[Cardiotoxicity of 5-fluorouracil: report of 6 cases].
5-fluorouracil (5-FU), a fluoropyrimidine antimetabolite, is widely used in the treatment of cancers of the digestive tract and breast. The clinical cardiotoxicity of 5-FU was first reported in 1975. Adverse cardiac effects include coronary disorders, heart failure and sudden death of suspected cardiac origin. Six new cases are reported, including 5 cases of angina and one of heart failure. The patients, 4 males and 2 females, were 26 to 71 years of age (mean: 56.2). They had no medical history of heart failure, myocardial ischemia or electrocardiographic anomalies prior to 5-FU treatment. Three patients had hypertension of whom one had had type-II diabetes mellitus for the past 20 years. Clinical symptoms included chest pain in 4 patients and heart failure in one, whereas the last patient had ECG changes with no associated clinical symptoms. Clinical symptoms of angina totally disappeared after the cessation of 5-FU administration, but heart failure was alleviated only after the introduction of digitalis, a converting-enzyme inhibitor and a diuretic. It has been estimated that 1.6% of patients treated with 5-FU develop adverse cardiac effects. Patients at greater risk are those with a history of ischemic cardiac disease, thoracic radiotherapy or high-dose 5-FU therapy. The mechanism involved is not clearly elucidated. Spasms of the coronary arteries or toxic inflammation of the myocardium have been suspected. These 6 new cases confirm the potential for cardiotoxicity of 5-FU and the need for careful cardiac monitoring of treated patients.
Timour
Q
Q
Centre Antipoison-Centre de Pharmacovigilance, Hôpital E. Herriot, Lyon, France. quadiri.timour@chu-lyon.fr
Lombard-Bohas
C
C
Slim
R
R
Barel
C
C
Bui-Xuan
B
B
Tabib
A
A
Bricca
G
G
Malonne
H
H
Vial
T
T
Iordescu
D
D
Descotes
J
J
D000328:Adult; D000368:Aged; D000963:Antimetabolites / Q000009:adverse effects*; D000975:Antioxidants / Q000378:metabolism; D017209:Apoptosis; D004562:Electrocardiography; D004931:Esophageal Achalasia / Q000139:chemically induced; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects*; D006331:Heart Diseases / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012519:Sarcoplasmic Reticulum / Q000473:pathology
D000963:Antimetabolites; D000975:Antioxidants; D005472:Fluorouracil