Alternative Treatment Options in Patients with Colorectal Cancer Who Encounter Fluoropyrimidine-Induced Cardiotoxicity

5-Fluorouracil (5-FU) remains to be the backbone of chemotherapy regimens approved for treatment of colorectal cancer and other gastrointestinal cancers and breast cancer. The incidence of cardiotoxicity associated with 5-FU ranges from 1.5–18%. Previous studies also concluded that rechallenging a patient with previous 5-FU cardiotoxicity with either lower dose or another mode of administration could result in repeat of cardiac complication in up to 45% of patients. Nearly 13% of patients died upon re-exposure to 5-FU. Clinical manifestations of cardiac complications of fluoropyrimidines including angina, myocardial infarction, arrhythmias, hypotension, Tako-Tsubo syndrome, heart failure, cardiogenic shock, pericarditis, and even sudden death have been reported. Cardiotoxicity is unpredictable and no alternative chemotherapeutics have been defined so far. The author describes here treatment options for patients with metastatic colorectal cancer who have encountered fluoropyrimidine-induced cardiotoxicity, including switching to a different fluoropyrimidine, switching to a different schedule of intravenous 5-FU, or switching to a non-fluoropyrimidine-containing chemotherapy regimen if one exists. Switching to a non-fluoropyrimidine-containing chemotherapy regimen is usually the most feasible choice for patients with metastatic disease as data on adjuvant setting is usually a fluoropyrimidine or its combination with oxaliplatin at present.