Safe administration of S-1 after 5-fluorouracil-induced cardiotoxicity in a patient with colorectal cancer

BMJ Case Rep. 2017 May 22:2017:bcr2016219162. doi: 10.1136/bcr-2016-219162.

Abstract

Cardiotoxicity is a rare but challenging complication of 5-fluorouracil (5-FU) therapy. Compared with 5-FU, after application of S-1 lower plasma levels of the cardiotoxic metabolite alpha-fluoro-beta-alanine have been reported. Evidence for safe administration of S-1 following 5-FU cardiotoxicity is limited to a case report in an Asian patient. Herein we report the first case of S-1 application after 5-FU cardiotoxicity in a Caucasian patient.A 67-year-old man with right-sided metastatic colorectal cancer and history of 5-FU cardiotoxicity had a progressive disease after 8-month therapy with irinotecan and bevacizumab. In consideration of known 5-FU cardiotoxicity, he was referred to our department for therapy counselling. We started a combination therapy with S-1, oxaliplatin and bevacizumab. The treatment was well tolerated without any cardiac problems.Our report confirms the safety of S-1 in cases of 5-FU cardiotoxicity also in a Caucasian patient.

Keywords: cancer intervention; drugs and medicines; gastroenterology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antimetabolites, Antineoplastic / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Cardiotoxicity / etiology*
  • Colorectal Neoplasms / drug therapy*
  • Drug Combinations
  • Fluorouracil / adverse effects*
  • Humans
  • Male
  • Oxonic Acid / therapeutic use
  • Pyridines / therapeutic use
  • Tegafur / therapeutic use

Substances

  • Antimetabolites, Antineoplastic
  • Drug Combinations
  • Pyridines
  • tegafur-gimeracil-oteracil
  • Tegafur
  • Oxonic Acid
  • Fluorouracil