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Ciuffini L, Wang T, Lodigiani C, Carrier M. Thromboprophylaxis of cancer patients undergoing systemic therapy in the ambulatory setting. Best Pract Res Clin Haematol 2022; 35:101351. [DOI: 10.1016/j.beha.2022.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 11/02/2022]
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2
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Dallos MC, Eisenberger AB, Bates SE. Prevention of Venous Thromboembolism in Pancreatic Cancer: Breaking Down a Complex Clinical Dilemma. Oncologist 2020; 25:132-139. [PMID: 32043768 PMCID: PMC7011653 DOI: 10.1634/theoncologist.2019-0264] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/31/2019] [Indexed: 12/14/2022] Open
Abstract
Venous thromboembolism (VTE) frequently occurs in patients with cancer, and particularly those with pancreatic ductal adenocarcinoma (PDAC). Therapeutic anticoagulation with either low-molecular-weight heparin or a direct oral anticoagulant is clearly beneficial in patients who develop a VTE. However, whether thromboprophylaxis improves patient outcomes remains unclear. Studies assessing this risk show a 10%-25% risk of VTE, with reduction to 5%-10% with thromboprophylaxis but no impact on survival. To aid in the risk stratification of patients, several tools have been developed to identify those at highest risk for a VTE event. However, the clinical application of these risk stratification models has been limited, and most patients, even those at the highest risk, will never have a VTE event. New oral anticoagulants have greatly improved the feasibility of prophylaxis but do show increased risk of bleeding in patients with the underlying gastrointestinal dysfunction frequently found in patients with pancreatic cancer. Recently, several completed clinical trials shed new light on this complicated risk versus benefit decision. Here, we present this recent evidence and discuss important considerations for the clinician in determining whether to initiate thromboprophylaxis in patients with PDAC. IMPLICATIONS FOR PRACTICE: Given the high risk of venous thromboembolism in patients with pancreatic adenocarcinoma (PDAC), whether to initiate prophylactic anticoagulation is a complex clinical decision. This review discusses recent evidence regarding the risk stratification and treatment options for thromboprophylaxis in patients with PDAC, with the goal of providing practicing clinicians with updates on recent developments in the field. This article also highlights important considerations for individualizing the treatment approach for a given patient given the lack of general consensus of uniform recommendations for this patient population.
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Affiliation(s)
- Matthew C. Dallos
- Division of Hematology/Oncology, Columbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Andrew B. Eisenberger
- Division of Hematology/Oncology, Columbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Susan E. Bates
- Division of Hematology/Oncology, Columbia University Irving Medical CenterNew YorkNew YorkUSA
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Jang LC, Choi YJ. Acute arterial thrombosis during adjuvant Adriamycin-cyclophosphamide chemotherapy in a patient with early breast cancer: A case report. Medicine (Baltimore) 2019; 98:e18249. [PMID: 31852092 PMCID: PMC6922512 DOI: 10.1097/md.0000000000018249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cancer and chemotherapy individually confer hypercoagulability and increased risks of thrombosis. Most thromboembolic complication after breast cancer chemotherapy was venous thrombosis after multiagent chemotherapy. Arterial thrombosis is extremely rare in early breast cancer patients receiving adjuvant chemotherapy. PRESENTING CONCERNS A 55-year-old woman with right breast cancer presented to the emergency department with sudden pain, numbness, and swelling in her left hand. She underwent breast conserving surgery and sentinel lymph node biopsy 2 months before the visit. She received the second cycle of adjuvant Adriamycin-cyclophosphamide chemotherapy 5 days before. INTERVENTIONS Computed tomography angiography revealed acute arterial thrombosis in the left brachial, radial, and ulnar arteries. Unfractionated heparin was initiated immediately, followed by brachial and radial-ulnar thrombectomy, restoring perfusion to the extremity. The postoperative course was uncomplicated; she was discharged on warfarin at a daily dose of 4 mg. OUTCOMES Chemotherapy was discontinued. Anticoagulation with warfarin was continued. She subsequently received adjuvant endocrine therapy with an aromatase inhibitor and adjuvant radiotherapy. MAIN LESSONS Despite the low risks of arterial thrombosis in breast cancer, it is a devastating complication with significant morbidity and mortality. Thromboprophylaxis should be considered in those at risk. Immediate anticoagulant therapy and surgical intervention should be considered in affected cases.
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Vaflard P, Ederhy S, Torregrosa C, André T, Cohen R, Lopez-Trabada D. [Fluoropyrimidines cardiac toxicity: 5-fluorouracil, capecitabine, compound S-1 and trifluridine/tipiracil]. Bull Cancer 2018; 105:707-719. [PMID: 29960638 DOI: 10.1016/j.bulcan.2018.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/03/2018] [Accepted: 05/06/2018] [Indexed: 10/28/2022]
Abstract
The incidence of cardiac toxicity of 5-flurorouracil (5-FU) IV and capecitabine varies from 1.2 to 18%. The physiopathology of this toxicity is still under study, various hypotheses are mentioned. In the absence of identified prophylactic treatment, reintroduction of this cytotoxic is at risk. A discussion between oncologists and cardiologists is essential to estimate the balance between benefit and risk and the careful reintroduction of treatment. An alternative compound might be raltitrexed which is currently the treatment recommended in case of intolerance to fluoropyrimidines. The compound S-1 does not have any cardiac toxicity. Of a total of 2910 patients in phase II or III studies, no grade III or IV cardiovascular events were reported. However, the treatment is not reimbursed in France and therefore not available. The trifluridine/tipiracil, for which approval from French authorities was obtained in November 2016 for patients with metastatic colorectal cancer in progress despite standard treatment lines, does not appear to have cardiac toxicity according to studies published to date. The pivotal phase III study (RECOURSE), that led to this marketing authorization, was performed in 800 patients with metastatic colorectal cancer refractory and only one patient (less than 1% of patients) treated with trifluridine/tipiracil presented an episode of cardiac ischemia. Thus, trifluridine/tipiracil, which is well tolerated, could be an alternative to raltitrexed for patients with cardiovascular history contraindicating or discouraging the use of fluoropyrimidines.
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Affiliation(s)
- Pauline Vaflard
- AP-HP, hôpital Saint-Antoine, département d'oncologie médicale, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Stéphane Ederhy
- AP-HP, hôpital Saint-Antoine, service de cardiologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Cécile Torregrosa
- UMPC Paris 06, Sorbonne université, 4, place Jussieu, 75005 Paris, France
| | - Thierry André
- AP-HP, hôpital Saint-Antoine, département d'oncologie médicale, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; AP-HP, hôpital Saint-Antoine, service de cardiologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; UMPC Paris 06, Sorbonne université, 4, place Jussieu, 75005 Paris, France
| | - Romain Cohen
- AP-HP, hôpital Saint-Antoine, département d'oncologie médicale, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; AP-HP, hôpital Saint-Antoine, service de cardiologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France; UMPC Paris 06, Sorbonne université, 4, place Jussieu, 75005 Paris, France
| | - Daniel Lopez-Trabada
- AP-HP, hôpital Saint-Antoine, département d'oncologie médicale, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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Akhtar SS, Wani BA, Bano ZA, Salim KP, Handoo FA. 5-Fluorouracil-Induced Severe but Reversible Cardiogenic Shock: A Case Report. TUMORI JOURNAL 2018; 82:505-7. [PMID: 9063536 DOI: 10.1177/030089169608200522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.
