levoleucovorin and Angina-Pectoris

The purpose of the study is evaluation and assessment of parameters of cardiac toxicity in patients subjected to 5-FU based chemotherapy. Cardiac morbidity is a reported outcome in different 5FU/LV regimens; however none of them are definite or proximate. The bimonthly regimen of high dose leucovorin is reported to be less toxic and more effective as compared to the monthly regimen of low dose leucovorin. We report the detailed assessment of few cardiac parameter of toxicity in patients of advanced colorectal carcinoma subjected to two Schedules of high and low dose Folinic Acid, 5-Fluorouracil, bolus and continuous infusion. The correlation of elevated cardiac biomarkers, angina and hypertension is comparatively assessed in patients with normal general status, hyperglycemia and known cardiac disorders subjected to two different 5FU based chemotherapeutic regimen.

Topics: Angina Pectoris; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Blood Pressure; Carcinoma; Chi-Square Distribution; Colorectal Neoplasms; Drug Administration Schedule; Female; Fluorouracil; Heart Diseases; Humans; Hypertension; Leucovorin; Male; Middle Aged; Prospective Studies; Risk Factors; Time Factors; Treatment Outcome

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.

Topics: Aged, 80 and over; Angina Pectoris; Antineoplastic Combined Chemotherapy Protocols; Calcium Channel Blockers; Colonic Neoplasms; Coronary Angiography; Coronary Vasospasm; Drug-Eluting Stents; Electrocardiography; Fluorouracil; Humans; Leucovorin; Male; Nifedipine; Nitroglycerin; Organoplatinum Compounds; Percutaneous Coronary Intervention; Recurrence; Severity of Illness Index; Treatment Outcome; Vasodilator Agents

Topics: Adenocarcinoma; Angina Pectoris; Electrocardiography; Female; Fluorouracil; Heart; Heart Diseases; Humans; Hypotension; Intestinal Neoplasms; Intestine, Small; Leucovorin; Middle Aged; Syndrome; Tachycardia; Ventricular Function, Left

Favorable results have been reported for the treatment of advanced colorectal cancer with the combination of 5-fluorouracil (5-FU) and leucovorin (LV). In these investigations the highest response rates were obtained in non-pretreated patients. In the present study, 22 patients with primary or acquired resistance to single-agent 5-FU and documented progressive disease on 5-FU were given a bolus injection of LV at a dose of 200 mg/m2, 1 h prior to a 2 h infusion of 5-FU at a dose of 370-770 mg/m2 on 5 consecutive days, and this was repeated every 3 weeks. Whenever possible the dose of 5-FU was escalated to find the maximum tolerable dose. No objective response was observed. Five patients had short-lasting stable disease. Despite 5-FU dose escalation, toxicity was acceptable. One patient developed 5-FU-related angina pectoris with EKG changes. It is concluded that in the schedule used, combined LV/5-FU treatment is ineffective for patients with 5-FU-resistant advanced colorectal cancer.

Topics: Adult; Aged; Angina Pectoris; Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Drug Resistance; Female; Fluorouracil; Humans; Leucovorin; Male; Middle Aged