Cardiotoxicity of fluoropyrimidine derivatives as a factor limiting the effectiveness of treatment

Abstract

5-fluorouracil and capecitabine are cytostatics of critical importance in the strategy of systemic therapy for colorectal cancer. Cardiotoxicity associated with these drugs is a documented adverse event. The mechanism causing cardiac side effects is poorly understood. In the course of administration of fluoropyrimidines the patients may suffer from, among other things, coronary vasospasm. In this paper we present the case of a rectal cancer patient who experienced symptoms of acute coronary syndrome during her treatment with 5-fluorouracil. Cardiotoxic symptoms also appeared during attempted prophylactic use of vasodilators and after the replacement of the chemotherapeutic agent with the oral fluoropyrimidine derivative capecitabine. Occurrence of cardiac side effects may cause large diagnostic and therapeutic difficulties and be the reason of treatment failure. What is needed is an algorithm to deal with such cases, based on the best available scientific evidence.