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Affiliation(s)
- S S Akhtar
- Department of Medical Oncology, S.K. Institute of Medical Sciences, Soura Srinagar, Kashmir, India
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6
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Layoun ME, Wickramasinghe CD, Peralta MV, Yang EH. Fluoropyrimidine-Induced Cardiotoxicity: Manifestations, Mechanisms, and Management. Curr Oncol Rep 2017; 18:35. [PMID: 27113369 DOI: 10.1007/s11912-016-0521-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Fluoropyrimidines-5-fluorouracil (5-FU) and capecitabine-have been implicated as cardiotoxic chemotherapy agents. This rare, albeit potentially serious toxicity has been described in nearly four decades of case reports, case series, and in vitro modeling; however, there is a paucity in clinical trials and prospective analyses focused on cardioprotective strategies and cardiotoxic surveillance of these agents. While much attention has focused on the well-known cardiac toxicity of anthracyclines and monoclonal antibody agents such as trastuzumab, fluoropyrimidines remain one of the most common causes of chemotherapy-associated cardiotoxicity. The introduction of capecitabine, an oral prodrug of 5-FU, has made the treatment of solid tumors more convenient along with a subsequent rise in documented cardiotoxic cases. This review discusses the symptomatology, clinical manifestations, and proposed molecular mechanisms that attempt to describe the heterogeneous spectrum of fluoropyrimidine-induced cardiotoxicity. Four case examples showcasing the varied manifestations of cardiotoxicity are presented. Finally, several proposed management strategies for cardiotoxicity and post-hospital course precautions are discussed.
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Affiliation(s)
- Michael E Layoun
- Department of Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Chanaka D Wickramasinghe
- Division of Cardiology, Department of Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA
| | - Maria V Peralta
- Division of Internal Medicine, Department of Medicine, Beaumont Hospital-Dearborn, Dearborn, MI, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, UCLA Medical Center, University of California at Los Angeles, Los Angeles, CA, USA.
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7
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Report of two cases of acute cardiac adverse events in patients with colorectal carcinoma receiving oral capecitabine. Anticancer Drugs 2017; 28:801-807. [DOI: 10.1097/cad.0000000000000509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Bern M. Observations on Possible Effects of Daily Vitamin K Replacement, Especially Upon Warfarin Therapy. JPEN J Parenter Enteral Nutr 2017; 28:388-98. [PMID: 15568285 DOI: 10.1177/0148607104028006388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Daily parenteral vitamin K supplement is now recommended by the U.S. Food and Drug Administration (FDA) for patients receiving IV hyperalimentation. This is considered as preferable to the previous recommendations of weekly parenteral or oral supplement, or as in some cases no supplement at all. Supplemental vitamin K1 will ensure adequate supplies for hepatic saturation and thus the production of clotting factors II, VII, IX, and X, plus the anticoagulants protein C, protein S, and protein Z. But this is not the entire story. This recommended supplement will affect other physiologic systems that also use vitamin K-dependent gamma-carboxylation. Vitamin K is not 1 molecule but rather 2 natural substances, vitamin K1 and K2, and the synthetic K3's. It is not understood, what, if any, effect may occur because of the saturation or competition from the vitamin K1 upon the functioning of vitamins K2 and the derivatives of K3 in vivo upon bone mineralization, cell growth, and blood vessel health, all known to be influenced by the vitamins K. There are probably other physiologic systems yet to be studied relative to vitamins K and gamma-carboxylation. This review also considers the available research upon warfarin when given to patients receiving hyperalimentation and what effects the vitamin K supplements may have. Because studies to date have not controlled for vitamin K intake, consideration is given to whether one should expect any change in previously reported outcomes when using low-dose warfarin for prophylaxis against central vein thrombosis. Also considered are possible positive or negative effects that chronic warfarin therapy may have upon the other vitamin K-dependent systems under discussion. This review offers a platform for further discussion and derived clinical research provoked by this new FDA recommendation.
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Affiliation(s)
- Murray Bern
- Cancer Center of Boston, New England Baptist Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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9
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Gray EJ, Darvishzadeh A, Sharma A, Ganeshan D, Faria SC, Lall C. Cancer therapy-related complications in the bowel and mesentery: an imaging perspective. Abdom Radiol (NY) 2016; 41:2031-47. [PMID: 27277528 DOI: 10.1007/s00261-016-0799-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cancer therapy-induced complications in the bowel and mesentery are fairly common. It is important for clinicians to be aware of these complications and the agents most frequently implicated. Cancer therapy is rapidly evolving and often encompasses both classic cytotoxic drugs and newer molecular targeted agents. Drugs from both broad classes can have numerous adverse effects on the bowel and mesentery that can be detected on imaging. These adverse effects include ileus, various forms of enterocolitis, gastrointestinal perforation, pneumatosis intestinalis, secretory diarrhea, and sclerosing mesenteritis. These complications are diverse and range from relatively benign to life threatening. The management is also variable, but many of these conditions are easily controlled and reversed with supportive care and cessation of the particular cancer therapy. The objective of this pictorial essay is to demonstrate some of the more common cancer therapy-induced complications of the bowel and mesentery, with a focus on the radiographic findings.
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Affiliation(s)
- Eric J Gray
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA.
| | - Ayeh Darvishzadeh
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA
| | - Ankush Sharma
- Department of Internal Medicine, University of California, Irvine School of Medicine, Orange, CA, USA
| | - Dhakshinamoorthy Ganeshan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Silvana C Faria
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiological Sciences, University of California, Irvine School of Medicine, 101 The City Drive South, Orange, CA, 92868, USA
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10
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Demirkan B, Ozcan MA, Glu AA, Yüksel F, Undar B, Alakavuklar M. The Effect of Anthracycline-Based (Epirubicin) Adjuvant Chemotherapy on Plasma TAFI and PAI-1 Levels in Operable Breast Cancer. Clin Appl Thromb Hemost 2016; 12:9-14. [PMID: 16444429 DOI: 10.1177/107602960601200103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An increased incidence of thromboembolic events has been described in women receiving systemic chemotherapy for breast cancer. The effect of anthracycline-based adjuvant chemotherapy regimens on fibrinolytic system markers of plasminogen activator inhibitor-1 (PAI-1) and thrombin activitable fibrinolysis inhibitor (TAFI) was investigated in patients with operable breast cancer. Twenty-four patients with operable breast cancer (median age, 54.5 years; range, 37-72 years) enrolled in our study. Stage I-II and stage IIIA cases received EC (Epirubicin 90 mg/m2/d1, I.V. and cyclophosphamide 600 mg/m2/d1, I.V.) and FEC (5-fluorouracil 500 mg/m2/d1, I.V., epirubicin 100 mg/m2/d1, I.V., and cyclophosphamide 500 mg/m2/d1, I.V.) as an adjuvant chemotherapy regimen, respectively. Each group consisted of 12 patients. Blood samples were obtained at baseline and just before the third cycle of EC and fourth cycle of FEC chemotherapy regimens. Plasma TAFI antigen and PAI-1 levels did not disclose any statistical difference between basal and postchemotherapy levels within each group and between two groups. Although postchemotherapy D-dimer levels were statistically higher in the FEC group than in the EC group, results in both groups were within normal ranges. More studies concerning the role of fibrinolytic system in breast cancer patients receiving chemotherapy, probably including cases with advanced stage and with different chemotherapy regimens and dose intensities, are needed.
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Affiliation(s)
- Binnaz Demirkan
- Dokuz Eylul University School of Medicine, Department of Internal Medicine, Division of Hematology-Oncology, Izmir, Turkey.
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11
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Fakhri Y, Dalsgaard M, Nielsen D, Lav Madsen P. 5-Fluorouracil-induced acute reversible heart failure not explained by coronary spasms, myocarditis or takotsubo: lessons from MRI. BMJ Case Rep 2016; 2016:bcr-2015-213783. [PMID: 27251602 DOI: 10.1136/bcr-2015-213783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A 69-year-old woman presented with arterial hypotension, pulmonary oedema and a severely depressed left ventricular ejection fraction (LVEF) of 25% only 3 days after having received her first treatment for colorectal cancer with 5-fluorouracil (5-FU)-based therapy. The ECG demonstrated widespread ST-segment depression and echocardiography showed uniform hypokinesia of all left ventricular (LV) myocardial segments without signs of regional LV ballooning. Coronary angiography was normal and the patient gained full recovery after receiving treatment with heart failure medication. Interestingly, cardiac MRI scan 9 days later showed a normal LVEF with signs of neither myocardial oedema nor necrosis. Despite the high therapeutic efficacy of 5-FU in treatment of colorectal cancer, it is associated with undesired cardiac toxicities including coronary spasms, toxic inflammation and takotsubo cardiomyopathy. However, our patient did not fulfil the diagnostic criteria for the aforementioned complications. Based on this case report, we discuss alternative mechanisms including myocardial adenosine triphosphate depletion suggested from animal experiments.
