Use of raltitrexed as an alternative to 5-fluorouracil and capecitabine in cancer patients with cardiac history.
AffiliationChristie Hospital, Wilmslow Road, Withington, Manchester M20 4BX, UK.
MetadataShow full item record
AbstractAIM: Fluoropyrimidines are the backbone of the majority of approved chemotherapy regimens for colorectal cancer (CRC). However, there are reports of fluoropyrimidine treatments being associated with cardiotoxicity which have led to permanent cardiovascular damage and even death. Raltitrexed is indicated for palliative treatment of advanced CRC where 5-fluorouracil (5-FU) is not tolerated or inappropriate. A systematic review was undertaken to determine the incidence of cardiotoxicity associated with 5-FU, capecitabine and raltitrexed. METHODS: An electronic search of PubMed was undertaken to identify articles relating to cardiotoxicity associated with 5-FU, capecitabine or raltitrexed, published between January 1991 and August 2011. Additionally, a retrospective review of cardiotoxicity associated with raltitrexed at our treatment centres was conducted. RESULTS: Twenty studies were examined. The overall incidence of cardiotoxicity associated with 5-FU/capecitabine varied between 0.55% and 19% (mean: 5.0%, median: 3.85%). No published data were identified reporting cardiotoxicity associated with raltitrexed. A retrospective review at our treatment centres revealed that the incidence was 4.5% amongst high-risk patients treated with raltitrexed (n=111) for advanced gastrointestinal cancer with a significant cardiac history and/or previous cardiotoxicity with 5-FU or capecitabine. CONCLUSION: The incidence of cardiotoxicity associated with raltitrexed in patients with advanced CRC treated is favourable in a highly skewed, at-risk patient population, all of whom had documented cardiotoxicity with other fluoropyrimidines or were unable to tolerate capecitabine due to cardiac history. Raltitrexed is therefore a suitable option for patients with fluoropyrimidine-induced cardiotoxicity or significant cardiovascular risk factors.
CitationUse of raltitrexed as an alternative to 5-fluorouracil and capecitabine in cancer patients with cardiac history. 2013: Eur J Cancer
JournalEuropean Journal of Cancer
- Final results of Australasian Gastrointestinal Trials Group ARCTIC study: an audit of raltitrexed for patients with cardiac toxicity induced by fluoropyrimidines.
- Authors: Ransom D, Wilson K, Fournier M, Simes RJ, Gebski V, Yip D, Tebbutt N, Karapetis CS, Ferry D, Gordon S, Price TJ
- Issue date: 2014 Jan
- Alternative treatment options in colorectal cancer patients with 5-fluorouracil- or capecitabine-induced cardiotoxicity.
- Authors: Deboever G, Hiltrop N, Cool M, Lambrecht G
- Issue date: 2013 Mar
- Bolus 5-fluorouracil as an alternative in patients with cardiotoxicity associated with infusion 5-fluorouracil and capecitabine: a case series.
- Authors: Saif MW, Garcon MC, Rodriguez G, Rodriguez T
- Issue date: 2013 Jul-Aug
- Open, randomized, multicenter trial of raltitrexed versus fluorouracil plus high-dose leucovorin in patients with advanced colorectal cancer. Tomudex Colorectal Cancer Study Group.
- Authors: Cocconi G, Cunningham D, Van Cutsem E, Francois E, Gustavsson B, van Hazel G, Kerr D, Possinger K, Hietschold SM
- Issue date: 1998 Sep
- Raltitrexed (Tomudex): an alternative drug for patients with colorectal cancer and 5-fluorouracil associated cardiotoxicity.
- Authors: Köhne CH, Thuss-Patience P, Friedrich M, Daniel PT, Kretzschmar A, Benter T, Bauer B, Dietz R, Dörken B
- Issue date: 1998 Mar