Acute Coronary Syndrome Associated with Continuous 5-Fluorouracil Infusion in a Patient with Metastatic Colorectal Cancer—A Case Report with a Discussion on This Clinical Dilemma

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• 作者：Carlos Eduardo Paiva (1) (5)
  Bianca Sakamoto Ribeiro Paiva (2)
  Rodrigo Garita (3)
  Odair Carlito Michelin (1) (4)
  Katashi Okoshi (4)
  
• 关键词：colonic neoplasms ; 5 ; fluorouracil ; adverse effects ; cardiotoxicity
• 刊名：Journal of Gastrointestinal Cancer
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：40
• 期：3-4
• 页码：133-137
• 全文大小：221KB
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• 作者单位：Carlos Eduardo Paiva (1) (5)
  Bianca Sakamoto Ribeiro Paiva (2)
  Rodrigo Garita (3)
  Odair Carlito Michelin (1) (4)
  Katashi Okoshi (4)
  
  1. Oncological and Hemato-Oncological Center, S?o Paulo State University, Botucatu, S?o Paulo, Brazil
  5. Pra?a Isabel Arruda, 138. Centro, Botucatu, SP, 18602-111, Brazil
  2. Department of Nursing, S?o Paulo State University, Botucatu, S?o Paulo, Brazil
  3. Department of Surgery, S?o Paulo State University, Botucatu, S?o Paulo, Brazil
  4. Department of Clinics, S?o Paulo State University, Botucatu, S?o Paulo, Brazil
  
• ISSN：1941-6636

文摘

Introduction 5-Fluorouracil (5-FU) is considered to be the backbone of colorectal cancer (CRC) systemic therapy since the great majority of recommended regimens include its administration. A clinical picture consisting of chest pain, sometimes cardiac enzyme elevation, electrocardiogram abnormalities consistent with myocardial ischemia, and normal coronary angiogram associated with 5-FU administration have been infrequently reported. The clinical dilemma is: which chemotherapy regimen should we use in CRC patients with a previous acute coronary syndrome (ACS) associated with 5-FU? Case Report We describe the case of a 55-year-old otherwise healthy woman with metastatic colon adenocarcinoma who presented an ACS probably secondary to arterial vasospasm while receiving continuous intravenous 5-FU infusion (mFOLFOX6 regimen). After the ACS, the patient was treated with raltitrexate plus oxaliplatin (TOMOX) and subsequently with irinotecan plus cetuximab with no other cardiac event. Conclusion The risk of cardiotoxicity associated with 5-FU is low but real. The probable mechanism is arterial vasospasm, as suggested by our case report. Both the use of the TOMOX regimen and irinotecan plus cetuximab seems to be safe regimens to be considered in this clinical scenario.