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Affiliation(s)
- Yama Fakhri
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Department of Medicine, Division of Cardiology, Nykøbing F Hospital, Copenhagen University Hospital, Nykøbing F, Denmark
| | - Morten Dalsgaard
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Dorte Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
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12
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Saif MW, Wasif K, Butler-Bowen H, Miller K, Diasio RB. Acquired factor VII deficiency following FOLFOX in a patient with colorectal cancer who was also DPD deficient. Therap Adv Gastroenterol 2016; 9:121-7. [PMID: 26770273 PMCID: PMC4699273 DOI: 10.1177/1756283x15604115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
| | | | - Harriette Butler-Bowen
- Division of Hematology/Oncology and Experimental Therapeutics, Tufts Medical Center, Boston, MA, USA
| | - Kenneth Miller
- Division of Hematology/Oncology and Experimental Therapeutics, Tufts Medical Center, Boston, MA, USA
| | - Robert B. Diasio
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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13
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Ray JC, Cho P, Dragon M, Graham CG. A Case of 5-Fluorouracil-Induced Cardiac Arrest. J Emerg Med 2016; 50:e1-6. [DOI: 10.1016/j.jemermed.2015.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/24/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
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14
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Lee SF, Chiang CL, Lee AS, Wong FCS, Tung SY. Severe ileitis associated with capecitabine: Two case reports and review of the literature. Mol Clin Oncol 2015; 3:1398-1400. [PMID: 26807255 DOI: 10.3892/mco.2015.635] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/04/2015] [Indexed: 12/20/2022] Open
Abstract
Capecitabine is a commonly used anticancer drug, which has been associated with adverse events, including skin and gastrointestinal symptoms, such as vomiting and diarrhea. We herein present treated two rare cases of capecitabine-associated ileitis. In one of the patients, ileitis occurred during combination chemotherapy for metastatic colon cancer, despite previous good tolerance to this drug; the other patient developed ileitis following adjuvant single-agent treatment. The first case is unlike previously reported cases, in which patients had no past exposure to capecitabine. Ileitis may be severe but reversible with early diagnosis and proper supportive treatment, and patients may resume chemotherapy following capecitabine discontinuation.
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Affiliation(s)
- Shing Fung Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Chi Leung Chiang
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Ann Shing Lee
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Frank Chi Shing Wong
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
| | - Stewart Yuk Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, SAR, P.R. China
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Khalil J, Bensaid B, Elkacemi H, Afif M, Bensaid Y, Kebdani T, Benjaafar N. Venous thromboembolism in cancer patients: an underestimated major health problem. World J Surg Oncol 2015; 13:204. [PMID: 26092573 PMCID: PMC4486121 DOI: 10.1186/s12957-015-0592-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/24/2015] [Indexed: 12/12/2022] Open
Abstract
Venous thromboembolism (VTE) is a major health problem among patients with cancer, its incidence in this particular population is widely increasing. Although VTE is associated with high rates of mortality and morbidity in cancer patients, its severity is still underestimated by many oncologists. Thromboprophylaxis of VTE now considered as a standard of care is still not prescribed in many institutions; the appropriate treatment of an established VTE is not yet well known by many physicians and nurses in the cancer field. Patients are also not well informed about VTE and its consequences. Many studies and meta-analyses have addressed this question so have many guidelines that dedicated a whole chapter to clarify and expose different treatment strategies adapted to this particular population. There is a general belief that the prevention and treatment of VTE cannot be optimized without a complete awareness by oncologists and patients. The aim of this article is to make VTE a more clear and understood subject.
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Affiliation(s)
- Jihane Khalil
- Radiation Oncology Department, National Institute of Oncology, Hay Riad, Rabat, 10000, Morocco.
| | - Badr Bensaid
- Vascular Surgery Department, Ibn Sina Hospital, Souissi, Rabat, 10000, Morocco.
| | - Hanan Elkacemi
- Radiation Oncology Department, National Institute of Oncology, Hay Riad, Rabat, 10000, Morocco.
| | - Mohamed Afif
- Radiation Oncology Department, National Institute of Oncology, Hay Riad, Rabat, 10000, Morocco.
| | - Younes Bensaid
- Vascular Surgery Department, Ibn Sina Hospital, Souissi, Rabat, 10000, Morocco.
| | - Tayeb Kebdani
- Radiation Oncology Department, National Institute of Oncology, Hay Riad, Rabat, 10000, Morocco.
| | - Noureddine Benjaafar
- Radiation Oncology Department, National Institute of Oncology, Hay Riad, Rabat, 10000, Morocco.
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16
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Topcu TO, Kavgacı H, Canyılmaz E, Orem A, Yaman H, Us D, Ozdemir F, Aydın F. The effect of adjuvant chemotherapy on plasma TAT and F 1+2 levels in patients with breast cancer. Biomed Pharmacother 2015. [PMID: 26211577 DOI: 10.1016/j.biopha.2015.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Increased thromboembolic disorders and chemotherapy-induced thromboembolic events are well known phenomena in patients with breast cancer. Antithrombin III (AT III) inactivates thrombin, resulting in increased thrombin-antithrombin (TAT) levels. Activated factor X cleaves prothrombin and thrombin, resulting in increased levels of prothrombin fragment 1+2 (F 1+2). Increased TAT and F 1+2 levels show coagulation activation. The aim of this study was to examine plasma levels of TAT and F 1+2 and the effect of anthracycline-based chemotherapy on plasma TAT and F 1+2 in patients with operable breast cancer. MATERIALS AND METHODS Seventy patients and 30 age-matched healthy controls were enrolled. Levels of TAT and F 1+2 were investigated before and after adjuvant chemotherapy. Basal levels (pre-chemotherapy) of TAT and F 1+2 in patients were compared with those in healthy controls and patient levels after 3 cycles of chemotherapy. Levels of TAT and F 1+2 were determined using the ELISA method. RESULTS TAT and d-dimer levels were significantly higher in patients, (P: 0.02 and P<0.001, respectively). Post-chemotherapy F 1+2 levels were higher than basal levels (P: 0.02). F 1+2 levels were higher in patients, although the difference was not statistically significant (P: 0.52). There was no difference between basal and post-chemotherapy TAT levels. DISCUSSION In conclusion, while higher post-chemotherapy F 1+2 levels suggest that the cumulative effect of chemotherapy increases the risk of thrombosis, TAT and d-dimer levels indicate that the effect of the cancer further increases the risk of thrombosis in patients with operable breast cancer.
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Affiliation(s)
- Turkan Ozturk Topcu
- Division of Medical Oncology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey.
| | - Halil Kavgacı
- Division of Medical Oncology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Emine Canyılmaz
- Division of Radiation oncology, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Asim Orem
- Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Huseyin Yaman
- Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Diler Us
- Department of Biochemistry, School of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Feyyaz Ozdemir
- Division of Medical Oncology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
| | - Fazıl Aydın
- Division of Medical Oncology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
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Iskandar MZ, Quasem W, El-Omar M. 5-Fluorouracil cardiotoxicity: reversible left ventricular systolic dysfunction with early detection. BMJ Case Rep 2015; 2015:bcr-2015-209347. [PMID: 25935919 DOI: 10.1136/bcr-2015-209347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old man presented to hospital with acute shortness of breath and evolving ST segment changes on ECG 3 days following a cycle of 5-fluorouracil (5-FU) for colon cancer. Despite no cardiac history, subsequent echocardiogram showed severe left ventricular systolic dysfunction. The patient was initially treated with heart failure medications and his coronary angiogram was normal. Chemotherapy was stopped and he was started on nitrates and calcium channel blockers. A repeat echocardiogram and cardiac MRI a week later showed complete resolution of his left ventricular dysfunction and he was discharged home. This case report summarises 5-FU cardiotoxicity, and emphasises the importance of early recognition and correct treatment, as left ventricular systolic dysfunction in this context is potentially reversible.
