ArticleActa oncologica (Stockholm, Sweden)2025
Incidence of myocardial ischemia during treatment with capecitabine: a cohort study with Holter recording and cardiac biomarkers.
Article in Acta oncologica (Stockholm, Sweden), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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8 authors.
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Abstract
background and purposeTreatment with fluoropyrimidines can lead to cardiotoxicity. For 5-fluorouracil, silent myocardial ischemia and effort-related myocardial ischemia have been demonstrated. We investigated the incidence of myocardial ischemia and clinical cardiotoxicity during treatment with capecitabine, a pro-drug of 5-fluorouracil. PATIENTS AND
methodsWe included patients with breast- or colorectal cancer, who received first-time treatment with capecitabine. Holter recording, clinical evaluation, 12-lead electrocardiogram, and measurement of plasma cardiac troponin I and copeptin were performed before and during treatment.
resultsA total of 42 patients with breast cancer and 39 with colorectal cancer were included. Seven patients (9%) experienced clinical cardiotoxicity; five with unstable angina, one with dyspnoea, ST elevations and anterolateral hypokinesia, and one with cardiac arrest. Six patients (8%) had myocardial ischemia on Holter recording during treatment. Among these were two with clinical cardiotoxicity, and four (5.0%) with silent myocardial ischemia. More patients had myocardial ischemia on Holter recording during treatment compared to before, but the difference was not statistically significant (1st cycle: p = 0.22, 3rd/4th cycle: p = 0.50). Plasma copeptin increased during 1st cycle (p = 0.004), while cardiac troponin I remained unchanged (p = 0.92). More patients had non-sustained ventricular tachycardia during 1st cycle of treatment than before (p = 0.020).
interpretationTreatment with capecitabine was associated with an incidence of myocardial ischemia of 8%, an incidence of clinical cardiotoxicity of 9%, and an increase in plasma copeptin and the frequency of non-sustained ventricular tachycardia episodes. Increases in cardiac troponin I were rare. The incidence of myocardial ischemia was lower than previously reported for 5-fluorouracil.
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