Cardiotoxicity and Capecitabine: A Case Report

Abstract

Oral fluoropyrimidines increasingly are being developed and studied as a novel treatment for breast, colorectal, and other cancers. Fluoropyrimidines are designed to generate 5-fluorouracil (5-FU) preferentially within tumors. Cardiotoxicity is a rare complication associated with 5-FU and oral fluoropyrimidine treatments. Chest pain is the most common presenting symptom, and, in many cases, the cardiotoxicity is partly or completely reversible. This article reviews fluoropyrimidine-induced cardiotoxicity and presents a case report of a woman who experienced this complication during capecitabine treatment.

Cardiovascular Complications of Cancer Therapy

“…Echocardiography (72,80,82,(87)(88)(89) and coronary angiogram were normal (72,80,82,86,87). Previous cardiac disease was not a consistent risk factor since it was not present in some cases (72,80,88), but present in others (79,82,83,89). Lastly, a history of 5-FU cardiotoxicity may be considered a risk factor for such effects related to capecitabine therapy (84,86).…”

“…In the case reports reviewed, the dosages of capecitabine ranged from 1,500 to 2,500 mg/m 2 /day, and typical angina symptoms appeared 3 h to 4 days after therapy (72,79,80,82,86 -89). ECG changes such as ST-segment elevation were noted in many cases (72,79,80,82,86,89) and when serum cardiac markers were checked, they were normal (72,80,86,89) except in 1 case (79). Echocardiography (72,80,82,(87)(88)(89) and coronary angiogram were normal (72,80,82,86,87).…”

Les toxicités cardiovasculaires des traitements oncologiques

“…Cependant, quelques cas de douleurs thoraciques ont é té dé crits, à des doses varié es mais toujours dans les 96 premiè res heures du traitement, avec dans les majorité s des cas des troubles de la repolarisation et, plus rarement, une é lé vation des enzymes cardiaques. Il existe plusieurs cas de toxicité lé tale rapporté s. Il ne semble pas y avoir d'anomalies é videntes chez les patients ayant eu une coronarographie, et certains patients avaient dé jà reç u du 5FU [54][55][56][57][58][59][60][61][62][63].…”

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

“…The cardiotoxic effects of 5-FU have been extensively reported [3,4,5,6,7,8,9]. More recently, cardiotoxicity has been reported with doxifluridine [10], tegafur [11] and the oral fluoropyrimidines capecitabine [12,13,14,15,16] and UFT [17,18,19], predominantly in patients with colorectal cancer. We report a case of cardiotoxicity during the first cycle of capecitabine treatment in a woman with metastatic breast cancer, followed by a review of the available literature and a discussion of the possible pathophysiology of this cardiotoxicity and its implications for practice.…”