Cardiotoxicity from Capecitabine Chemotherapy: Prospective Study of Incidence at Rest and During Physical Exercise

Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major arrhythmias) of 5-Fluorouracil, but this risk has never been investigated for its prodrug capecitabine. One hundred and ninety-two consecutive patients undergoing capecitabine chemotherapy from December 1, 2010 thr...

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Published in:The oncologist (Dayton, Ohio) Ohio), 2022-03, Vol.27 (2), p.e158-e167
Main Authors: Lestuzzi, Chiara, Stolfo, Davide, De Paoli, Antonino, Banzato, Alberto, Buonadonna, Angela, Bidoli, Ettore, Tartuferi, Lucia, Viel, Elda, De Angelis, Giulia, Lonardi, Sara, Innocente, Roberto, Berretta, Massimiliano, Bergamo, Francesca, Guglielmi, Alessandra, Sinagra, Gianfranco, Herrmann, Joerg
Format: Article
Language:English
Subjects:
Arrhythmias, Cardiac - epidemiology
Capecitabine
Capecitabine - toxicity
Cardiotoxicity - etiology
Complications and side effects
Diagnosis
Dosage and administration
Exercise
Exercise tests
Health aspects
Heart diseases
Humans
Incidence
New Drug Development and Clinical Pharmacology
Prospective Studies
Risk factors
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Summary:Physical activity may increase the risk of cardiotoxicity (myocardial ischemia, major arrhythmias) of 5-Fluorouracil, but this risk has never been investigated for its prodrug capecitabine. One hundred and ninety-two consecutive patients undergoing capecitabine chemotherapy from December 1, 2010 through July 31, 2016 were prospectively evaluated. The baseline evaluation included electrocardiography (ECG) and echocardiography (2DE); a follow-up evaluation, including ECG and exercise stress testing (2DE in case of ECG abnormalities), was done after ≥10 days of treatment. Cardiotoxicity was suspected from ischemic ECG changes, new kinetic abnormalities at 2DE, Lown classification ≥2 ventricular arrhythmia, symptomatic arrhythmias, or positive stress test, and confirmed by a negative stress test after capecitabine washout. Cardiotoxicity was diagnosed in 32 patients (16.7%): six at rest and 26 during exercise. All 32 patients had ECG abnormalities: ST-segment changes (24 patients), negative T-waves (2) and/or arrhythmias: ventricular arrhythmias (14 cases), supraventricular tachycardia (2), complete heart block (1). Eight patients had typical symptoms, 6 had atypical symptoms, 1 had syncope, 17 (53%) were asymptomatic. Cardiotoxicity was more common in patients with atypical symptoms during daily life (OR = 15.7) and in those on a therapeutic schedule of 5 days/week (OR = 9.44). Capecitabine cardiotoxicity is frequent, and often elicited by physical effort. Oncologists, cardiologists, and general practitioners should be aware of this risk. Active cardiotoxicity surveillance with ECG (and echocardiogram and/or stress testing in suspected cases) during therapy is recommended. CRO-2010-17.
ISSN:1083-7159
1549-490X
DOI:10.1093/oncolo/oyab035