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Various Manifestations of 5-Fluorouracil Cardiotoxicity: A Multicenter Case Series and Review of Literature

  • John D. AllisonEmail author
  • Toug Tanavin
  • Yang Yang
  • Gilad Birnbaum
  • Umair Khalid
Article

Abstract

5-Fluorouracil is a key element to the treatment of colon cancer. But it is also one of the most cardiotoxic chemotherapies, and the management of those that experience cardiotoxicity can be challenging. We present three cases of 5-FU cardiac toxicity that manifested as myocardial infarction, cardiogenic shock, and ventricular fibrillation. Additionally, we discuss the current literature regarding 5-fluorouracil cardiotoxicity mechanisms as well as management.

Keywords

Cardiotoxicity Pharmacotherapy Chemotherapy 5-Fluorouracil Acute myocardial infarction Cardiogenic shock Ventricular fibrillation Arrhythmia Colon cancer 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Arney, K. (2016). “Fluorouracil”. Chemistry World. Audio blog post. Royal Society of Chemistry. https://www.chemistryworld.com/podcasts/fluorouracil/1017474.article.Google Scholar
  2. 2.
    Devita, V. T., Jr., & Chu, E. (2008). A history of cancer chemotherapy. Cancer Research,68(21), 8643–8653.CrossRefGoogle Scholar
  3. 3.
    Heidelberger, C., Chaudhuari, N. K., & Danenberg, P. (1957). Fluorinated pyrimidines. A new class of tumor inhibitory compounds. Nature,179, 663–666.CrossRefGoogle Scholar
  4. 4.
    Grem, J. L. (2000). 5-Fluorouracil: Forty-plus and still ticking. A review of its preclinical and clinical development. Investigational New Drugs,18(4), 299–313.CrossRefGoogle Scholar
  5. 5.
    de Gramont, A., Figer, A., Seymour, M., et al. (2000). Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. Journal of Clinical Oncology,18(16), 2938.CrossRefGoogle Scholar
  6. 6.
    Anand, A. J. (1994). Fluorouracil cardiotoxicity. Annals of Pharmacotherapy,28(3), 374.CrossRefGoogle Scholar
  7. 7.
    Akhtar, S. S., Salim, K. P., & Bano, Z. A. (1993). Symptomatic cardiotoxicity with high dose 5-fluorouracil infusion: A prospective study. Oncology,50(6), 441.CrossRefGoogle Scholar
  8. 8.
    Mougdil, R., & Yeh, E. T. (2016). Mechanisms of cardiotoxicity of cancer chemotherapeutic agents: Cardiomyopathy and beyond. Canadian Journal of Cardiology,32(7), 863–870.CrossRefGoogle Scholar
  9. 9.
    Sorrentino, M. F., Kim, J., Foderaro, A. E., & Truesdell, A. G. (2012). 5-Fluorouracil induced cardiotoxicity: Review of the literature. Cardiology Journal,19(5), 453–458.CrossRefGoogle Scholar
  10. 10.
    Sara, J. D., Kaur, J., Khodadadi, R., Rehman, M., Lobo, R., Chakrabarti, S., Hermann, J., Lerman, A., Grothey, A. (2018). 5-Fluorouracil and cardiotoxicity: A review. Therapeutic Advances in Medical Oncology, 10, 1–18.CrossRefGoogle Scholar
  11. 11.
    Polk, A., Visitsen, K., Vaage-Nilsen, M., & Nielson, D. (2014). A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity. BMC Pharmacology and Toxicology,15, 47–58.CrossRefGoogle Scholar
  12. 12.
    Schober, C., Papageorgiou, E., Harstrick, A., et al. (1993). Cardiotoxicity of 5-fluorouracil in combination with folinic acid in patients with gastrointestinal cancer. Cancer,72(7), 2242–2247.CrossRefGoogle Scholar
  13. 13.
    Kosmas, C., Kallistratos, M. S., Kopertides, P., et al. (2008). Cardiotoxicity of fluoropyrimidines in different schedules of administration: A prospective study. Journal of Cancer Research and Clinical Oncology,134(1), 75–82.CrossRefGoogle Scholar
  14. 14.
    Meyer, C. C., Calis, K. A., Burke, L. B., et al. (1997). Symptomatic cardiotoxicity associated with 5-fluorouracil. Pharmacotherapy,17(4), 729–736.PubMedGoogle Scholar
  15. 15.
    Jensen, S. A., & Sorensen, J. B. (2006). Risk factors and prevention of cardiotoxicity induced by 5-fluorouracil or capecitabine. Cancer Chemotherapy and Pharmacology,58(4), 487–493.CrossRefGoogle Scholar
  16. 16.
    Saif, M. W., Shah, M. M., & Shah, A. R. (2009). Fluoropyrimidine-associated cardiotoxicity: Revisited. Expert Opinion on Drug Safety,8(2), 191–202.CrossRefGoogle Scholar
  17. 17.
    Kleinman, N. S., Lehane, D. E., Geyer, C. E., et al. (1987). Prinzmetal’s angina during 5-fluorouracil chemotherapy. American Journal of Medicine,82(3), 566–568.CrossRefGoogle Scholar
  18. 18.
    Cianci, G., Morelli, M. F., Cannita, K., et al. (2003). Prophylactic options in patients with 5-fluorouracil-associated cardiotoxicity. British Journal of Cancer,88, 1507–1509.CrossRefGoogle Scholar
  19. 19.
    Porschen, R., Arkenau, H. T., Kubicka, S., et al. (2007). Phase III study of capecitabine plus oxaliplatin compared with fluorouracil and leucovorin plus oxaliplatin in metastatic colorectal cancer: A final report of the AIO Colorectal Study Group. Journal of Clinical Oncology,25(27), 4217.CrossRefGoogle Scholar
  20. 20.
    Frickhofen, N., Beck, F. J., Jung, B., et al. (2002). Capecitabine can induce acute coronary syndrome similar to 5-fluorouracil. Annals of Oncology,13(5), 797–801.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Section of Cardiology, Department of MedicineBaylor College of MedicineHoustonUSA

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