelbine and trastuzumab combination therapy. The initial echocardiogram and the ECG were considered normal. She began treatment with 3-weekly cycles of the combination therapy. After the fourth dose of capecitabine, she presented with severe chest and arm pain, which was responsive to nitroglycerine spray. ECG at admission demonstrated tachycardia with ST-segment elevation suggesting ischemia. The clinical symptoms returned to baseline after a few hours and within 24 h the ECG showed inverted T in leads V3–V6. Cardiac ultrasonography revealed hypokinesia in the left ventricle without segmentary hypokinesia, with mildly reduced global systolic function, which normalized 1 week later. Two weeks later, she was rechallenged with capecitabine. After the fourth dose, the patient developed chest pain. ECG showed infero-apico-lateral injury, which normalized after administration of nitrates, nicorandil and verapamil and discontinuation of capecitabine. This case suggests that capecitabine can lead to the cardiotoxicity characteristic of other fluoropyrimidines. Therefore, it is important to inform patients about the risk of angina-like chest pain, to stop treatment immediately if symptoms occur, and to monitor the patient in hospital. Fluoropyrimidine rechallenge should be avoided because of the risk of ischemic event or sudden death.

Adverse reaction of a combined treatment for unresectable liver cancer

“…All the symptoms were classified into TACE embolization syndrome [23]. After chemoembolization, the edema of the liver tissue and portal venous drainage were blocked, which led to intestinal congestion, edema of the bowel wall and gas accumulation in the bowel.…”

Cancer Therapy-Induced Cardiotoxicity: Where are We Now?

“…Alkylating drugs nitrogen mustards mechlorethamine unclear melphalan yes [28] chlorambucil unclear cyclophosphamide yes [29,30,33] ifeofamide yes [30,33] alkyl sulphonates busulfan yes [31,33] triazines dacarbazine yes [32] temozolomide unclear nitrosoureas carmustine yes [33] lomustine unclear streptozocin unclear metal salts cisplatin yes [30,33] carboplatin unclear oxaliplatin yes [34] pentostatin yes [33] ethylenimine derivatives thiotepa unclear Antimetabolites antifolates methotrexate yes [36] raltitrexed unclear permetrexed unclear purine analogues cladribine yes [33] fludarabine unclear mercaptopurine unclear thioguanine unclear pyrimidine analogues azacitidine unclear capecitabine yes [30] cytarabine yes [31] 5-flourouracil yes [30,31,33] gemcitabine yes [37] Natural products anthracyclines bleomycin yes [30] dactinomycin unclear daunorubicin yes [38] doxorubicin yes [32] epirubicin yes [35] idarubicin yes [38] mitomycin yes [30,33] mitoxantrone yes [30] liposomal daunorubicin unclear liposomal doxorubicin unclear enzymes asparginase yes [31,33] taxanes doxcetaxel unclear paclitaxel unclear mitotic inhibitors vinblastine unclear vincristine yes [39] vinorelbine yes [40] vindesine unclear topoisomerase I inhibitors irinotecan unclear topotecan unclear topoisomerase II inhibitors etoposide yes [31,33] tenoposide yes [31,…”

Adverse cardiac events to monoclonal antibodies used for cancer therapy

“…Additional reports have pointed to trastuzumab as a possible cause of acute myocardial infarction. 15 , 16 In a 45-y-old woman suffering from metastatic breast carcinoma, the administration of trastuzumab plus vinorelbine and capecitabine induced chest and arm pain that was responsive to nitroglycerine. The electrocardiogram was compatible with a diagnosis of acute myocardial ischemia.…”