Peng Tao, Ouyang Yulu, Tong Kanger
Department of Oncology, Hospital of Traditional Chinese Medicine, Keqiao District, Shaoxing City, Zhejiang Province, China.
Medicine (Baltimore). 2019 Jan;98(2):e14057. doi: 10.1097/MD.0000000000014057.
Fluoropyrimidine-induced cardiotoxicity is a rare but potentially serious toxicity. The most common symptom is anginal chest pain.
A 35-year-old woman was diagnosed with rectal cancer with metastasis to the liver.
A computed tomography scan showed a 9.3 × 4.5-cm predominantly hypodense lesion within the left lobe of the liver and thickening of the rectum. Liver biopsy showed moderately differentiated adenocarcinoma with necrosis involving the liver parenchyma, and immunohistochemistry for mismatch repair proteins indicated that the tumor was positive for MutL Homolog 1, MutS Homolog 2, MutS Homolog 6, and Protein Homolog 2. Rectal biopsy indicated moderately differentiated adenocarcinoma.
She received chemotherapy of fluorouracil 1600 mg/m, leucovorin 500 mg/m, and irinotecan 100 mg/m every week. During the second cycle of chemotherapy, she developed severe anginal chest pain. We replaced fluorouracil with capecitabine 1500 mg (3 pills) a day every 2 weeks, with 1 week off, with irinotecan 100 mg/m on day 1 and bevacizumab 5 mg/kg at 200 ml/h for 30 min every 2 weeks. She was treated with chemotherapy for approximately 6 months.
The liver lesion showed a significant response to chemotherapy, so she underwent resection of the liver tumor and rectum. After the surgery, she received radiation therapy to the rectal area, and 3 months of chemotherapy were administered prior to colostomy reversal.
Although the mechanism of fluoropyrimidine-induced cardiotoxicity is still uncertain, our case provides clinical evidence that cardiotoxicity could be a dose-related complication. Reducing the dose of fluoropyrimidine should be considered as a strategy after fluoropyrimidine-induced cardiotoxicity. However, this must be discussed with a multidisciplinary team including oncologists and cardiologists. Close monitoring of serial biomarkers and echocardiography are necessary for early diagnosis of cardiotoxicity.
氟尿嘧啶引起的心脏毒性是一种罕见但可能严重的毒性反应。最常见的症状是心绞痛。
一名35岁女性被诊断为直肠癌伴肝转移。
计算机断层扫描显示肝左叶有一个9.3×4.5厘米的主要低密度病变以及直肠增厚。肝活检显示为中度分化腺癌，伴有肝实质坏死，错配修复蛋白免疫组化显示肿瘤MutL同源蛋白1、MutS同源蛋白2、MutS同源蛋白6和蛋白同源蛋白2呈阳性。直肠活检显示为中度分化腺癌。
她每周接受氟尿嘧啶1600mg/m²、亚叶酸钙500mg/m²和伊立替康100mg/m²的化疗。在化疗的第二个周期，她出现了严重的心绞痛。我们将氟尿嘧啶换成了卡培他滨，每2周每天1500mg（3片），休息1周，第1天使用伊立替康100mg/m²，每2周以200ml/h的速度静脉滴注贝伐单抗5mg/kg，持续30分钟。她接受了大约6个月的化疗。
肝脏病变对化疗有显著反应，因此她接受了肝肿瘤和直肠切除术。手术后，她接受了直肠区域的放射治疗，并在结肠造口还纳术前进行了3个月的化疗。
虽然氟尿嘧啶引起心脏毒性的机制仍不确定，但我们的病例提供了临床证据，表明心脏毒性可能是一种与剂量相关的并发症。在氟尿嘧啶引起心脏毒性后，应考虑降低氟尿嘧啶的剂量作为一种策略。然而，这必须与包括肿瘤学家和心脏病学家在内的多学科团队进行讨论。密切监测系列生物标志物和超声心动图对于心脏毒性的早期诊断是必要的。
