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Capecitabine-Induced Chest Pain Relieved by Diltiazem

Published:September 03, 2012DOI:https://doi.org/10.1016/j.amjcard.2012.07.026
      Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma were started on a 2-weeks-on, 1-week-off capecitabine dosing regimen in addition to other chemotherapeutic agents and/or radiation. Within the first few doses, patients experienced chest pain and/or dyspnea at rest or with exertion. Acute electrocardiographic findings suggestive of ischemia were found in some cases at initial presentation, and 1 patient had troponin elevation consistent with an acute ST-segment elevation myocardial infarction. Subsequent ischemia evaluations were not suggestive of clinically significant coronary artery disease. All patients experienced immediate and sustained relief from chest pain after discontinuation of capecitabine and were able to successfully tolerate retreatment using a novel management strategy based on secondary prophylaxis with diltiazem. In conclusion, guidelines for the evaluation of and therapy for capecitabine-induced chest pain are proposed.
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      Linked Article

      • Cardiotoxicity With 5-Fluorouracil Based Agents: Rechallenge Cannot Currently Be Safely Advised
        American Journal of CardiologyVol. 111Issue 3
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          Ambrosy et al1 recently reported cardiotoxicity attributed to coronary spasm in 5 patients with cancer who underwent treatment with the 5-fluorouracil (5FU) prodrug capecitabine. All were subsequently rechallenged with capecitabine after commencement of calcium channel blockade (CCB) as an antivasospasm therapy. Because 4 of 5 patients experienced no recurrence of symptoms, the investigators concluded that this is a safe management approach in such patients. We believe that this conclusion is potentially dangerous and cannot currently be justified.
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