Shah N R, Shah A, Rather A
Department of Cardiology, Watford General Hospital, Watford, Hertfordshire, UK.
J Oncol Pharm Pract. 2012 Mar;18(1):132-5. doi: 10.1177/1078155211399164. Epub 2011 Feb 14.
Capecitabine is a member of the fluoropyrimidine family of chemotherapeutic agents that selectively delivers 5-fluorouracil (5-FU) to tumors. It is increasingly used as part of combined modality treatment for gastrointestinal malignancies. Cardiotoxicity has been documented to occur with 5-FU, but due to an expansion in capecitabine use, reports exist of its propensity to coronary vasospasm. We report the case of a 28-year-old man, with no preceding angina, presenting with a reversible episode of ventricular fibrillation (VF) at rest in his fifth course of capecitabine chemotherapy for metastatic colorectal cancer. Emergency resuscitation successfully restored spontaneous circulation, with initial ST segment elevation in the inferolateral leads on electrocardiogram prompting emergency coronary angiography. This demonstrated normal coronary arteries. ST segments normalized post-angiography and the patient rapidly recovered with no myocardial damage sustained. An implantable cardioverter-defibrillator was placed for secondary prevention of sudden death, and capecitabine was implicated as the cause of coronary vasospasm which resulted in his presentation of VF. To our knowledge, this is the first episode of VF as a consequence of suspected capecitabine-induced coronary vasospasm occurring at rest. Our case highlights the potential for severe cardiotoxic consequences of capecitabine including sudden death from VF, and given the multi-disciplinary approach to managing oncology patients, health professionals should be aware of this.
卡培他滨是化疗药物氟嘧啶家族的一员，可选择性地将5-氟尿嘧啶（5-FU）输送至肿瘤部位。它越来越多地被用作胃肠道恶性肿瘤联合治疗方案的一部分。已有文献记载5-FU会引发心脏毒性，但由于卡培他滨的使用范围不断扩大，也有关于其引发冠状动脉痉挛倾向的报道。我们报告了一例28岁男性患者，既往无心绞痛病史，在接受转移性结直肠癌的第五疗程卡培他滨化疗时，静息状态下出现了一次可逆性室颤（VF）发作。紧急复苏成功恢复了自主循环，心电图下壁导联和侧壁导联最初出现ST段抬高，促使患者接受了紧急冠状动脉造影。结果显示冠状动脉正常。造影后ST段恢复正常，患者迅速康复，未出现心肌损伤。为预防猝死，植入了植入式心脏复律除颤器，卡培他滨被认为是导致冠状动脉痉挛并引发室颤的原因。据我们所知，这是首例因疑似卡培他滨诱发的冠状动脉痉挛导致静息状态下出现室颤的病例。我们的病例突出了卡培他滨可能导致严重心脏毒性后果，包括室颤猝死，鉴于肿瘤患者的多学科管理方法，医疗专业人员应了解这一点。
