Increased incidence of cardiotoxicity after infusional 5-fluorouracil, cisplatin and docetaxel combination chemotherapy in patients with locally advanced head and neck cancer

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5568 Background: Infusional 5 fluorouracil (5FU) combination with cisplatin remain the most active regimen in previously untreated patients with locally advanced head and neck cancer. Recent combination of this regimen with taxanes have further improved the overall responses suggesting its potential for improved survival. Infusional 5FU is described to cause cardiotoxicity, reported between 4–16% in case series. We report an experience of increased cardiac events in patients receiving chemotherapy containing infusional 5FU, docetaxel and cisplatin (TPF). Methods: A retrospective review of medical records of all patients with locally advanced squamous cell carcinoma of the head and neck treated with TPF regimen from January 2002 to January 2004. The objective of the review was to identify patients who had experienced cardiac events such as chest pain consistent with angina or myocardial infarction, syncope, or cardiac arrhythmias after initiation of infusional 5FU, requiring interruption of treatment. Investigations included electrocardiogram, echocardiogram, holter monitoring and cardiac catheterization. Results: Twelve patients with head and neck cancer (eleven male and one female) were treated with TPF regimen during this 2-year period. The mean age was 64 years. All patients had stage III or IV disease. Five of the twelve patients (42%) experienced significant cardiac event that include: One death due to massive myocardial infarction, angina pectoris in two patients with ischemic changes on EKG. In both of these patients, an angiogram was normal but significant ventricular dysfunction became apparent during treatment. One patient had a syncopal episode with arrhythmia, and echocardiogram showed ventricular dysfunction. Finally, one patient had episodes of paroxysmal hypotension. 5FU was discontinued in all the patients that experienced cardiotoxicity. Conclusions: Infusional 5FU with docetaxel and cisplatin may have higher cardio- toxicity. The incidence noted in our small retrospective series is concerning and warrants prospective monitoring of increased cardiac toxicity in the taxane containing 5FU regimens. No significant financial relationships to disclose.

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