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Japanese Journal of Clinical Oncology Advance Access published online on April 26, 2005
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyi071
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© 2005 Foundation for Promotion of Cancer Research
Received December 19, 2004
Accepted March 14, 2005

Original Article

Cardiotoxicity of de Gramont's Regimen Incidence, Clinical Characteristics and Long-term Follow-up

Nezih Meydan 1*, Isil Kundak 2, Tugba Yavuzsen 2, Ilhan Oztop 2, Sabri Barutca 1, Ugur Yilmaz 2, and Mehmet Niyazi Alakavuklar 2

1 Division of Medical Oncology, University of Adnan Menderes, Aydin, Turkey
2 Division of Hematology/Oncology, University of Dokuz Eylul, Izmir, Turkey

* To whom correspondence should be addressed.
Nezih Meydan, E-mail: nezihmeydan{at}yahoo.com; nmeydan@adu.edu.tr


  Abstract

Background: The incidence of 5-fluorouracil (5-FU)-related cardiotoxicity seems to be dosage and schedule dependent. It was reported as 1.6-3% with earlier bolus regimens whereas this increased up to 7.6-18% with prolonged (4-5 days) infusion regimens. Knowledge of the cardiotoxicity incidence in patients treated with the widely used de Gramont's regimen (2 days infusional 5-FU) and the long-term follow-up of affected patients is still limited.

Methods: We investigated the incidence and clinical characteristics of the cardiotoxicity of de Gramont's regimen and long-term follow-up of the affected patients.

Results: Nine of a total of 231 patients receiving de Gramont's regimen experienced cardiac events, revealing an overall incidence of 3.9%. Four (2.5%) cases were receiving de Gramont's regimen only. Cardiac manifestations were acute coronary syndrome (n = 6), congestive heart failure (n = 2) and atrial fibrillation (n = 1). Cardiotoxicity occurred in the first cycle in eight patients, and in the second cycle in one. The median onset day was day 2. Cardiac symptoms occurred mostly at night time (seven patients) and the onset was a few hours after the bolus part of the regimen in four out of seven patients. After the cardiotoxicity, treatments were continued safely without 5-FU.

Conclusions: de Gramont's regimen has a lower incidence of cardiotoxicity compared with more prolonged 5-FU-based infusion regimens. Nevertheless, patients should still be carefully monitored especially in the first cycles and at night time.

Keywords: 5-fluorouracil; cardiotoxicity; de Gramont's regimen; follow-up; leucovorin.
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