Fluoropyrimidine-Associated Cardiotoxicity

Kanduri, Jaya; More, Luis Alberto; Godishala, Anuradha; Asnani, Aarti

doi:10.1016/j.ccl.2019.07.004

Cited by 52 publications

(56 citation statements)

References 34 publications

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“…Even though cardiac toxicity is a rare adverse effect, fluoropyrimidines such as 5-FU are the second most common cause of chemotherapy-induced cardiotoxicity [10]. Clinical cardiac toxicities associated with 5-FU covers a wide range of manifestations: coronary vasospasms leading to angina, myocardial infarction, dysrhythmia, cardiomyopathy including TCM, sinoatrial and atrioventricular nodal dysfunction, QT prolongation with torsade's de pointes ventricular tachycardia, cardiac arrest, and sudden death have been reported in the literature [1,2]. In our case, the patient developed TCM after receiving continuous infusion of 5-FU chemotherapy for five days.…”

Section: Discussionmentioning

confidence: 99%

“…The fluoropyrimidines, namely 5-fluorouracil (5-FU) and its oral prodrug, capecitabine, are antimetabolites, which are widely used for the treatment of solid tumors of glandular and squamous origin, such as those involving the head and neck, gastrointestinal tract, and bladder [1,2]. Its mechanism of action includes inhibition of thymidylate transferase and incorporation into deoxyribonucleic acid (DNA) and ribonucleic acid (RNA) [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…5-FU is the gold standard of adjuvant therapy with radiation in anorectal cancer. It is commonly associated with adverse reactions of diarrhea, mucositis, and myelosuppression, and, rarely, cardiotoxicity, with an incidence of 1.2% [2,3,5].…”

Section: Introductionmentioning

confidence: 99%

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5-Fluorouracil Induced Takotsubo Cardiomyopathy Complicated by Left Ventricular Thrombosis

Kumar¹,

Warsha²,

Mehta³

et al. 2021

Cureus

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A 42-year-old woman with a remote history of smoking and recently diagnosed anorectal cancer presented with typical anginal chest pain, dyspnea, palpitations, and hallucinations. She was started on continuous 5flurouracil (5-FU) infusion five days before presentation. Her physical examination was significant for bilateral bibasilar crackles and tachycardia. Her bloodwork was significant for an increased troponin and brain natriuretic peptide (BNP). Electrocardiogram (EKG) showed sinus tachycardia with ST elevation in multiple contiguous leads, whereas transthoracic echocardiogram (TTE) showed estimated ejection fraction of 17% with severe global hypokinesis with apical akinesis and matted thrombus at the apex. Coronary angiogram showed 20% occlusion of the left anterior descending artery. She was diagnosed with 5-FU induced Takotsubo cardiomyopathy complicated by left ventricular (LV) thrombosis. 5-FU was discontinued, uridine triacetate was given as reversal agent. Aspirin and apixaban were started for three months for LV thrombosis. Her six-week TTE showed return of normal heart function with resolution of LV thrombosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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5-Fluorouracil Induced Takotsubo Cardiomyopathy Complicated by Left Ventricular Thrombosis

Kumar¹,

Warsha²,

Mehta³

et al. 2021

Cureus

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“…Patients with cardiovascular disease are at higher risk of cardiotoxicity [ 38 ]. Moreover, infusional regimen of 5-FU is associated with a greater risk of cardiotoxicity than bolus regimens.…”

Section: Mechanisms Of Acs In Cancer Patientsmentioning

confidence: 99%

“…Moreover, infusional regimen of 5-FU is associated with a greater risk of cardiotoxicity than bolus regimens. The mechanisms underlying 5-FU cardiotoxicity are not fully understood, but coronary vasospasm and thrombus formation are the most widely accepted hypotheses [ 36 , 37 , 38 ]. This agent can also cause direct cellular damage of both cardiomyocytes and endothelial cells [ 36 , 37 , 38 ].…”

Section: Mechanisms Of Acs In Cancer Patientsmentioning

confidence: 99%

Characteristics, Management, and Outcomes of Acute Coronary Syndrome Patients with Cancer

Milazzo

Cosentino

Campodonico

et al. 2020

JCM

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Patients with cancer are at increased risk of cardiovascular disease, with a reported prevalence of acute coronary syndrome (ACS) ranging from 3% to 17%. The increased risk of ACS in these patients seems to be due to the complex interaction of shared cardiovascular risk factors, cancer type and stage, and chemotherapeutic and radiotherapy regimens. The management of ACS in patients with cancer is a clinical challenge, particularly due to cancer’s unique pathophysiology, which makes it difficult to balance thrombotic and bleeding risks in this specific patient population. In addition, patients with cancer have largely been excluded from ACS trials. Hence, an evidence-based treatment for ACS in this group of patients is unknown and only a limited proportion of them is treated with antiplatelets or invasive revascularization, despite initial reports suggesting their beneficial prognostic effects in cancer patients. Finally, cancer patients experiencing ACS are also at higher risk of in-hospital and long-term mortality as compared to non-cancer patients. In this review, we will provide an overview on the available evidence of the relationship between ACS and cancer, in terms of clinical manifestations, possible underlying mechanisms, and therapeutic and prognostic implications.

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