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Affiliation(s)
| | - Wahid Quasem
- Department of Acute Medicine, Manchester Royal Infirmary, Manchester, UK
| | - Magdi El-Omar
- Department of Cardiology, Manchester Royal Infirmary, Manchester, UK
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18
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Polk A, Vistisen K, Vaage-Nilsen M, Nielsen DL. A systematic review of the pathophysiology of 5-fluorouracil-induced cardiotoxicity. BMC Pharmacol Toxicol 2014; 15:47. [PMID: 25186061 PMCID: PMC4170068 DOI: 10.1186/2050-6511-15-47] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/19/2014] [Indexed: 12/29/2022] Open
Abstract
Background Cardiotoxicity is a serious side effect to treatment with 5-fluorouracil (5-FU), but the underlying mechanisms are not fully understood. The objective of this systematic review was to evaluate the pathophysiology of 5-FU- induced cardiotoxicity. Methods We systematically searched PubMed for articles in English using the search terms: 5-FU OR 5-fluorouracil OR capecitabine AND cardiotoxicity. Papers evaluating the pathophysiology of this cardiotoxicity were included. Results We identified 27 articles of 26 studies concerning the pathophysiology of 5-FU-induced cardiotoxicity. The studies demonstrated 5-FU-induced: hemorrhagic infarction, interstitial fibrosis and inflammatory reaction in the myocardium; damage of the arterial endothelium followed by platelet aggregation; increased myocardial energy metabolism and depletion of high energy phosphate compounds; increased superoxide anion levels and a reduced antioxidant capacity; vasoconstriction of arteries; changes in red blood cell (RBC) structure, function and metabolism; alterations in plasma levels of substances involved in coagulation and fibrinolysis and increased endothelin-1 levels and N-terminal-pro brain natriuretic peptide levels. Based on these findings the proposed mechanisms are: endothelial injury followed by thrombosis, increased metabolism leading to energy depletion and ischemia, oxidative stress causing cellular damage, coronary artery spasm leading to myocardial ischemia and diminished ability of RBCs to transfer oxygen resulting in myocardial ischemia. Conclusions There is no evidence for a single mechanism responsible for 5-FU-induced cardiotoxicity, and the underlying mechanisms might be multifactorial. Further research is needed to elucidate the pathogenesis of this side effect.
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Affiliation(s)
- Anne Polk
- Departments of Cardiology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark.
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19
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20
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Kim SM, Kwak CH, Lee B, Kim SB, Sir JJ, Cho WH, Choi SK. A case of severe coronary spasm associated with 5-fluorouracil chemotherapy. Korean J Intern Med 2012; 27:342-5. [PMID: 23019400 PMCID: PMC3443728 DOI: 10.3904/kjim.2012.27.3.342] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Revised: 06/16/2008] [Accepted: 07/30/2008] [Indexed: 11/27/2022] Open
Abstract
Cardiotoxicity associated with 5-fluorouracil (FU) is an uncommon, but potentially lethal, condition. The case of an 83-year-old man with colon cancer who developed chest pain during 5-FU infusion is presented. The electrocardiogram (ECG) showed pronounced ST elevation in the lateral leads, and the chest pain was resolved after infusion of nitroglycerin. A coronary angiogram (CAG) revealed that the patient had significant atherosclerosis in the proximal left circumflex artery. Coronary artery spasm with fixed stenosis was considered, and a drug-eluting stent was implanted. After 8 hours, the patient complained of recurring chest pain, paralleled by ST elevation on the ECG. The chest pain subsided after administration of intravenous nitroglycerin followed by sublingual nifedipine. Repeated CAG showed patency of the previous stent. This case supports the vasospastic hypothesis of 5-FU cardiac toxicity, indicating that a calcium channel blocker may be effective in the prevention or treatment of 5-FU cardiotoxicity.
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Affiliation(s)
- Sang-Min Kim
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Cheol-Hoon Kwak
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Bora Lee
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Seong Beom Kim
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Jung-Ju Sir
- Department of Internal Medicine, Cardiovascular Center, National Medical Center, Seoul, Korea
| | - Wook-Hyun Cho
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Suk-Koo Choi
- Department of Internal Medicine, Cardiovascular Center, Inje University Seoul Paik Hospital, Seoul, Korea
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21
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Initial dose effect of 5-fluorouracil: rapidly improving severe, acute toxic myopericarditis. Am J Emerg Med 2012; 30:257.e1-3. [DOI: 10.1016/j.ajem.2010.10.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 11/16/2022] Open
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Yamane H, Matsubara M, Umemura S, Suwaki T, Kamei H, Takigawa N, Kiura K, Tanimoto M. Variant angina pectoris associated with FOLFOX4 therapy. World J Gastrointest Oncol 2011; 3:165-8. [PMID: 22110843 PMCID: PMC3220725 DOI: 10.4251/wjgo.v3.i11.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 10/03/2011] [Accepted: 10/10/2011] [Indexed: 02/05/2023] Open
Abstract
The patient was a 71-year-old man who underwent a right hemicolectomy for ascending colon cancer (pT3, pN1, pM0) and who opted not to receive adjuvant chemotherapy. Eight months later, multiple liver metastases occurred. He therefore received FOLFOX4 (5-fluorouracil/leucovorin and 85 mg/m2 oxaliplatin) therapy, up to a total of 5 courses, and showed a partial response. While receiving the sixth course of FOLFOX4, he complained of chest pain and systemic itching approximately 15 min after the start of chemotherapy. An electrocardiogram revealed typical signs of ischemia. Coronary arteriography showed that the coronary arteries were intact. Believing the chest pain to be merely coincidental, we continued with the same therapy. However, he again developed the same chest pain during the seventh cycle of FOLFOX4 and treatment was stopped. We concluded that the patient’s symptoms were due to acute coronary syndrome (ACS) associated with the FOLFOX4 regimen. Variant angina as a type of ACS is a rare adverse effect of FOLFOX4. Clinicians should be aware of this potential adverse effect when monitoring patients receiving FOLFOX4.
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Affiliation(s)
- Hiromichi Yamane
- Hiromichi Yamane, Shigeki Umemura, Toshimitsu Suwaki, Haruhito Kamei, Division of Clinical Oncology, Sumitomo-Besshi Hospital Cancer Center, 3-1Ohji-cho, Niihama, Ehime 792-8543, Japan
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Ang C, Kornbluth M, Thirlwell MP, Rajan RD. Capecitabine-induced cardiotoxicity: case report and review of the literature. ACTA ACUST UNITED AC 2011; 17:59-63. [PMID: 20179805 PMCID: PMC2826779 DOI: 10.3747/co.v17i1.437] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Capecitabine, an oral prodrug of 5-fluorouracil (5fu), has been integrated into the management of multiple cancer types because of convenience of administration and efficacy comparable with 5fu. Cardiotoxicity induced by 5fu—in particular angina—has been well described in the literature, but reports of adverse cardiac events with capecitabine are also emerging. The mechanism underlying 5fu cardiotoxicity has long been thought to result from coronary vasospasm, but animal-model studies and patient echocardiographic findings both suggest a cardiomyopathic picture. Although 5fu cardiotoxicity is often reversible and can be managed supportively, presentations that are more severe—including arrhythmias, acute ischemic events, and cardiogenic shock—have been documented. In this report, we describe the case of a patient who ultimately required a pacemaker after developing symptomatic bradycardia and sinus arrest while receiving capecitabine for colon cancer.
