ArticleJACC. CardioOncology2025
Fluoropyrimidine Chemotherapy and the Risk of Death and Cardiovascular Events in Patients With Gastrointestinal Cancer.
Article in JACC. CardioOncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Completion vs. early discontinuation of chemotherapy and the impact on 5-year all-cause mortality in women treated for early-stage breast cancer from 2015 to 2020: A cohort study using a target trial emulation approach.British journal of clinical pharmacology · 2026Article
- Fluoropyrimidine-induced cardiotoxicity: outcomes and safety of chemotherapy reintroduction in a retrospective cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Incidence of myocardial ischemia during treatment with capecitabine: a cohort study with Holter recording and cardiac biomarkers.Acta oncologica (Stockholm, Sweden) · 2025Article
- Fluoropyrimidine Therapy in Gastrointestinal Cancer: Balancing Survival Benefits and Cardiotoxicity Risks.JACC. CardioOncology · 2025Article
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19 authors.
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Abstract
backgroundFluoropyrimidine chemotherapy is administered first-line for many gastrointestinal cancers. However, patients with cardiovascular disease commonly receive alternative treatment due to cardiotoxicity concerns.
objectivesThis study sought to assess the risks of all-cause mortality and acute cardiovascular events with fluoropyrimidine treatment.
methodsWe conducted an observational cohort study applying a target trial emulation framework to linked national cancer, cardiac, and hospitalization registry data from the Virtual Cardio-Oncology Research Initiative. Adults diagnosed with tumors eligible for fluoropyrimidine-based chemotherapy as first-line therapy were included. All-cause mortality and a composite of hospitalization for acute cardiovascular events (acute coronary syndrome, heart failure, cardiac arrhythmia, cardiac intervention, cardiac arrest, and cardiac death) were compared in patients treated with fluoropyrimidine-based chemotherapy vs alternative management. Adjusted, weighted pooled logistic regression models were used to estimate the 1-year risk difference (RD).
resultsAmong 103,110 patients (mean age 69.7 years, 59% male), the absolute risk of death at 1 year was significantly lower in fluoropyrimidine-treated patients (RD: -7.7%; 95% CI: -8.7% to -6.7%) with a small increased risk of acute cardiovascular events (RD: 0.9%; 95% CI: 0.0% to 1.9%). This was primarily due to arrhythmias (RD: 0.8%; 95% CI: 0.1% to 1.6%) and cardiac arrest (RD: 0.3%; 95% CI: 0.1% to 0.5%), with no increased risk of acute coronary syndromes including in the subgroup of patients with pre-existing coronary artery disease.
conclusionsThe markedly improved overall survival with fluoropyrimidines in patients with gastrointestinal cancer significantly outweighs the small risk of cardiac arrhythmia and arrest. Oncologists should take this into consideration for decision making to avoid undue clinical conservatism, particularly in patients with cardiovascular disease.
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