Manojlovic Nebojsa, Babic Dragana, Stojanovic Snezana, Filipovic Ivana, Radoje Doder
Clinic for Gastroenterology and Hepatology, Military Medical Academy of Serbia, Crnotravska 17, 11000 Belgrade, Serbia.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1249-56.
This study presents 3 case reports of patients who experienced anginous pain during treatment with capecitabine. The interruption of capecitabine and sublingual or intravenous nitroglycerine treatment lead to recovery. Rechallenge of capecitabine with dose reduction of 30% lead to repeated anginous pain in 2 patients. Treatment with capecitabine had been replaced with weekly bolus 5FU-LV, without further cardiotoxicity. The literature contains data from about 50 patients who experienced cardiotoxicity during capecitabine treatment. The most frequent manifestations of capecitabine cardiotoxicity included: anginous pain in 38/53 (71.7%), arrhythmia in 6/53 (11.3%), myocardial infarction in 6/53 (11.3%). Cardiotoxicity of capecitabine lead to death in 6/53 (11.3%) patients. Risk factors for cardiotoxicity are associated with the grade 4 and the fatal outcome of cardiotoxicity (p = 0.035, p = 0.015), but not with the symptom recurrence upon capecitabine rechallenge (p = 0.18). The combination chemotherapy regimens are associated with the grade 4 of cardiotoxicity (p = 0.048), but not with the fatal outcome (p = 0.3). Rechallenge of capecitabine lead to symptoms recurrence in 10/16 patients. Neither the dose reduction of capecitabine (p = 0.18) nor the additional medical prophylaxis (p = 0.37) were important for the outcome of capecitabine rechallenge.
本研究报告了3例在接受卡培他滨治疗期间出现心绞痛样疼痛的患者。停用卡培他滨并进行舌下含服或静脉注射硝酸甘油治疗后症状缓解。2例患者在卡培他滨剂量降低30%再次给药时再次出现心绞痛样疼痛。卡培他滨治疗已被每周大剂量5-氟尿嘧啶-亚叶酸钙替代，未再出现心脏毒性。文献中包含约50例在卡培他滨治疗期间出现心脏毒性的患者数据。卡培他滨心脏毒性最常见的表现包括：38/53例（71.7%）出现心绞痛样疼痛，6/53例（11.3%）出现心律失常，6/53例（11.3%）出现心肌梗死。卡培他滨心脏毒性导致6/53例（11.3%）患者死亡。心脏毒性的危险因素与4级心脏毒性及心脏毒性的致命结局相关（p = 0.035，p = 0.015），但与卡培他滨再次给药时症状复发无关（p = 0.18）。联合化疗方案与4级心脏毒性相关（p = 0.048），但与致命结局无关（p = 0.3）。16例患者中有10例在卡培他滨再次给药时出现症状复发。卡培他滨剂量降低（p = 0.18）和额外的药物预防措施（p = 0.37）对卡培他滨再次给药的结果均无重要影响。