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Affiliation(s)
- C Ang
- Department of Oncology, McGill University Health Centre, Montreal, QC
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Sentürk T, Kanat O, Evrensel T, Aydinlar A. Capecitabine-induced cardiotoxicity mimicking myocardial infarction. Neth Heart J 2011; 17:277-80. [PMID: 19789694 DOI: 10.1007/bf03086265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Capecitabine, a fluoropyrimidine derivative, is an orally administered drug that delivers 5-fluorouracil (5-FU) selectively to the tumour. The drug has demonstrated activity in metastatic colorectal cancer. We describe a male patient receiving capecitabine therapy with typical chest pain and electrocardiographic changes consistent with STsegment elevation myocardial infarction. Capecitabine-induced cardiotoxicity may develop in patients who have had a previous episode of 5-FU-induced cardiotoxicity. Capecitabine-induced cardiotoxicity is a rare condition that may lead to diagnostic and therapeutic dilemmas. (Neth Heart J 2009;17:277-80.).
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Affiliation(s)
- T Sentürk
- Department of Cardiology, Uludag University School of Medicine, Görükle, Bursa, Turkey
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25
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Karabay CY, Gecmen C, Aung SM, Guler A, Candan O, Batgerel U, Kalayci A, Kirma C. Is 5-fluorouracil-induced vasospasm a Kounis syndrome? A diagnostic challenge. Perfusion 2011; 26:542-5. [PMID: 21628340 DOI: 10.1177/0267659111410347] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cardiovascular hypersensitivity is a rare and well-documented side-effect of 5-FU (5-fluorouracil). Besides the common complications such as angina pectoris and myocardial infarction, it can also cause cardiogenic shock, and supraventricular and ventricular arrhythmias. Studies have reported that FU-induced angina most commonly occurred due to vasospasm. In our case, 9 hours after stopping the infusion of 5-FU, the patients developed symptoms and electrocardiographic (ECG) findings consistent with acute myocardial infarction. We intend to share this rare case and discuss whether this late complication after 5-FU infusion is an FU-induced vasospasm or rather an allergic reaction leading to Kounis syndrome.
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Affiliation(s)
- C Y Karabay
- Kartal Koşuyolu Heart & Research Hospital, Cardiology Clinic, Istanbul, Turkey.
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26
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Jensen SA, Sørensen JB. 5-fluorouracil-based therapy induces endovascular injury having potential significance to development of clinically overt cardiotoxicity. Cancer Chemother Pharmacol 2011; 69:57-64. [PMID: 21603868 DOI: 10.1007/s00280-011-1669-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/03/2011] [Indexed: 01/26/2023]
Abstract
AIM This study aimed to elucidate the influence of 5-fluorouracil (5-FU)-based therapy on the vascular endothelium and its association with 5-FU-induced heart ischemia. METHODS The study prospectively accrued patients (n = 106) having completely resected colorectal cancer and receiving adjuvant treatment with 5-FU, folinic acid, and oxaliplatin. The levels of plasma von Willebrand factor (vWf), urine albumin-to-creatinine ratio (UACR), coagulation factor II + VII + X, and fibrin D-dimer were serially assessed before, during, and after chemotherapy. RESULTS The vWf level increased from median (range) 1.43 kU/l (0.48 to >3) to 2.64 kU/l (0.23 to >3) (P = 0.001), the UACR increased from 1.1 ± 0.2 mg/mmol (mean ± SE) to 2.1 ± 0.3 mg/mmol (P = 0.001), the coagulation factor II + VII + X activity decreased from 1.00 ± 0.02 to 0.94 ± 0.02 U/l (P = 0.001), and the fibrin D-dimer level increased from 1.1 ± 0.2 to 2.1 ± 0.3 kU/l (P = 0.001) at baseline and during chemotherapy, respectively. The changes in the levels of vWf (P = 0.3), UACR (P = 0.8), coagulation factor II + VII + X (P = 0.8), and fibrin D-dimer (P = 0.6) in nine (8.5%) patients having clinical signs of cardiotoxicity were not significantly different from that of the patients not having cardiotoxicity. The 5-FU-induced rise in plasma biomarkers was not significantly related to the cardiovascular morbidity or its risk factors (P = 0.9). CONCLUSIONS 5-FU therapy induces global reversible endothelial injury leading to a procoagulant state. The ensuing endothelial dysfunction may be of significance to the pathogenesis of 5-FU-induced clinically overt cardiotoxicity. Cardiovascular disease is not significant for the vulnerability of the endothelium to 5-FU-based chemotherapy.
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Affiliation(s)
- Søren Astrup Jensen
- Department of Oncology 5073, Rigshospitalet, Copenhagen University Hospital, 9 Blegdamsvej, 2100 Copenhagen, Denmark.
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27
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Ferté C, Gomez Roca C, Loriot Y, Bahleda R, Moldovan C, Cohen A, Izzedine H, Soria JC, Ederhy S. Reversible cardiogenic shock following 5-Fluorouracil infusion. Invest New Drugs 2010; 28:531-3. [DOI: 10.1007/s10637-009-9271-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
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Abstract
Cardiotoxicity due to 5-fluorouracil involves rare and life-threatening cardiotoxic events occurring in less than 1% of the patients. We describe a case of coronary vasospasm due to parenteral 5-fluorouracil, which did not recur with oral capecitabine. We also give a brief review of the cardiotoxicity of 5-fluorouracil, its treatment and prevention.
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Affiliation(s)
- Jaya D Bathina
- Department of Cardiology, University of Texas, MD Anderson Cancer Center, Houston, Texas 77030, USA
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29
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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. J Gastrointest Cancer 2010. [PMID: 19936641 DOI: 10.1007/s12029-] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
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.
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30
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Kumar A, Kumar R, Sandilium A, Shukla J, Pradhan S. 5-Fluorouracil induces defects in platelet function. Platelets 2010. [DOI: 10.1080/09537109909169176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lee JE, Kim HR, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Shim YS, Yang SC. Clinical characteristics of pulmonary embolism with underlying malignancy. Korean J Intern Med 2010; 25:66-70. [PMID: 20195405 PMCID: PMC2829418 DOI: 10.3904/kjim.2010.25.1.66] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 09/24/2009] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/AIMS The risk of venous thromboembolism (VTE), which encompasses deep vein thrombosis and pulmonary embolism (PE), increases in patients with cancer. Anticancer treatment is also associated with an increased risk for VTE. We conducted this study to investigate the clinical characteristics of patients with cancer and PE related to anticancer treatment in a tertiary care hospital in Korea. METHODS We retrospectively reviewed the clinical data of patients with an underlying malignancy who were diagnosed with PE by chest computed tomography (CT) with or without lower extremity CT angiography between January 2006 and December 2007 at Seoul National University Hospital. RESULTS Overall, 95 patients with malignancies among 168 with PE were analyzed. The median age was 64 years. The median time interval from the malignancy diagnosis to the PE diagnosis was 5.5 months. Lung cancer was the most common malignancy (23.0%), followed by pancreatobiliary cancer, stomach cancer, gynecological cancer, breast cancer, and hepatocellular carcinoma. Platinum-containing and pyrimidine analog-containing chemotherapeutic regimens were common. CONCLUSIONS PE was diagnosed within 1 year after the cancer diagnosis in almost 70% of patients. Lung cancer was the most common underlying malignancy.
