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- Title
Fluoropyrimidine-induced cardiac toxicity: challenges and treatment opportunities. Case report.
- Authors
Ciontea, Maria-Loredana; Dumitrescu, Elena-Adriana; Simiceanu, Crina-Maria; Stolojanu, Anca-Alexandra; Matei, Radu; Gheorghe, Adelina-Silvana; Chirea, Irina-Alexandra; Prundianu, Sânziana; Stănculeanu, Dana-Lucia
- Abstract
This case report aims to present the importance of cardiac evaluation in patients with advanced colorectal cancer and how to adjust the treatment according to cardiac pathology. A 60-year-old female patient, with a personal history of breast cancer, presented in our clinic in August 2020 with resected rectal adenocarcinoma, with poorly differentiate histology obtained from the surgical specimen (June 2020). She received adjuvant therapy with capecitabin (six cycles) and radiotherapy. In July 2022, the PET scan revealed enlarged retroperitoneal lymph nodes with high metabolic activity. In October 2022, the patient received radiotherapy at the level of adenopathies in the renal hilumadenopathies with a total dose of 30 Gy, with good tolerance. In November 2022, she started chemotherapy with FOLFOX and bevacizumab. Suddenly after that, she was diagnosed with inferior myocardial infarction. Given the cardiac pathology and the oncological treatment, the patient was considered to be at a very high risk for cardiac toxicity. The cardiologist recommended close surveillance of the cardiac function, stopping the therapy with known cardiac toxicity (coronary vasospasm) such as fluoropyrimidines and continuing bevacizumab with caution. Every three months, she had a cardiac evaluation and the patient was stationary, without severe cardiac dysfunction. The oncological treatment continued since February 2023, but it was adjusted (only oxaliplatin 85 mg/m² and bevacizumab, initially 5 mg/kg b.w., and then an increased dose at 7.5 mg/kg b.w.). The evolution was favorable, the imagistic evaluation from May 2023 showing the regression of the retroperitoneal adenopathies. Currently, she is at the 11th series with oxaliplatin in monotherapy, with good tolerance. Fluoropyrimidines, such as fluorouracil, are associated with vasospasm and can produce myocardial infarction, especially in patients with poor adherence to cardiological treatment. There is a high recommendation for cardiac function monitoring in patients receiving oncological treatment.
- Subjects
CARDIOTOXICITY; INFERIOR wall myocardial infarction; CORONARY vasospasm; CANCER patients; PATIENT compliance; HEART diseases
- Publication
Oncolog-Hematolog, 2023, Issue 64, p33
- ISSN
2066-8716
- Publication type
Article