Incidence of 5-fluorouracil related in cardiotoxicity in patients with head and neck cancer.

Abstract

e24123 Background: Combination chemotherapy with cisplatin-fluoropyrimidine backbone is the standard of care for locally advanced head and neck cancer in the neoadjuvant setting. 5-Fluorouracil (5FU) is administered as a continuous intravenous infusion over 5 days. However, 5-FU may induce acute cardiotoxicity preventing its subsequent use. Incidence of 5-FU-induced cardiotoxicity ranges from 0.99 to 19.9% in published studies, which have been assessed predominantly in gastrointestinal malignancies. In the pivotal TAX323 and TAX324 trials, utilizing 5FU (750 mg/m2 continuous infusion for 5 days), docetaxel and cisplatin (TPF) as neoadjuvant chemotherapy, no cardiotoxicity was reported. We evaluated the development of cardiotoxicity from the use of the TPF regime in our patients with locally advanced head and neck cancer. Methods: Post-hoc analysis of patients treated on the TPF arm of a randomized controlled trial in our institution for locally advanced head and neck cancer in the neoadjuvant setting from 2016 to 2019. Results: 246 patients received TPF neoadjuvant chemotherapy for locally advanced head and neck cancer. Cardiotoxicity occurred in 16 patients; thus, the incidence was 6.5% (95% CI, 3-10%). Two-thirds of the cardiac events occurred in the 1st cycle. Mean time to onset of symptoms was 109.5 hours (4th day of the infusion). The most common events were chest pain (9 patients [56%]), asymptomatic bradycardia (5 patients [31%]) and syncope (2 patients [12%]). Dynamic ECG changes were seen in 5 patients with ST-segment elevation myocardial infarction occurring in one patient. Most common rhythm abnormality identified was bradycardia (7 patients) and in most cases, patients were asymptomatic (5 patients) for the same. Only 2 patients had LV dysfunction detected on echocardiography after the event. Cardiotoxicity resolved in 12 patients (75%). Conclusions: 6.5% of patients treated with 5-FU developed cardiotoxicity with most patients developing symptoms by day 4 of the 1st cycle; chest pain was the most common symptom.