ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2026
Fluoropyrimidine-induced cardiotoxicity: outcomes and safety of chemotherapy reintroduction in a retrospective cohort study.
Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsFluoropyrimidines, including 5-fluorouracil (5-FU) and capecitabine, remain foundational in the treatment of various cancers, despite their well-documented risk of cardiotoxicity. This study aimed to characterize cardiovascular events associated with fluoropyrimidine use, evaluate their management, and assess the prognostic impact of fluoropyrimidine reintroduction.
methodsWe conducted a retrospective cohort study of patients admitted for cardiovascular events between January 2014 and October 2024 at Croix-Rousse and Lyon Sud University Hospitals (Hospices Civils de Lyon, France), who had received fluoropyrimidine-based chemotherapy within the preceding year.
resultsAmong 141 patients, the most frequent cardiovascular events were coronary artery disease (30.5%), atrial fibrillation (28.4%), and heart failure (19.9%). Post-event, three primary therapeutic strategies were implemented in the follow-up cohort (n = 114): fluoropyrimidine reintroduction (n = 54, 38.3%), switch to alternative chemotherapy (n = 25, 17.7%), and transition to palliative care (n = 36, 25.5%). Recurrent cardiotoxicity after reintroduction occurred in eight patients (14.8%), with only one recurrent coronary event. At 2-year follow-up, overall survival tended to be higher in the reintroduction group compared to the group of patients switching to an alternative chemotherapy (HR = 1.77 [0.92-3.42]; p = 0.088) and to palliative care (HR = 8.31 [4.67-14.79]; p < 0.001). No significant increase in unplanned hospitalizations was observed in the reintroduction group compared to the alternative chemotherapy group (HR = 1.48 [0.83-2.66]; p = 0.185).
conclusionOur findings suggest that fluoropyrimidine reintroduction-guided by multidisciplinary evaluation, cardiovascular management, and close monitoring-appears to have a favorable benefit/risk balance for selected patients.
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