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Aims <p>Fluoropyrimidines, 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.</p> Methods <p>We 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.</p> Results <p>Among 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 (<i>n</i> = 114): fluoropyrimidine reintroduction (<i>n</i> = 54, 38.3%), switch to alternative chemotherapy (<i>n</i> = 25, 17.7%), and transition to palliative care (<i>n</i> = 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]; <i>p</i> = 0.088) and to palliative care (HR = 8.31 [4.67–14.79]; <i>p</i> &lt; 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]; <i>p</i> = 0.185).</p> Conclusion <p>Our 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.</p>

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Fluoropyrimidine-induced cardiotoxicity: outcomes and safety of chemotherapy reintroduction in a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月8日

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  • Océane Réa,
  • Anissa Bouali,
  • Michaël Serraille,
  • Julien Péron,
  • Claire Falandry,
  • Justine Fort,
  • Laurent François,
  • Brahim Harbaoui,
  • Pierre Lantelme,
  • Pierre-Yves Courand

摘要

Aims

Fluoropyrimidines, 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.

Methods

We 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.

Results

Among 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).

Conclusion

Our 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.