5-Fluorouracil cardiotoxicity induced by alpha-fluoro-beta-alanine.
Cardiotoxicity is a rare complication occurring during 5-fluorouracil (5-FU) treatment for malignancies. We herein report the case of a 70-year-old man with 5-FU-induced cardiotoxicity, in whom a high serum level of alpha-fluoro-beta-alanine (FBAL) was observed. The patient, who had unresectable colon cancer metastases to the liver and lung, was referred to us for chemotherapy from an affiliated hospital; he had no cardiac history. After admission, the patient received a continuous intravenous infusion of 5-FU (1000 mg/day), during which precordial pain with right bundle branch block occurred concomitantly with a high serum FBAL concentration of 1955 ng/ml. Both the precordial pain and the electrocardiographic changes disappeared spontaneously after the discontinuation of 5-FU. As the precordial pain in this patient was considered to have been due to 5-FU-induced cardiotoxicity, the administration of 5-FU was abandoned. Instead, oral administration of S-1 (a derivative of 5-FU), at 200 mg/day twice a week, was instituted, because S-1 has a strong inhibitory effect on dihydropyrimidine dehydrogenase, which catalyzes the degradative of 5-FU into FBAL. The serum FBAL concentration subsequently decreased to 352 ng/ml, the same as the value measured on the first day of S-1 administration. Thereafter, no cardiac symptoms were observed. The patient achieved a partial response 6 months after the initiation of the S-1 treatment. The experience of this case, together with a review of the literature, suggests that FBAL is related to 5-FU-induced cardiotoxicity. S-1 may be administered safely to patients with 5-FU-induced cardiotoxicity.
Muneoka
Katsuki
K
Department of Surgery, Niitsu Medical Center Hospital, Niigata, Japan.
Shirai
Yoshio
Y
Yokoyama
Naoyuki
N
Wakai
Toshifumi
T
Hatakeyama
Katsuyoshi
K
D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D003110:Colonic Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000473:pathology; D004338:Drug Combinations; D004562:Electrocardiography; D005472:Fluorouracil / Q000009:adverse effects*; D006321:Heart / Q000187:drug effects; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000188:drug therapy / Q000556:secondary; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy / Q000556:secondary; D008297:Male; D010094:Oxonic Acid / Q000627:therapeutic use*; D005641:Tegafur / Q000627:therapeutic use*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000097:blood
D000964:Antimetabolites, Antineoplastic; D004338:Drug Combinations; D015091:beta-Alanine; C079198:S 1 (combination); D005641:Tegafur; C032348:alpha-fluoro-beta-alanine; D010094:Oxonic Acid; D005472:Fluorouracil