Cardiac toxicity of fluoropyrimidines in the treatment of solid gastrointestinal tumors

Background. Fluoropyrimidines are highly effective and commonly prescribed anticancer drugs that are used in a wide range of chemotherapy (CT) regimens to treat various types of cancer. Their cardiac toxicity is not only a life-threatening complication, but also leads to the rejection of effective chemotherapy, thereby reducing the life expectancy of patients.

Methods. A cohort of 16 patients with various types of solid gastrointestinal tumors, treated with fluoropyrimidines with detected cardiotoxicity was selected. All patients received treatment at the N.N. Blokhin National Medical Research Institute of Oncology from February 2021 to February 2022.

Results. The most common symptoms of cardiotoxicity included dyspnea, retrosternal pain, and short-term loss of consciousness. An increase in the blood troponin I and NTproBNP levels was registered in 4 patients. In 56% of patients, cardiotoxicity was noted during the first course of treatment. In 1 (6.25%) of 16 cases, a fatal outcome was registered: sudden death during the first infusion of fluorouracil (5-FU).

Conclusion. Patients treated with fluoropyrimidines should be closely monitored and 5-FU should be discontinued at the first sign of cardiovascular toxicity. Re-administration of fluoropyrimidines is not recommended unless they significantly improve the prognosis; but after careful examination of the cardiovascular system, prophylaxis under close monitoring against the background of enhanced cardiac therapy, it is worth considering switching to a bolus of 5-FU. Recognition of risk factors for fluoropyrimidine-associated cardiotoxicity even before the start of chemotherapy is necessary, since it allows either to reduce their influence or to enhance control to detect complications at an early stage.