How do you approach colon cancer chemotherapy in a patient who has had documented coronary vasospasm with FOLFOX?

Although there are case reports of successful rechallenging with infusional 5-FU in the setting of calcium channel blocker treatment, I don't endorse this approach given the potential cardiac consequences. Capecitabine is not an appropriate alternative since it's just infusional 5-FU in a different form and therefore very likely to produce the same symptoms.

In this setting, I would recommend switching to a bolus 5-FU regimen (FLOX), which is typically not associated with coronary vasospasm. I have used this approach with several patients without recurrence of anginal symptoms. I always give the first dose in a closely monitored setting to ensure the safety of subsequent routine outpatient administration.