Association of pre-existing cardiovascular disease with administration of fluoropyrimidine chemotherapy in patients with gastrointestinal malignancies

ObjectiveFluoropyrimidine chemotherapy is a first-line treatment for many gastrointestinal (GI) cancers, however, cardiotoxicity concerns may limit administration in patients with pre-existing cardiovascular disease (CVD). This study investigated the association of pre-existing CVD with use of fluor...

Full description

Saved in:

Bibliographic Details
Published in:	BMJ Oncology Vol. 3; no. 1
Main Authors:	Abiodun, Aderonke Temilade, Ju, Chengsheng, Welch, Catherine A, Lai, Jennifer, Tyrer, Freya, Chambers, Pinkie, Paley, Lizz, Vernon, Sally, Deanfield, John, de Belder, Mark, Rutherford, Mark, Lambert, Paul C, Slater, Sarah, Shiu, Kai Keen, Wei, Li, Peake, Michael D, Adlam, David, Manisty, Charlotte, Peake, Mick, Elliss-Brookes, Lucy, Belder, Mark de, Darby, Sarah, Gale, Chris, Hawkins, Mike, Lambert, Paul, Lyon, Alexander, Rashbass, Jem, Reulen, Raoul, Ring, Alistair, Sweeting, Michael, Timmis, Adam, Charlton, Paul, Jeans, Sally, Fielding, Alison, Deutsch, Andy, Chal, James, Donkor, Akosua, Fazal, Nadeem, Gunesh, Anil, Harrison, Andrew, Shand, Brian, Khushnood, Abbas, Goodwin, Andrew, Ludman, Peter, McDonagh, Theresa, Murgatroyd, Francis, Weston, Clive
Format:	Journal Article
Language:	English
Published:	BMJ Publishing Group Ltd 01-08-2024 BMJ Publishing Group
Subjects:	Chemotherapy Colorectal cancer Gastric cancer Oesophageal cancer Original research
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	ObjectiveFluoropyrimidine chemotherapy is a first-line treatment for many gastrointestinal (GI) cancers, however, cardiotoxicity concerns may limit administration in patients with pre-existing cardiovascular disease (CVD). This study investigated the association of pre-existing CVD with use of fluoropyrimidine chemotherapy in tumour-eligible GI cancer patients.Methods and analysisNational cancer registry data from the Virtual Cardio-Oncology Research Initiative from England between 2014 and 2018 was used to identify GI cancer patients eligible to receive fluoropyrimidine chemotherapy. Linkage to Hospital Episode Statistics and CVD registry data were used to ascertain prior CVD and outcomes. Primary outcome was first administration of fluoropyrimidine chemotherapy following cancer diagnosis. Cox proportional hazard models determined HR and 95% CIs for the association between initiation of fluoropyrimidine treatment and prior CVD.Results112 726 eligible patients were identified (median age 71 years (IQR 62–80), 39.7% female). 33 026 (29.3%) had pre-existing CVD. 73 392 (65.1%) patients had a diagnosis of colorectal, 23 208 (20.6%) oesophageal, 14 788 (13.1%) gastric and 1338 (1.2%) small bowel cancer. Individuals with pre-existing CVD had a 27% reduced rate of receiving fluoropyrimidine chemotherapy (HR, 0.73; 95% CI 0.70 to 0.75) on multivariable analysis. Significantly reduced rates of fluoropyrimidine administration were found across all subtypes of pre-existing CVD.ConclusionsGI cancer patients with all types of pre-existing CVD are less likely to receive fluoropyrimidine chemotherapy despite eligibility. This suggests widespread caution regarding administration of fluoropyrimidines across this population; further research is needed to assess whether such conservatism is justified.
ISSN:	2752-7948
DOI:	10.1136/bmjonc-2024-000323