title: Capecitabine-induced cardiotoxicity: more evidence or clinical approaches to protect the patients' heart?
abstract: Fluoropyrimidines, such as capecitabine and 5-fluorouracil, may cause cardiac toxicity. In recent years, the incidence of this side effect has increased and it is expected to further rise due to the population aging and the disproportionate incidence of breast and gastrointestinal cancers in older individuals. The spectrum of cardiac manifestations includes different signs and symptoms and the diagnosis may be difficult. Here, we report the case of a 43-year-old woman with advanced breast cancer who was rechallenged with a capecitabine-based regimen after experiencing a cardiac adverse event during the first fluoropyrimidine exposure. This real-practice case serves as a springboard for discussion about the current evidence on differential diagnosis of capecitabine-related cardiac toxicity, its risk factors, and the underpinning mechanisms of early onset. Moreover, we discussed whether a rechallenge with fluoropyrimidines could be safe in patients who had experienced a previous cardiac adverse event.
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Fontanella
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Aita
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Marika
authors.initials: M
authors.lastname: Cinausero
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.affiliation: Department of Cardiology, Palmanova General Hospital, Palmanova, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Baldin
authors.affiliation: Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Dusi
authors.affiliation: Department of Cardiology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lestuzzi
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy.
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Fasola
authors.affiliation: Department of Oncology, University Hospital of Udine, Udine, Italy ; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Puglisi
keywords: clinical manifestation; rechallenge; risk factors