Coronary artery disease
Capecitabine-Induced Chest Pain Relieved by Diltiazem

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Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma were started on a 2-weeks-on, 1-week-off capecitabine dosing regimen in addition to other chemotherapeutic agents and/or radiation. Within the first few doses, patients experienced chest pain and/or dyspnea at rest or with exertion. Acute electrocardiographic findings suggestive of ischemia were found in some cases at initial presentation, and 1 patient had troponin elevation consistent with an acute ST-segment elevation myocardial infarction. Subsequent ischemia evaluations were not suggestive of clinically significant coronary artery disease. All patients experienced immediate and sustained relief from chest pain after discontinuation of capecitabine and were able to successfully tolerate retreatment using a novel management strategy based on secondary prophylaxis with diltiazem. In conclusion, guidelines for the evaluation of and therapy for capecitabine-induced chest pain are proposed.

Section snippets

Methods

Five patients with primary colorectal adenocarcinoma or anal squamous cell carcinoma and without histories of clinically significant coronary artery disease received capecitabine using a 2-weeks-on, 1-week-off schedule in addition to other chemotherapy and/or radiation (Table 1).

Results

Within the first several doses of capecitabine administered, all 5 patients experienced chest pain and/or dyspnea at rest or with exertion.

Patient 1 experienced typical angina during his initial capecitabine cycles, and the chest pain resolved between cycles; results of stress echocardiography were normal. Patient 2 underwent electrocardiography without evidence of acute ischemia during an episode of chest pain and subsequently had negative results on stress echocardiography. Patient 3

Discussion

To the best of our knowledge, this is the first report to describe successful retreatment with capecitabine in patients with suspected capecitabine-induced coronary vasospasm using prophylactic diltiazem.

There are several salient features of the clinical presentations that have been previously highlighted that merit further mention.10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22 First, our cohort was relatively young, had no known histories of coronary artery disease, and had normal results

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