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5-Fluorouracil Rechallenge After Cardiotoxicity

Patient: Male, 66-year-old Final Diagnosis: Colon adenocarcinoma • ventricular arrhythmia Symptoms: Cardiac arrest • syncope Medication: — Clinical Procedure: Cardiac catheterization • Cardiac Electronic Implantable Device (CEID) Specialty: Cardiology • General and Internal Medicine • Oncology OBJEC...

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Autores principales: Desai, Aakash, Mohammed, Turab, Patel, Kunal N., Almnajam, Mansour, Kim, Agnes S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483515/
https://www.ncbi.nlm.nih.gov/pubmed/32860674
http://dx.doi.org/10.12659/AJCR.924446
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author Desai, Aakash
Mohammed, Turab
Patel, Kunal N.
Almnajam, Mansour
Kim, Agnes S.
author_facet Desai, Aakash
Mohammed, Turab
Patel, Kunal N.
Almnajam, Mansour
Kim, Agnes S.
author_sort Desai, Aakash
collection PubMed
description Patient: Male, 66-year-old Final Diagnosis: Colon adenocarcinoma • ventricular arrhythmia Symptoms: Cardiac arrest • syncope Medication: — Clinical Procedure: Cardiac catheterization • Cardiac Electronic Implantable Device (CEID) Specialty: Cardiology • General and Internal Medicine • Oncology OBJECTIVE: Unusual clinical course BACKGROUND: 5-Fluorouracil (5-FU) is a widely used intravenous chemotherapy agent that is highly effective in the treatment of a variety of solid malignancies. Cardiotoxicity related to 5-FU is a complex clinical entity associated with significant morbidity and mortality. Whether a patient who experienced a major cardiac side effect from 5-FU can be safely rechallenged with this drug is a clinical dilemma. CASE REPORT: We present the case of a patient with stage III colorectal adenocarcinoma who experienced ventricular fibrillation during the first cycle of FOLFOX (5-FU, folinic acid, and oxaliplatin) regimen in the adjuvant setting. Post-resuscitation electrocardiogram revealed ST-elevation in the inferior leads with reciprocal changes. Coronary angiogram revealed no obstructive coronary artery disease. Cardiac workup led to the conclusion of probable fluorouracil-induced vasospasm as the cause of his cardiac arrest. He received implantable cardioverter defibrillator. The decision was made to hold 5-FU. At 3-month follow-up, there was evidence of progressive metastasis. After comprehensive risk-benefit discussions, the decision was made for palliative chemotherapy using 5-FU/leucovorin. A pre-treatment regimen including isosorbide dinitrate, diltiazem, and metoprolol was used. The patient tolerated 5-FU rechallenge without recurrent cardiovascular complication. CONCLUSIONS: The cardiotoxicity profile of 5-FU can range from anginal chest pain to sudden cardiac death. When considering 5-FU rechallenge, clinicians should adopt a multidisciplinary approach, favor using prophylactic antianginal therapy, change to bolus dosing, and use continuous telemetry monitoring. Screening patients for dihydropyrimidine dehydrogenase deficiency prior to 5-FU administration may facilitate an individualized strategy for optimal dosing and safety.
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spelling pubmed-74835152020-09-18 5-Fluorouracil Rechallenge After Cardiotoxicity Desai, Aakash Mohammed, Turab Patel, Kunal N. Almnajam, Mansour Kim, Agnes S. Am J Case Rep Articles Patient: Male, 66-year-old Final Diagnosis: Colon adenocarcinoma • ventricular arrhythmia Symptoms: Cardiac arrest • syncope Medication: — Clinical Procedure: Cardiac catheterization • Cardiac Electronic Implantable Device (CEID) Specialty: Cardiology • General and Internal Medicine • Oncology OBJECTIVE: Unusual clinical course BACKGROUND: 5-Fluorouracil (5-FU) is a widely used intravenous chemotherapy agent that is highly effective in the treatment of a variety of solid malignancies. Cardiotoxicity related to 5-FU is a complex clinical entity associated with significant morbidity and mortality. Whether a patient who experienced a major cardiac side effect from 5-FU can be safely rechallenged with this drug is a clinical dilemma. CASE REPORT: We present the case of a patient with stage III colorectal adenocarcinoma who experienced ventricular fibrillation during the first cycle of FOLFOX (5-FU, folinic acid, and oxaliplatin) regimen in the adjuvant setting. Post-resuscitation electrocardiogram revealed ST-elevation in the inferior leads with reciprocal changes. Coronary angiogram revealed no obstructive coronary artery disease. Cardiac workup led to the conclusion of probable fluorouracil-induced vasospasm as the cause of his cardiac arrest. He received implantable cardioverter defibrillator. The decision was made to hold 5-FU. At 3-month follow-up, there was evidence of progressive metastasis. After comprehensive risk-benefit discussions, the decision was made for palliative chemotherapy using 5-FU/leucovorin. A pre-treatment regimen including isosorbide dinitrate, diltiazem, and metoprolol was used. The patient tolerated 5-FU rechallenge without recurrent cardiovascular complication. CONCLUSIONS: The cardiotoxicity profile of 5-FU can range from anginal chest pain to sudden cardiac death. When considering 5-FU rechallenge, clinicians should adopt a multidisciplinary approach, favor using prophylactic antianginal therapy, change to bolus dosing, and use continuous telemetry monitoring. Screening patients for dihydropyrimidine dehydrogenase deficiency prior to 5-FU administration may facilitate an individualized strategy for optimal dosing and safety. International Scientific Literature, Inc. 2020-08-29 /pmc/articles/PMC7483515/ /pubmed/32860674 http://dx.doi.org/10.12659/AJCR.924446 Text en © Am J Case Rep, 2020 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Desai, Aakash
Mohammed, Turab
Patel, Kunal N.
Almnajam, Mansour
Kim, Agnes S.
5-Fluorouracil Rechallenge After Cardiotoxicity
title 5-Fluorouracil Rechallenge After Cardiotoxicity
title_full 5-Fluorouracil Rechallenge After Cardiotoxicity
title_fullStr 5-Fluorouracil Rechallenge After Cardiotoxicity
title_full_unstemmed 5-Fluorouracil Rechallenge After Cardiotoxicity
title_short 5-Fluorouracil Rechallenge After Cardiotoxicity
title_sort 5-fluorouracil rechallenge after cardiotoxicity
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483515/
https://www.ncbi.nlm.nih.gov/pubmed/32860674
http://dx.doi.org/10.12659/AJCR.924446
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