Medical Oncology, The University of Kansas Medical Center, Kansas City, Kansas, USA.
Hematology-Oncology Physician, Cancer Care Specialists of Illinois, Decatur, USA.
J Oncol Pharm Pract. 2023 Dec;29(8):1951-1956. doi: 10.1177/10781552231161822. Epub 2023 Mar 7.
Fluoropyrimidines (FP) are cornerstone drugs in the treatment of gastrointestinal (GI) malignancies. Cardiotoxicity secondary to an FP chemotherapy is a serious complication. There are no standardized guidelines on the treatment of FP induced cardiotoxicity which may result in interruption and even discontinuation of life saving treatment. We present our experience in FP rechallenge using a novel outpatient regimen based on our "up-front" triple agent antianginal protocol.
We report the retrospective study of the patients with suspected FP induced cardiotoxicity. Patients meeting the criteria were selected by C3OD (curated cancer clinical outcomes database) at Kansas University Medical Center (KUMC). We identified all patients with gastrointestinal malignancies who had suspected FP induced cardiotoxicity from January 2015 to March 2022. We then included the patients who were rechallenged with planned fluoropyrimidine regimen utilizing the three drug KU-protocol. We utilized a novel regimen by repurposing the already FDA-approved anti-anginal drugs in a manner that minimizes the risk of hypotension and bradycardia.
In this retrospective study, 10 patients with suspected fluoropyrimidine induced cardiotoxicity were included from January-2015 to March-2022 at KUMC. Out of 10 patients who were rechallenged utilizing KU-protocol, eight patients (80%) were able to complete the previously planned fluoropyrimidine regimen. None of the patients required ER visits or hospital admission due to cardiac symptoms during the rechallenge utilizing the KU-protocol.
Utilizing our novel outpatient regimen, we have successfully and safely allowed re-challenge of FP chemotherapy with good tolerability and completion of the intended course of chemotherapy without recurrent morbidity.
氟嘧啶类药物（FP）是治疗胃肠道（GI）恶性肿瘤的基石药物。FP 化疗引起的心脏毒性是一种严重的并发症。目前尚无关于 FP 引起的心脏毒性治疗的标准化指南，这可能导致救命治疗的中断甚至停止。我们报告了使用基于我们“预先”三联抗心绞痛方案的新型门诊方案重新挑战 FP 的经验。
我们报告了堪萨斯大学医学中心（KUMC）的 C3OD（精心策划的癌症临床结果数据库）对疑似 FP 引起的心脏毒性的患者进行的回顾性研究。符合标准的患者通过 C3OD（精心策划的癌症临床结果数据库）进行选择。我们确定了所有 2015 年 1 月至 2022 年 3 月间患有胃肠道恶性肿瘤且疑似 FP 引起的心脏毒性的患者。然后，我们纳入了计划使用氟嘧啶方案重新挑战且利用 KU 方案的患者。我们通过以最小化低血压和心动过缓风险的方式重新利用已获得 FDA 批准的抗心绞痛药物来利用一种新型方案。
在这项回顾性研究中，我们从 2015 年 1 月至 2022 年 3 月在 KUMC 纳入了 10 名疑似氟嘧啶引起的心脏毒性的患者。在利用 KU 方案重新挑战的 10 名患者中，有 8 名（80%）能够完成之前计划的氟嘧啶方案。在利用 KU 方案重新挑战期间，没有患者因心脏症状而需要急诊就诊或住院。
利用我们的新型门诊方案，我们成功且安全地允许重新挑战 FP 化疗，且具有良好的耐受性和完成预期的化疗疗程，没有复发的发病率。
