title: Coronary artery spasm induced by capecitabine.
abstract: Capecitabine is a new chemotherapeutic agent considered highly specific for sensitive tumour cells, which convert the drug to 5-fluorouracil. Capecitabine is administered on an ambulatory basis for the treatment of metastatic breast and colorectal cancer, and both general practitioners and specialists are likely to deal with patients treated with this drug. We describe the case of a 44-year-old woman, with no cardiovascular risk factors, who started therapy with capecitabine for relapsing of breast carcinoma. She subsequently developed effort angina. Standard electrocardiogram and echocardiography were normal, whereas ST-segment elevation and angina were induced during exercise stress test. Capecitabine was withdrawn and therapy with diltiazem and transdermal nitroglycerine was started. The patient became asymptomatic and repeated symptom-limited exercise stress test did not induce any ST-segment changes or angina, even after withdrawal of anti-ischaemic therapy, thus confirming the hypothesis of capecitabine-induced coronary artery spasm as the cause of patient's symptoms.
authors.affiliation: Institutes of Internal Medicine/Oncology, Università Cattolica del Sacro-Cuore, Rome, Italy. a.sestito@eudoramail.com
authors.forename: Alfonso
authors.initials: A
authors.lastname: Sestito
authors.forename: Gregory Angelo
authors.initials: GA
authors.lastname: Sgueglia
authors.forename: Carmelo
authors.initials: C
authors.lastname: Pozzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cassano
authors.forename: Carlo
authors.initials: C
authors.lastname: Barone
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Gaetano Antonio
authors.initials: GA
authors.lastname: Lanza
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000139:chemically induced; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D000069287:Capecitabine; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy*; D003329:Coronary Vasospasm / Q000139:chemically induced*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil