Faheem Beenish, Kania Brooke, Ashkar Hamdallah, Bondili Leena, Maroules Michael
St. Joseph's University Medical Center, Department(s) of Hematology/Oncology and Internal Medicine, 703 Main Street, Paterson, 07503, NJ, USA.
J Community Hosp Intern Med Perspect. 2022 Sep 9;12(5):71-74. doi: 10.55729/2000-9666.1094. eCollection 2022.
FOLFIRINOX has been commonly utilized to treat patients with pancreatic cancer; however, it can manifest with rare, significant adverse effects. In particular, 5-FU has been associated with cardiotoxic effects, including but not limited to ischemic events, myocarditis, cardiac arrhythmias, cardiac death, heart failure, as well as coronary vasospasm. Two common thought processes regarding the mechanism of cardiotoxicity with 5-FU include exacerbation of ischemia secondary to coronary vasospasm and direct cell injury to the myocardium. Management of cardiotoxic adverse effects includes discontinuing 5-FU therapy if the patient can tolerate an alternative regimen or initiating prophylactic antianginal treatments with very close monitoring of the patient while they receive 5-FU therapy. Here, we describe a case of a 77-year-old patient with stage III pancreatic cancer who developed coronary vasospasm after initiation of combination therapy including 5-FU. Additional studies to gain further understanding of 5-FU cardiotoxicity are warranted, especially considering the common use of this medication with regards to pancreatic cancer patients. Further research of this topic may benefit patient care, prevent cardiovascular events, and determine which patients may benefit from prophylactic therapy while receiving 5-FU.
FOLFIRINOX方案常用于治疗胰腺癌患者；然而，它可能会出现罕见但严重的不良反应。特别是，5-氟尿嘧啶（5-FU）与心脏毒性作用有关，包括但不限于缺血性事件、心肌炎、心律失常、心源性死亡、心力衰竭以及冠状动脉痉挛。关于5-FU心脏毒性机制的两种常见思路包括冠状动脉痉挛继发的缺血加重和心肌的直接细胞损伤。心脏毒性不良反应的处理包括：如果患者能够耐受替代方案，则停用5-FU治疗；或者在患者接受5-FU治疗时，启动预防性抗心绞痛治疗并密切监测患者。在此，我们描述了一例77岁的III期胰腺癌患者，在开始包括5-FU的联合治疗后发生冠状动脉痉挛的病例。鉴于5-FU在胰腺癌患者中的广泛使用，有必要进行更多研究以进一步了解其心脏毒性。对该主题的进一步研究可能有益于患者护理、预防心血管事件，并确定哪些患者在接受5-FU治疗时可能从预防性治疗中获益。
