Cardiotoxicity of 5-fluorouracil and capecitabine in Chinese patients: a prospective study

Cancer Communications

Jianjun Peng¹  Hao Yu²  Min Zhang³  Wenhao Zhou⁴  Gong Chen⁴  Fenghua Wang⁵  Meng Qiu⁶  Chang Wang⁷  Weihua Li⁸  Chao Dong⁹  Bo Zhu^1,10  Ying Yuan^1,11  Qiong Wu^1,12  Wenliang Li^1,13  Jun Zhang^1,14  Qun Zhao^1,15 

[1] Center of Gastrointestinal Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China;Department of Biological Statistics, School of Public Health, Nanjing Medical University, Nanjing, P. R. China;Department of Cardiology, Shanghai Jiaotong University, Shanghai, P. R. China;Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China;Department of Internal Medicine, Sun Yat-sen University Cancer Center, Guangzhou, P. R. China;Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, West China Hospital, West China Medical School, Sichuan University, Chengdu, P. R. China;Department of Oncology, The First Hospital of Jilin University, Changchun, P. R. China;Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, P. R. China;Department of the Second Medical Oncology, The 3rd Affiliated Hospital of Kunming Medical University, Yunnan Tumor Hospital, Kunming, P. R. China;Institute of Cancer, Xinqiao Hospital of Third Military Medical University, Chongqing, P. R. China;Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P. R. China;Medical Oncology, The first Affiliated Hospital of Bengbu Medical College, Bengbu, P. R. China;Oncology Department, First Affiliated Hospital of Kunming Medical University, Kunming, P. R. China;Oncology Department, Shanghai Ruijin Hospital, Shanghai, P. R. China;The Third Surgery Department, the Fourth Hospital of Hebei Medical University, Tumor Hospital of Hebei Province, Shijiazhuang, P. R. China

关键词: 5-Fluorouracil;    Capecitabine;    Cardiotoxicity;   

DOI  :  10.1186/s40880-018-0292-1

学科分类：肿瘤学

来源: Springer

【 摘 要 】

5-Fluorouracil (5-FU) and capecitabine-associated cardiotoxicity ranging from asymptomatic electrocardiography (ECG) abnormalities to severe myocardial infarction has been reported in a number of studies, but such cardiotoxicity in Chinese patients with malignant diseases has not been investigated to date. In the present study, we aimed to prospectively evaluate the incidence rates and clinical manifestations of 5-FU- and capecitabine-associated cardiotoxicity in cancer patients recruited from multiple centers in China. Among the 527 patients who completed the study, 196 received 5-FU-based chemotherapy and 331 received capecitabine-based chemotherapy as either first-line or adjuvant therapy. Adverse events were reported during the treatment and up to 28 days of follow-up. Outcome measures included ECG, myocardial enzymes, cardiac troponin, brain natriuretic peptide and echocardiography. Univariate analysis and logistic regression were performed for subgroup analysis and identification of significant independent variables that are associated with cardiotoxicity of both agents. In total, 161 of 527 patients (30.6%) experienced cardiotoxicity. The incidence rate of cardiotoxicity was 33.8% (112/331) in the capecitabine group, which was significantly higher than the rate of 25% (49/196) in the 5-FU group (P = 0.0042). 110/527 patients (20.9%) suffered arrhythmia, 105/527 (19.9%) developed ischemic changes, while only 20/527 patients (3.8%) presented heart failure and 6/527 patients (1.1%) had myocardial infarction. Pre-existing cardiac disease, hypertension, capecitabine-based chemotherapy and duration of treatment were identified as significant risk factors associated with cardiotoxicity. The odds ratio were 15.7 (prior history of cardiac disease versus no history), 1.86 (capecitabine versus 5-FU), 1.06 (5–8 versus 1–4 chemotherapy cycles) and 1.58 (hypertension versus no hypertension), respectively. Cardiotoxicity induced by fluoropyrimidines in the Chinese population may be underestimated in clinical practice. Close monitoring of patients is recommended, especially for those patients at high risk for cardiotoxicity. Possible risk factors are duration of treatment, capecitabine-based chemotherapy, pre-existing cardiac diseases and hypertension. Trial registration This study was initiated on January 22, 2014 and has been retrospectively registered with the registration number ChiCTR1800015434.

【 授权许可】

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