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Affiliation(s)
- Ji Eun Lee
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Hye-Ryoun Kim
- Department of Internal Medicine, Korea Cancer Center Hospital, Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Soo Shim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Chul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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Byrne M, Reynolds JV, O'Donnell JS, Keogan M, White B, Byrne M, Murphy S, Maher SG, Pidgeon GP. Long-term activation of the pro-coagulant response after neoadjuvant chemoradiation and major cancer surgery. Br J Cancer 2009; 102:73-9. [PMID: 19953092 PMCID: PMC2813764 DOI: 10.1038/sj.bjc.6605463] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: The association between cancer, major surgery and venous thromboembolism (VTE) is well established. Multimodal therapy is increasingly being used as standard treatment for localised gastrointestinal cancer. The aim of this study was to examine the markers of pro-coagulation response and VTE risk in an exemplar multimodal model of pre-operative combination chemotherapy and radiation therapy, followed by complex cancer surgery. Methods: Consecutive patients (n=36) with localised oesophageal cancer were studied at baseline after the first and second cycles of chemoradiation, and on post-operative days 1–28, and at 3, 6 and 9 months. Factors regulating the pro- and anti-coagulant response, as well as pro-inflammatory markers including NFκB activation in peripheral blood mononuclear cells, were examined. All patients received enoxaparin 40 mg s.c. postoperatively up to discharge, and underwent pulmonary CT-pulmonary angiography and venography on day 10 postoperatively. Results: Four (11%) non-fatal thromboembolic events were documented, all after hospital discharge. Neoadjuvant therapy before surgery activated factor VIII (FVIII) and pro-inflammatory NFκB, and increased D-dimers, pro-thrombin fragment 1+2 (F1+2) and the thrombin-anti-thrombin complex (TAT). Surgery significantly (P<0.05) increased pro-thrombin time (PT), activated partial thromboplastin time, fibrinogen, D-dimers, TAT, F1+2 and FVIII up to 6 months. Conclusion: These data highlight the linked pro-coagulant and immunoinflammatory pathways in the multimodal management of oesophageal cancer, and suggest that the duration of current standard thromboprophylaxis regimens warrants further study.
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Affiliation(s)
- M Byrne
- Department of Surgery, St James's Hospital, Trinity College, Dublin 8, Ireland
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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. J Gastrointest Cancer 2009; 40:133-7. [DOI: 10.1007/s12029-009-9101-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND The syndrome of 5-fluorouracil (5-FU)-associated cardiotoxicity remains poorly defined. PATIENTS AND METHODS We performed a literature review (1969 - 2007) and compiled data derived from 377 evaluable cases out of 448 reported cases. RESULTS Patient age ranged from 14 to 86 years. Of the patients 65% were 55 years old and the male:female ratio was 1.5:1. The most commonly treated tumors were gastrointestinal (60%), head and neck (22%) and breast (4%). Of the patients 14% had a history of heart disease whereas cardiac risk factors were found in 37%. Mode of administration included: continuous infusion (72%); bolus (22.5%); intermediate infusion (3%); oral (2%); and intraperitoneal (1 patient). The dosages of 5-FU used were < 750 mg/m(2)/day (36%), 751 - 999 (16%), 1,000 (26%), 1,001 - 1,499 (4%) and 1,500 (16%). Of the patients 54% received 5-FU in combination with other chemotherapeutic agents (cisplatin 44%) whereas 51% received 5-FU alone or with leucovorin. Only 4% patients had undergone previous or concomitant radiation therapy to the mediastinum. Of cardiac incidents that happened 69% were seen during or within 72 h of the first cycle of 5-FU. Angina occurred in 45% of patients whereas myocardial infarction was seen in 22%, arrhythmias in 23, acute pulmonary edema in 5, cardiac arrest and pericarditis in 1.4 and heart failure in 2. Electro-cardiographic evidence of ischemia or ST-T changes were recorded in 69% of patients, but abnormal cardiac enzymes were found in only 12%. The cardiac symptoms were reproducible in 47%, including in one patient subsequently treated with 5-FU p.o. Symptoms were also elicited when the same patients were treated with lower doses or different schedules. Of the patients 68% responded to conservative anti-anginal therapy, although prophylactic coronary vasodilators had limited efficacy. Overall, 8% of patients showing cardiotoxicity on 5-FU administration died. Furthermore, 13% reexposed to 5-FU died. CONCLUSIONS Our review suggests that 5-FU cardiotoxicity is an infrequent but real phenomenon that is independent of dose and may be related to a continuous infusion schedule. The presence of cardiac risk factors is not predictive. Patients should be observed closely and 5-FU administration discontinued if cardiac symptoms develop. A rechallenge with 5-FU should be reserved only for those patients in whom there is no reasonable alternative therapy and should be performed in the setting of aggressive prophylaxis and close monitoring.
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Affiliation(s)
- M Wasif Saif
- Yale University School of Medicine, FMP 116, CT 06520, New Haven, USA.
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HOY J, NEEMAN T, STUART-HARRIS R, DAVIS A. Risk of venous thromboembolism in patients receiving adjuvant chemotherapy with 5-fluorouracil, epirubicin and cyclophosphamide for early breast cancer. Asia Pac J Clin Oncol 2009. [DOI: 10.1111/j.1743-7563.2009.01205.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jacobson G, Lammli J, Zamba G, Hua L, Goodheart MJ. Thromboembolic events in patients with cervical carcinoma: Incidence and effect on survival. Gynecol Oncol 2009; 113:240-4. [DOI: 10.1016/j.ygyno.2009.01.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 01/20/2009] [Accepted: 01/27/2009] [Indexed: 12/27/2022]
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Cerny J, Hassan A, Smith C, Piperdi B. Coronary Vasospasm with Myocardial Stunning in a Patient with Colon Cancer Receiving Adjuvant Chemotherapy with FOLFOX Regimen. Clin Colorectal Cancer 2009; 8:55-8. [DOI: 10.3816/ccc.2009.n.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Spasojević I, Jelić S, Zakrzewska J, Bačić G. Decreased oxygen transfer capacity of erythrocytes as a cause of 5-fluorouracil related ischemia. Molecules 2008; 14:53-67. [PMID: 19127237 PMCID: PMC6253945 DOI: 10.3390/molecules14010053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 12/21/2008] [Accepted: 12/24/2008] [Indexed: 12/19/2022] Open
Abstract
Various mechanisms have been proposed to account for chemotherapy related ischemia, but none of them can explain the available clinical data. In order to explore the possibility that the decreased ability of erythrocytes to deliver oxygen to the heart could be responsible for cardiotoxicity, we have performed an ex vivo and in vivo study of the effects of cisplatin/5-FU on erythrocytes, using a variety of biophysical techniques. Combining EPR and microscopy it was concluded that both cardiotoxic 5-FU and non-cardiotoxic cisplatin have similar effects on the erythrocyte membrane, thus eliminating those changes as a potential source of cardiotoxicity. On the contrary, 31P-NMR and polarography showed that the effects of these cytostatics on the intracellular milieu differ significantly. 5-FU provoked a pronounced decrease of the O2 level in blood and affected the metabolism of phosphate compounds, while cisplatin had no such effects. When combined these two drugs showed synergistic effects, which matches the higher frequency of cardiotoxicity of the combination relative to the sole application of 5-FU. Preliminary results acquired on blood of patients receiving cisplatin/5-FU therapy verified observations obtained ex vivo. These results open a possibility of applying NMR in preclinical trials of new drugs in order to predict their ischemic potential.
