title: Capecitabine-induced chest pain relieved by diltiazem.
abstract: Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma were started on a 2-weeks-on, 1-week-off capecitabine dosing regimen in addition to other chemotherapeutic agents and/or radiation. Within the first few doses, patients experienced chest pain and/or dyspnea at rest or with exertion. Acute electrocardiographic findings suggestive of ischemia were found in some cases at initial presentation, and 1 patient had troponin elevation consistent with an acute ST-segment elevation myocardial infarction. Subsequent ischemia evaluations were not suggestive of clinically significant coronary artery disease. All patients experienced immediate and sustained relief from chest pain after discontinuation of capecitabine and were able to successfully tolerate retreatment using a novel management strategy based on secondary prophylaxis with diltiazem. In conclusion, guidelines for the evaluation of and therapy for capecitabine-induced chest pain are proposed.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Kunz
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Witteles
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000188:drug therapy / Q000473:pathology; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D000069287:Capecitabine; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology; D002637:Chest Pain / Q000139:chemically induced* / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003329:Coronary Vasospasm / Q000139:chemically induced / Q000517:prevention & control; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004110:Diltiazem / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011355:Prodrugs; D055502:Secondary Prevention / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D002121:Calcium Channel Blockers; D011355:Prodrugs; D003841:Deoxycytidine; D000069287:Capecitabine; D004110:Diltiazem; D005472:Fluorouracil