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CASE REPORT
Treatment of advanced colorectal cancer in a patient with cardiotoxic reactions to 5-fluorouracil and capecitabine using suboptimal doses
  1. Joseph H Cioffi1,
  2. Derek J Estes2,
  3. Vaia Florou3,
  4. Bach Ardalan4
  1. 1School of Medicine, University of Miami, Miami, Florida, USA
  2. 2Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
  3. 3Department of Haematology/Oncology, Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
  4. 4Department of Haematology and Oncology, Internal Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida, USA
  1. Correspondence to Joseph H Cioffi, jhc22{at}med.miami.edu

Summary

A 32-year-old female with stage IV colorectal cancer and metastasis to the liver experienced cardiotoxic reactions after treatment with 5-fluorouracil and its oral prodrug capecitabine even at two-thirds the recommended dose. After careful considerations, the decision was made to attempt capecitabine retrial at a further suboptimal dose with combination chemotherapy where she no longer experienced cardiac events. As a result, the liver tumour shrank and rectal mass stabilised, tumour markers dropped and she underwent surgical resection of both masses. Later there was local recurrence of disease near the previous liver tumour, so the suboptimal capecitabine therapy was restarted without complaint. The patient became a candidate for a NanoKnife procedure, offering a potentially curative therapy. This case report summarises a novel treatment strategy for those patients with advanced colorectal cancer who experience cardiotoxic reactions to fluoropyrimidines, the active agent of gold standard treatment.

  • cancer intervention
  • chemotherapy
  • colon cancer
  • unwanted effects / adverse reactions
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Footnotes

  • Contributors JHC: corresponding author, performed literature review and background search, worked as main writer on drafts and their revisions with aid of other authors, gave final approval of submitted version and attests to accuracy and integrity of all aspects of information. DJE: performed literature review, worked on draft and revision editing, utilised clinical experience to aid in imaging review and selection, gave final approval of submitted version and attests to accuracy and integrity of all aspects of information. VF: utilised clinical experience as haemotology/oncology fellow to advise on use of novel treatment in relation to standard of care, performed literature review and further research on current state of novel treatments, worked on draft and revision editing, gave final approval of submitted version and attests to accuracy and integrity of all aspects of information. BA: responsible for implementing and recognising novelty of patient treatment, wrote first-hand experience of patient experience throughout patient treatment, obtained patient consent, utilised clinical experience for background information and current state of treatment options, worked on draft and revision editing, gave final approval of submitted version and attests to accuracy and integrity of all aspects of information.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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