title: Alternative treatment options in colorectal cancer patients with 5-fluorouracil- or capecitabine-induced cardiotoxicity.
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.
authors.affiliation: Department of Gastroenterology - Hepatology - Digestive Oncology, AZ Damiaan Ziekenhuis, Oostende, Belgium. gdeboever@azdamiaan.be
authors.forename: Guido
authors.initials: G
authors.lastname: Deboever
authors.forename: Nick
authors.initials: N
authors.lastname: Hiltrop
authors.forename: Mike
authors.initials: M
authors.lastname: Cool
authors.forename: Guy
authors.initials: G
authors.lastname: Lambrecht
mesh_terms: D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects*; D000069287:Capecitabine; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005472:Fluorouracil / Q000009:adverse effects* / Q000031:analogs & derivatives*; D006331:Heart Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans
chemical_list: D000964:Antimetabolites, Antineoplastic; D002317:Cardiovascular Agents; D003841:Deoxycytidine; D000069287:Capecitabine; D005472:Fluorouracil