Acute coronary syndrome associated with continuous 5-fluorouracil infusion in a patient with metastatic colorectal cancer-a case report with a discussion on this clinical dilemma

Introduction: 5-Fluorouracil (5-FU) is considered to be the backbone of colorectal cancer (CRC) systemic therapy since the great majority of recommended regimens include its administration. A clinical picture consisting of chest pain, sometimes cardiac enzyme elevation, electrocardiogram abnormalities consistent with myocardial ischemia, and normal coronary angiogram associated with 5-FU administration have been infrequently reported. The clinical dilemma is: Which chemotherapy regimen should we use in CRC patients with a previous acute coronary syndrome (ACS) associated with 5-FU? Case Report: We describe the case of a 55-year-old otherwise healthy woman with metastatic colon adenocarcinoma who presented an ACS probably secondary to arterial vasospasm while receiving continuous intravenous 5-FU infusion (mFOLFOX6 regimen). After the ACS, the patient was treated with raltitrexate plus oxaliplatin (TOMOX) and subsequently with irinotecan plus cetuximab with no other cardiac event. Conclusion: The risk of cardiotoxicity associated with 5-FU is low but real. The probable mechanism is arterial vasospasm, as suggested by our case report. Both the use of the TOMOX regimen and irinotecan plus cetuximab seems to be safe regimens to be considered in this clinical scenario. © 2009 Humana Press Inc.

Keywords

5-fluorouracil, Adverse effects, Cardiotoxicity, Colonic neoplasms, acetylsalicylic acid, beta adrenergic receptor blocking agent, cetuximab, clopidogrel, fluorouracil, folinic acid, glyceryl trinitrate, irinotecan, isosorbide dinitrate, oxaliplatin, raltitrexed, acute coronary syndrome, adult, anemia, burning sensation, cancer combination chemotherapy, cancer palliative therapy, case report, colon adenocarcinoma, colon obstruction, continuous infusion, coronary artery spasm, drug safety, drug withdrawal, ECG abnormality, female, hemicolectomy, human, liver metastasis, lymph node metastasis, multiple cycle treatment, priority journal, retrosternal pain, sigmoid, ST segment depression, ST segment elevation, treatment outcome, Acute Coronary Syndrome, Adenocarcinoma, Antibodies, Monoclonal, Antimetabolites, Antineoplastic, Antineoplastic Combined Chemotherapy Protocols, Camptothecin, Colorectal Neoplasms, Female, Fluorouracil, Humans, Infusions, Intravenous, Leucovorin, Middle Aged, Organoplatinum Compounds, Quinazolines, Thiophenes