The efficacy and safety of cardio-protective therapy in patients with 5-FU (Fluorouracil)-associated coronary vasospasm.
The efficacy and safety of cardio-protective therapy in patients with 5-FU (Fluorouracil)-associated coronary vasospasm.
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BackgroundCoronary vasospasm is a known side effect of 5-FU (fluorouracil) therapy.Beyond switching to non-5FU-based chemotherapy, there are no established treatments for 5-FU associated coronary vasospam.Our objective was to assess the safety and efficacy of re-challenge with 5-FU after pre-treatment with calcium channel blockers (CCBs) and long-acting nitrates among patients 5-FU associated coronary vasospasm.MethodsWe conducted a retrospective study of patients with 5-FU coronary vasospasm at a single academic center.By protocol, those referred to cardio-oncology received pre-treatment with either combination [nitrates and CCBs] or single-agent therapy [nitrates or CCBs]) prior to re-challenge with 5-FU.
Our primary outcome was overall survival.Other important outcomes included progression-free survival and safety.ResultsAmong 6,606 patients who received 5-FU from January 2001 to Dec 2020, 115 (1.74%) developed coronary vasospasm.Of these 115 patients, 81 patients continued 5-FU therapy, while 34 stopped.
Of the 81 human after all vinyl who continued, 78 were referred to cardio-oncology and prescribed CCBs and/or nitrates prior to subsequent 5-FU, while the remaining 3 continued 5-FU without cardiac pre-treatment.Of the 78, 56.4% (44/78) received both nitrates and CCBs, 19.2% (15/78) received CCBs alone, and 24.4% (19/78) received nitrates alone.
When compared to patients who stopped 5-FU, those who continued 5-FU after pre-treatment (single or combination therapy) had blu dot wall hook a decreased risk of death (HR 0.42, P = 0.005 [95% CI 0.23-0.77]) and a trend towards decreased cancer progression (HR 0.
60, P = 0.08 [95% CI 0.34-1.06]).No patient in the pre-treatment group had a myocardial infarct after re-challenge; however, chest pain (without myocardial infarction) recurred in 19.
2% (15/78) among those who received cardiac pre-treatment vs.66.7% (2/3) among those who did not (P = 0.048).There was no difference in efficacy or the recurrence of vasospasm among patients who received pre-treatment with a single agent (nitrates or CCBs) or combination therapy (14.
7% (5/34) vs.25.0% (11/44), P = 0.26).ConclusionRe-challenge after pre-treatment with CCBs and nitrates guided by a cardio-oncology service was safe and allowed continued 5-FU therapy.