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Affiliation(s)
- Ivan Spasojević
- Author to whom correspondence is addressed; E-mail: ; Tel: +38 1112630796; Fax: +38 1112187133
| | - Svetislav Jelić
- Institute for Multidisciplinary Research, University of Belgrade, Kneza Višeslava 1, Belgrade, 11000, Serbia; E-Mail:
| | - Joanna Zakrzewska
- National Cancer Research Institute, Pasterova 14, Belgrade, 11000, Serbia; E-mail:
| | - Goran Bačić
- Insitute of General and Physical Chemistry, Studentski trg 12-16, Belgrade, 11000, Serbia; E-mail:
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39
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Marinho FCDA, Takagaki TY. Hypercoagulability and lung cancer. J Bras Pneumol 2008; 34:312-22. [PMID: 18545828 DOI: 10.1590/s1806-37132008000500011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Accepted: 01/07/2008] [Indexed: 11/22/2022] Open
Abstract
The relationship between cancer and coagulopathy was suggested by Trousseau nearly 150 years ago. Later, it became more evident that oncologic patients are at a higher risk of experiencing thromboembolic events. This can be due to activation of the coagulation system either by neoplastic cells or by prescribed therapies (chemotherapy or surgical procedures). In fact, these events can constitute the first manifestation of cancer, and their recurrence, despite efficient anticoagulation, has been described. The coagulation system is normally activated in order to provide healing. In the presence of neoplasms, this complex system is activated as a response to multiple stimuli and seems to contribute to cancer progression. Activation of the coagulation system has a greater effect on metastatic foci than on the primary tumor. However, most cancer victims die from complications caused by metastasis, which underscores the importance of this theme. In this area, various mechanisms have been described, creating promising perspectives for future treatments. The current success in using low-molecular-weight heparins against small cell lung cancer is encouraging. Although the knowledge of those mechanisms is relatively incipient, many basic research and clinical studies are underway.
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40
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Dupont AG, Cohen MG. 5-Fluorouracil-Induced Chest Pain and ST-Segment Elevation. Clin Med Cardiol 2008. [DOI: 10.4137/cmc.s297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Allison G. Dupont
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mauricio G. Cohen
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sauter A, Triller J, Schmidt F, Kickuth R. Treatment of Superior Vena Cava (SVC) Syndrome and Inferior Vena Cava (IVC) Thrombosis in a Patient with Colorectal Cancer: Combination of SVC Stenting and IVC Filter Placement to Palliate Symptoms and Pave the Way for Port Implantation. Cardiovasc Intervent Radiol 2007; 31 Suppl 2:S144-8. [PMID: 17605068 DOI: 10.1007/s00270-007-9113-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Thrombosis of the inferior vena cava is a life-threatening complication in cancer patients leading to pulmonary embolism. These patients can also be affected by superior vena cava syndrome causing dyspnea followed by trunk or extremity swelling. We report the case of a 61-year-old female suffering from an extended colorectal tumor who became affected by both of the mentioned complications. Due to thrombus formation within the right vena jugularis interna, thrombosis of the inferior vena cava, and superior vena cava syndrome, a combined interventional procedure via a left jugular access with stenting of the superior vena cava and filter placement into the inferior vena cava was performed As a consequence, relief of the patient's symptoms, prevention of pulmonary embolism, and paving of the way for further venous chemotherapy were achieved.
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Affiliation(s)
- Alexander Sauter
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Berne, Freiburgstrasse 20, CH-3010 Berne, Switzerland
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42
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Arbea L, Coma-Canella I, Martinez-Monge R, García-Foncillas J. A case of capecitabine-induced coronary microspasm in a patient with rectal cancer. World J Gastroenterol 2007; 13:2135-7. [PMID: 17465463 PMCID: PMC4319140 DOI: 10.3748/wjg.v13.i14.2135] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
5-Fluorouracil (5-FU) is the most frequently used chemotherapy agent concomitant with radiotherapy in the management of patients with rectal cancer. Capecitabine is an oral fluoropyrimidine that mimics the pharmaconkinetics of infusional 5-FU. This new drug is replacing 5-FU as a part of the combined-modality treatment of a number of gastrointestinal cancers. While cardiac events associated with the use of 5-FU are a well known side effect, capecitabine-induced cardiotoxicity has been only rarely reported. Here, we reviewed the case of a patient with rectal cancer who had a capecitabine-induced coronary vasospasm. The most prominent mutation of the dihydropyrimidine dehydrogenase gene was also analyzed.
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Affiliation(s)
- Leire Arbea
- Radiation Oncology Division, Department of Oncology, Clinica Universitaria, University of Navarra, Avda, Pio XII s/n. 31080, Spain.
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Villman K, Ohd JF, Lidbrink E, Malmberg L, Lindh B, Blomqvist C, Nordgren H, Bergh J, Bergström D, Ahlgren J. A phase II study of epirubicin, cisplatin and capecitabine as neoadjuvant chemotherapy in locally advanced or inflammatory breast cancer. Eur J Cancer 2007; 43:1153-60. [PMID: 17398088 DOI: 10.1016/j.ejca.2007.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 12/22/2006] [Accepted: 02/12/2007] [Indexed: 11/16/2022]
Abstract
AIM To assess the efficacy and safety of epirubicin, capecitabine and cisplatin (EXC) combination therapy in locally advanced breast cancer (LABC) and investigate the predictive value of selected biomarkers. METHODS Newly diagnosed LABC patients received four 3-weekly cycles of neoadjuvant EXC (epirubicin 60 mg/m(2) day 1; capecitabine 1000 mg/m(2) bid, days 1-14; cisplatin 60 mg/m(2)day 1) and two cycles of post-operative EXC. RESULTS Eight (17%) of 48 patients had inflammatory breast cancer. Overall response rate was 74% (95% CI: 59-86%), including complete responses in 13% (95% CI: 5-26%). Nine (22%; 95% CI: 11-38%) of 41 patients undergoing surgery achieved pathologic complete response (pCR), giving a pCR rate of 19% (95% CI: 9-33%) in the intent-to-treat population. Haematological toxicity was manageable. The most problematic toxicities were chemotherapy-induced nausea/vomiting and hypercoagulative disorders. None of the biomarkers investigated, including HER2, predicted response. CONCLUSION EXC showed high efficacy in LABC, with high clinical response and pCR rate. Nausea and vomiting were unexpectedly frequent, and more aggressive prophylaxis and management of these side effects is recommended in future studies of this combination.
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Affiliation(s)
- Kenneth Villman
- Department of Oncology, Orebro University Hospital, Orebro, Sweden.
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Viale PH, Schwartz RN. Venous Thromboembolism in Patients With Cancer Part I: Survey of Oncology Nurses' Attitudes and Treatment Practices for Ambulatory Settings. Clin J Oncol Nurs 2007; 8:455-61. [PMID: 15515279 DOI: 10.1188/04.cjon.455-461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with cancer have a higher incidence of venous thromboembolism (VTE). Little information currently exists on VTE and the understanding and beliefs of oncology nurses. Therefore, the attitudes and treatment practices of ambulatory oncology nurses were surveyed to determine the current knowledge base of VTE in patients with cancer. Survey results are presented along with a thorough literature review of thromboembolism and the unique risk factors for this frequent complication in patients with cancer. The causes of VTE in this patient population often are multifactorial and include hypercoagulability, stasis, and vascular endothelial damage from procedures or the neoplastic process itself. In particular, chemotherapy administration can increase the risk of thrombosis considerably. New therapies, including thalidomide, require oncology nurses caring for these patients to have heightened awareness of the potential for thrombogenic complications. This is the first of two articles that address the problem of thromboembolism in patients with cancer, including the survey results. (See part II on page 465.) Oncology nurses are essential in the care of VTE in patients with cancer and can help with patient identification, treatment, and compliance for improved patient outcomes.
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Hrovatin E, Viel E, Lestuzzi C, Tartuferi L, Zardo F, Brieda M, Dametto E, Piazza R, Antonini-Canterin F, Vaccher E, Meneguzzo N, Nicolosi GL. Severe ventricular dysrhythmias and silent ischemia during infusion of the antimetabolite 5-fluorouracil and cis-platin. J Cardiovasc Med (Hagerstown) 2006; 7:637-40. [PMID: 16858245 DOI: 10.2459/01.jcm.0000237914.12915.dd] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The antimetabolite 5-fluorouracil is frequently used in the therapy of various malignancies. Cardiotoxicity has frequently been described during treatment, but there is no common agreement on the need to perform cardiovascular monitoring of patients during 5-fluorouracil administration. We report the case of a young patient with an head-neck cancer on whom a continuous electrocardiogram recording was performed, documenting serious ventricular dysrhythmias in the presence of myocardial ischemia during 5-fluorouracil and cis-platin infusion.
