Division of Hematology-Oncology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
Curr Oncol Rep. 2022 Jul;24(7):943-950. doi: 10.1007/s11912-022-01256-6. Epub 2022 Mar 26.
Fluoropyrimidine (FDP) chemotherapy regimens used in the treatment of solid tumors such as breast, gastrointestinal, and hepatobiliary malignancies have led to significant survival benefits. However, FDP cardiotoxicity can lead to premature termination of FDP-based chemotherapy treatments. Resuming these crucial therapies after initial FDP cardiotoxicity can be challenging for patients and healthcare providers.
Symptomatic cardiotoxicity occurs in up to 35% of patients treated with FDP-based chemotherapy. The most common symptom is chest pain, but palpitations, dyspnea, myocardial infarction, cardiogenic shock, and cardiac arrest can also occur. Several large studies have attempted to discern clinical and genetic risk factors in those who develop FDP cardiotoxicity. With cardiac risk factor optimization and aggressive pre-treatment with anti-anginal agents, rechallenging with FDP is possible and allows patients to resume optimal cancer-directed treatment. FDP cardiotoxicity remains a poorly understood identity. We highlight several recent publications attempting to define the risk factors associated with developing FDP cardiotoxicity. The management of FDP cardiotoxicity and consideration of rechallenge of FDP-based regimens highlights the importance of a multidisciplinary partnership between oncologists and cardiologists/cardio-oncologists.
氟嘧啶（FDP）化疗方案在治疗乳腺癌、胃肠道和肝胆恶性肿瘤等实体瘤方面取得了显著的生存获益。然而，FDP 心脏毒性可导致 FDP 为基础的化疗治疗提前终止。对于患者和医疗保健提供者来说，在最初的 FDP 心脏毒性后重新开始这些关键治疗具有挑战性。
多达 35%接受 FDP 为基础化疗的患者发生有症状的心脏毒性。最常见的症状是胸痛，但也可能出现心悸、呼吸困难、心肌梗死、心源性休克和心脏骤停。几项大型研究试图在发生 FDP 心脏毒性的患者中识别临床和遗传风险因素。通过心脏风险因素的优化和抗心绞痛药物的积极预处理，可以重新使用 FDP，使患者能够恢复最佳的癌症靶向治疗。FDP 心脏毒性仍然是一个未被充分了解的问题。我们强调了几项最近的出版物，试图确定与 FDP 心脏毒性发展相关的风险因素。FDP 心脏毒性的管理和重新考虑使用 FDP 为基础的方案的考虑突出了肿瘤学家和心脏病专家/心脏肿瘤学家之间多学科合作的重要性。
