Alternative Treatment Options in Colorectal Cancer Patients With 5–Fluorouracil- or Capecitabine-Induced Cardiotoxicity

• Published in: Clinical colorectal cancer Vol. 12; no. 1; pp. 8 - 14
• Main Authors: Deboever, Guido, Hiltrop, Nick, Cool, Mike, Lambrecht, Guy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2013
• Subjects: Animals; Antimetabolites, Antineoplastic - adverse effects; Capecitabine; Cardiovascular Agents - therapeutic use; Chemotherapy; Colorectal Neoplasms - drug therapy; Deoxycytidine - adverse effects; Deoxycytidine - analogs & derivatives; Fluoropyrimidine-induced toxicity; Fluorouracil - adverse effects; Fluorouracil - analogs & derivatives; Gastroenterology and Hepatology; Heart Diseases - chemically induced; Heart Diseases - prevention & control; Hematology, Oncology and Palliative Medicine; Humans; Raltitrexed; S-1; Raltitrexed; Fluoropyrimidine-induced toxicity; Chemotherapy; S-1
• ISSN: 1533-0028; 1938-0674
• DOI: 10.1016/j.clcc.2012.09.003

Abstract Most chemotherapy regimens in colorectal cancer treatment are 5-fluorouracil (5-FU)/leucovorin or capecitabine-based. Cardiotoxicity is a less common but potentially lethal complication of 5-FU or capecitabine treatment, and some physicians might be unfamiliar with treatment alternatives. Rechallenging should be avoided because it carries a high risk of recurrence of the cardiac symptoms and prophylactic treatment is not always protective. Possible alternative treatment options to be considered are to replace the oral capecitabine or intravenous 5-FU by a 5-FU bolus regimen, by uracil-tegafur or tegafur/gimeracil/oteracil, both oral fluoropyrimidines combining a 5-FU prodrug with a dihydropyrimidine dehydrogenase (DPD) inhibitor, or by raltitrexed, a thymidilate synthase inhibitor whose metabolism is independent of DPD. Patients with advanced colorectal cancer and fluoropyrimidine-induced cardiotoxicity can be treated with other non-fluoropyrimidine related chemotherapy, either as a single agent, combined, or in combination with biological agents. In this report we discuss the different alternative treatment options.