( 6) found no significant differences in the distribution of pre-treatment risk characteristics and subsequent cardiac symptoms due to fluoropyrimidine treatment. The precise role of age, cardiovascular (CV) risk factors, and underlying CV disease on the risk of coronary vasospasm remains uncertain. Vasospasm is the predominant mechanism of chest pain ( 1–4), and varies between 1% and 13%, dependent on the drug, route of administration, co-administered chemotherapy (e.g., platinum-based drugs), and reporting criteria ( 2–5). Asymptomatic ECG changes have also been reported. Cardiac toxicity typically presents as chest pain that may be atypical or typical, or consistent with an acute coronary syndrome. Their toxicity has been extensively reviewed ( 1), and their use is limited by noncardiac (cytopenias, mucositis, diarrhea, palmar-plantar erythdysthesia syndrome) and cardiac toxicities (electrocardiographic changes, atrial fibrillation, and other arrhythmias ischemia pericarditis stress cardiomyopathy myocarditis and death). These agents are also used as radio-sensitizing agents in conjunction with therapeutic radiation. The fluoropyrimidines (5-fluorouracil and oral pro-drug capecitabine) are the central components of gastrointestinal malignancy chemotherapy, with efficacy for brain, head and neck, bladder, and breast cancers.
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