Introduction: Fluoropyrimidine chemotherapy (5-FU and capecitabine) are used to treat of various solid malignancies. Their use has been limited by cardiac toxicity, presenting as a spectrum of asymptomatic (EKG changes) and symptomatic (chest pain) manifestations related to coronary vasospasm leading to myocardial ischemia. Patients with cardiotoxicity have been treated with traditional ischemic workup and anti-anginal therapies. Patients are not rechallenged after experiencing initial cardiovascular side-effects with resulting interruption of planned chemotherapy regimens.
Methods: We report a case series of 11 consecutive patients with suspected fluoropyrimidine-induced coronary vasospasm who were successfully rechallenged to allow for chemotherapy completion. Our protocol utilized rechallenge with bolus infusional regimen of IV 5-FU chemotherapy and oral capecitabine with cardioprotective pretreatment with 2 calcium blockers (CCB) and long-acting oral nitrates.
Results: We successfully continued and completed the previously planned first-line chemotherapy regimen for all 11 patients with minimal therapeutic interruption. There have been no cardiac events or evidence of recurrent coronary spasm after completion of therapy with discontinuation of prophylactic medications upon therapy completion.
Conclusions: We report a single-institution experience of successful rechallenge with fluoropyrimidines with careful cardiac monitoring and the combined use of CCB and nitrates. With further study, this algorithm can be used to safely continue fluoropyrmidines, a potentially curative regimen in the treatment of many solid tumors.