Incidence and risk markers of 5-fluorouracil and capecitabine cardiotoxicity in patients with colorectal cancer
Incidence and risk markers of 5-fluorouracil and capecitabine cardiotoxicity in patients with colorectal cancer
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DOI：
10.1080/0284186x.2019.1711164
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发表时间：
2020-01-13
期刊：
影响因子：
3.1
通讯作者：
Nielsen, Dorte
中科院分区：
文献类型：
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作者：
Dyhl-Polk, Anne;Vaage-Nilsen, Merete;Nielsen, Dorte
背景：氟嘧啶类药物是治疗胃肠道肿瘤的主要化疗药物，也可用于治疗乳腺癌和头颈癌。然而，5-氟尿嘧啶(5-FU)和卡培他滨可引起心脏毒性，主要表现为急性冠脉综合征。我们比较了5-FU和卡培他滨在结直肠癌患者中引起心脏毒性的发生率，并试图确定心脏毒性的危险标记物。方法：我们回顾了所有连续接受5-FU或卡培他滨治疗的结直肠癌患者，这些患者在同一机构接受了新辅助治疗(2007-2016)、辅助治疗(2000-2016)或转移治疗(2007-2016)。结果：995例患者接受5-FU治疗，1241例患者接受卡培他滨治疗。5-FU的心脏毒性发生率为5.2%[95%可信区间：3.8-6.6%]，卡培他滨的心脏毒性发生率为4.1%(95%可信区间：3.0-5.2%)(p=.21)。最常见的事件是无缺血的心绞痛(5-FU：1.6%，卡培他滨：1.3%，p=.53)，心电图有缺血的心绞痛(5-FU：0.9%，卡培他滨：0.8%，p=.53)，不明原因的胸痛(5-FU：0.9%，卡培他滨：0.6%，p=.34)，ST段抬高的心肌梗死(5-FU：0.5%；卡培他滨：0.4%，p=.76)和非ST段抬高心肌梗死(5-FU：0.7%，卡培他滨：0.5%，p=.50)。心脏骤停和猝死的发生率分别为0.5%和0.4%(p=1)。未发现5-FU心脏毒性的危险标志物。在卡培他滨组，缺血性心脏病是一个危险标记(优势比：2.9，95%可信区间：1.2-7.0，p=.016)。结论：接受5-FU治疗的患者中有5%出现心脏毒性，接受卡培他滨治疗的患者中有4%发生心脏毒性。缺血性心脏病是卡培他滨心脏毒性的危险标志。
Background: Fluoropyrimidines are mainstay chemotherapeutics in the treatment of gastrointestinal cancers and are also used to treat breast cancer and head and neck cancers. However, 5-flourouracil (5-FU) and capecitabine may induce cardiotoxicity that mostly presents as acute coronary syndromes. We compared the incidence of cardiotoxicity induced by 5-FU and capecitabine in patients with colorectal cancer and sought to identify risk markers for cardiotoxicity. Methods: We reviewed all consecutive patients with colorectal cancer who received 5-FU or capecitabine at one institution in the neoadjuvant (2007-2016), adjuvant (2000-2016) or metastatic setting (2007-2016). Results: Totally, 995 patients received 5-FU and 1241 received capecitabine. The incidence of cardiotoxicity induced by 5-FU was 5.2% [95% confidence interval (CI): 3.8-6.6%] and 4.1% (95% CI: 3.0-5.2%) induced by capecitabine (p = .21). The most common events were angina without ischemia (5-FU: 1.6%, capecitabine: 1.3%, p = .53), angina with ischemia on ECG (5-FU: 0.9%, capecitabine: 0.8%, p = .53), unspecified chest pain (5-FU: 0.9%, capecitabine: 0.6%, p = .34), ST-elevation myocardial infarction (5-FU: 0.5%; capecitabine: 0.4%, p = .76) and non-ST-elevation myocardial infarction (5-FU: 0.7%, capecitabine: 0.5%, p = .50). Cardiac arrest or sudden death occurred in 0.5 and 0.4%, respectively (p = 1). No risk markers for cardiotoxicity induced by 5-FU were identified. In the capecitabine group, ischemic heart disease was a risk marker (odds ratio: 2.9, 95% CI: 1.2-7.0, p = .016). Conclusions: Five percent of patients treated with 5-FU developed cardiotoxicity and 4% treated with capecitabine. Ischemic heart disease was a risk marker for cardiotoxicity induced by capecitabine.