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Affiliation(s)
- Enzo Hrovatin
- UO Cardiologia-ARC, Dip. Emergenza, AO SM degli Angeli, Italy.
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Abstract
Among the various deleterious effects of cancer chemotherapy, vascular toxicity is the least well recognized. This lack of recognition may be because the vasculotoxic phenomena are not unique to antineoplastic agents, can occur in patients without exposure to these agents, and the fact cancer itself may produce a hypercoagulable state. As a result, many vascular events either go unnoticed, are ignored, and/or are attributed to the underlying malignancy. Many antineoplastic therapies are associated with various vascular phenomena that range from simple phelibitis to lethal microangiopathy. Recognition of these events is important to minimize the morbidity and even prevent unnecessary deaths. Herein we review the vascular syndromes that have been reported in association with antineoplastic agents.
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Affiliation(s)
- Nasir Shahab
- Department of Medicine, Division of Hematology-Medical Oncology, Ellis Fischel Cancer Center, University of Missouri-Columbia, Columbia, MO 65203, USA.
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Jensen SA, Sørensen JB. Risk factors and prevention of cardiotoxicity induced by 5-fluorouracil or capecitabine. Cancer Chemother Pharmacol 2006; 58:487-93. [PMID: 16418875 DOI: 10.1007/s00280-005-0178-1] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 12/20/2005] [Indexed: 11/29/2022]
Abstract
AIM 5-fluorouracil (5-FU) and its prodrug capecitabine are cardiotoxic. This retrospective study aimed to identify risk factors and to give practical measures to make such chemotherapy feasible if cardiotoxicity occur. METHOD Review of cardiotoxicity among 668 patients treated with 5-FU or capecitabine for gastrointestinal cancers. RESULTS Cardiotoxicity occurred in 29 cases (4.3%). The number of cases according to cardiotoxicity CTC grades 2-4 for patients with and without pre-existing cardiovascular disease were none, 10, and 2 cases, and 3, 14, and no cases, respectively (P=0.16). In three patients intercurrent decrease of renal clearances to <30, 48 and 71 ml min(-1) led to markedly increased cardiotoxicity. Chemotherapy dose reduction to 70 or 50%, either alone or in addition to antiangina medication prevented cardiotoxicity during subsequent chemotherapy in nine (60%) and three (20%) cases out of 15 assessable patients (P=0.001), respectively. To abolish symptoms of cardiotoxicity, sublingual nitroglycerine was efficient for 15 patients and inefficient for two (P=0.001). CONCLUSION Cardiac and renal co-morbidity are risk factors for 5-FU induced cardiotoxicity. In this situation, rechallenge with modified 5-FU-based chemotherapy regimen supported by symptomatic medical treatment is feasible.
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Affiliation(s)
- Søren Astrup Jensen
- Department of Oncology 5073, National University Hospital, 9 Blegdamsvej, 2100, Copenhagen, Denmark.
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48
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Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res 2006; 118:555-68. [PMID: 16388837 DOI: 10.1016/j.thromres.2005.10.015] [Citation(s) in RCA: 243] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Revised: 10/27/2005] [Accepted: 10/28/2005] [Indexed: 12/25/2022]
Abstract
Venous thromboembolism (VTE) is a frequent and potentially life-threatening complication associated with hematological and solid tumor malignancies. In patients with cancer, VTE portends a poor prognosis; in fact, only 12% of those who suffer an event will survive beyond one year. There are several different risk factors for the development of VTE in cancer patients that are well-described in the literature. One that has become increasingly recognized over the past two decades is the independent risk factor of chemotherapy. The annual incidence of VTE in patients receiving chemotherapy is estimated at 11%. This risk can climb to 20% or higher depending on the type of drug(s) being administered. In addition to chemotherapy, there are many other anti-neoplastic and supportive therapies that are also associated with an increased risk for the development of VTE. At present, several original basic science studies and clinical trials are underway in an effort to enhance our understanding of the mechanisms by which different chemotherapeutic agents can generate a prothrombotic state. The purpose of this article is to review the pertinent literature related to VTE in malignancy, and more specifically, chemotherapy and other cancer-related treatments associated with VTE.
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Affiliation(s)
- Tufia C Haddad
- Department of Hematology, Oncology and Transplantation, University of Minnesota Cancer Center, Minneapolis, MN 55455, USA.
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49
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Ohashi S, Yazumi S, Nishio A, Fukui T, Asada M, Chiba T. Acute cerebral infarction during combination chemotherapy with s-1 and cisplatin for a young patient with a mucin-producing adenocarcinoma of the stomach. Intern Med 2006; 45:1049-53. [PMID: 17043376 DOI: 10.2169/internalmedicine.45.1720] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a 29-year-old woman with gastric cancer who developed Trousseau's syndrome, a malignancy-related thromboembolism, during chemotherapy. She was diagnosed with a mucin-producing adenocarcinoma of the stomach, and chemotherapy with S-1 and cisplatin was commenced. During treatment, she developed a sudden onset of right hemiplegia. Magnetic resonance imaging showed an acute cerebral infarction of the left cerebral hemisphere. The underlying pathophysiology is thought to be chronic disseminated intravascular coagulation due to mucin-producing adenocarcinomas. However, cisplatin-induced vascular toxicity and hypercoagulability caused by decreased plasma protein C activity, elevated plasma von-Willebrand factor levels, and hypomagnesemia has also been proposed to be associated with thrombogenicity.
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Affiliation(s)
- Shinya Ohashi
- Department of Gastroenterology and Hepatology, Tazuke-Kofukai Medical Research Institute and Kitano Hospital, 2-4-20 Ogimachi, Kita-ku, Osaka 530-8480, Japan
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Pavic M, Debourdeau P, Aletti M, Farge-Bancel D, Rousset H. [Venous thromboembolism and cancer]. Rev Med Interne 2005; 27:313-22. [PMID: 16414153 DOI: 10.1016/j.revmed.2005.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 11/28/2005] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The risk of venous thrombosis during cancer is largely increased especially in case of chemotherapy, surgery, advanced stage disease, coagulation abnormalities. Survival of patients with cancer experiencing venous thrombosis seems to be worse. Although thrombosis may be a presenting feature of occult malignancy, there are insufficient data to support a more extensive screening than comprehensive medical history, physical examination, routine laboratory tests and chest radiography. CURRENT KNOWLEDGE AND KEY POINTS Pathophysiology of venous thrombosis during cancer is unspecific: venous stasis, vessel wall damage, hypercoagulability). Other factors like platelet abnormalities or the direct responsibility of chemotherapy or hormonotherapy have recently been though to play a causative role. Treatment of cancer-associated thrombosis usually requires at least 6 months of low-molecular-weight heparin therapy rather than oral anticoagulant. Inferior vena cava filters are not indicated. Primary prophylaxis of thrombosis during cancer could safely been achieved with low-molecular-weight heparin. Central venous catheters can be associated with thrombotic complications. Many risks factors have been identified: catheter's type, modalities of catheter's implantation, type of perfusion, bulky mediastinal mass... Prophylactic anticoagulation is not routinely recommended. FUTURE PROSPECTS AND PROJECTS Knew oral anticoagulants could facilitate the treatment of venous thrombosis occurring during cancer in the next years.
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Affiliation(s)
- M Pavic
- Service de Médecine Interne, Hôpital d'Instruction des Armées Desgenettes, 108, boulevard Pinel, 69003 Lyon, France.
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