Saneeymehri Seyyedeh S, Markey Kelly R, Mahipal Amit
Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Department of GI Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
J Oncol Pharm Pract. 2016 Jun;22(3):552-5. doi: 10.1177/1078155215579303. Epub 2015 Apr 6.
5-fluorouracil is a chemotherapeutic agent that plays an important role in the treatment of various cancers including head and neck and gastrointestinal malignancies. Therapy with 5-fluorouracil is rarely associated with cardiotoxic effects including angina, heart failure, myocardial infarction and cardiac arrest, resulting in discontinuation at the expense of sub-optimal treatment of the targeted malignancy. In this article, we review the literature reported on 5-fluorouracil-associated cardiotoxicity and present a case of a patient who experienced chest pain on 5-fluorouracil. The cardiac symptoms subsided after initiation of capecitabine, the oral formulation of 5-fluorouracil. To our knowledge, this is only the second reported case where 5-fluorouracil was successfully replaced by capecitabine without recurrence of cardiac symptoms. Capecitabine may be a viable option for patients who develop 5-fluorouracil-induced chest pain. However, large clinical trials are warranted to confirm these findings. Currently, there is insufficient evidence to recommend an optimal approach for safe and effective alternative treatment for patients who experience 5-fluorouracil-induced cardiac adverse events.
5-氟尿嘧啶是一种化疗药物，在包括头颈癌和胃肠道恶性肿瘤在内的多种癌症治疗中发挥着重要作用。使用5-氟尿嘧啶进行治疗很少会引发心脏毒性反应，如心绞痛、心力衰竭、心肌梗死和心脏骤停，这可能导致治疗中断，从而影响对目标恶性肿瘤的最佳治疗。在本文中，我们回顾了有关5-氟尿嘧啶相关心脏毒性的文献报道，并介绍了一例在使用5-氟尿嘧啶时出现胸痛的患者。在开始使用5-氟尿嘧啶的口服制剂卡培他滨后，心脏症状得到缓解。据我们所知，这是第二例报道的成功用卡培他滨替代5-氟尿嘧啶且心脏症状未复发的病例。对于出现5-氟尿嘧啶诱发胸痛的患者，卡培他滨可能是一种可行的选择。然而，需要大型临床试验来证实这些发现。目前，对于经历5-氟尿嘧啶诱发心脏不良事件的患者，尚无足够证据推荐一种安全有效的替代治疗的最佳方法。
