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Fluoropyrimidine-Induced Cardiotoxicity: Manifestations, Mechanisms, and Management

  • Cardio-oncology (EH Yang, Section Editor)
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Abstract

Fluoropyrimidines—5-fluorouracil (5-FU) and capecitabine—have been implicated as cardiotoxic chemotherapy agents. This rare, albeit potentially serious toxicity has been described in nearly four decades of case reports, case series, and in vitro modeling; however, there is a paucity in clinical trials and prospective analyses focused on cardioprotective strategies and cardiotoxic surveillance of these agents. While much attention has focused on the well-known cardiac toxicity of anthracyclines and monoclonal antibody agents such as trastuzumab, fluoropyrimidines remain one of the most common causes of chemotherapy-associated cardiotoxicity. The introduction of capecitabine, an oral prodrug of 5-FU, has made the treatment of solid tumors more convenient along with a subsequent rise in documented cardiotoxic cases. This review discusses the symptomatology, clinical manifestations, and proposed molecular mechanisms that attempt to describe the heterogeneous spectrum of fluoropyrimidine-induced cardiotoxicity. Four case examples showcasing the varied manifestations of cardiotoxicity are presented. Finally, several proposed management strategies for cardiotoxicity and post-hospital course precautions are discussed.

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Acknowledgments

The authors would like to thank Dr. J. Michael Criley and Dr. Hussam Ghalib for their assistance in obtaining relevant data for this manuscript.

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Authors and Affiliations

  1. Department of Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA

    Michael E. Layoun

  2. Division of Cardiology, Department of Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA

    Chanaka D. Wickramasinghe & Eric H. Yang

  3. Division of Internal Medicine, Department of Medicine, Beaumont Hospital—Dearborn, Dearborn, MI, USA

    Maria V. Peralta

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Michael E. Layoun, Chanaka D. Wickramasinghe, Maria V. Peralta, and Eric H. Yang declare that they have no conflict of interest.

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Layoun, M.E., Wickramasinghe, C.D., Peralta, M.V. et al. Fluoropyrimidine-Induced Cardiotoxicity: Manifestations, Mechanisms, and Management. Curr Oncol Rep 18, 35 (2016). https://doi.org/10.1007/s11912-016-0521-1

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