How would you manage a patient with anal squamous cell carcinoma and 5 FU induced coronary vasospasm 36 hours after starting definitive chemoradiation?

Topics: Gastrointestinal Cancers • Medical Oncology

No known cardiac risk factors

Answer from: Medical Oncologist at Academic Institution

I would seek the assistance of an oncocardiologist, if available. Did the patient develop EKG changes? Troponin leak? For coronary vasospasm induced by 5FU, there is a range of severity and risk. Given that this patient only requires a second dose of 5FU, I would see if there were any possibility o...

Comments

Medical Oncologist at Cleveland Clinic
ST elevation was noted, but no troponin leak.

Medical Oncologist at Dana-Farber Cancer Institute
Does she have blood pressure room for vasodilators...

Medical Oncologist at Reg Cancer Center
We recently had a case of a young man with rectal ...

Medical Oncologist at Ironwood Cancer & Research Center
Will switching these patients to Capecitabine help...

Medical Oncologist at Torrance Memorial Medical Center
Consider concurrent paclitaxel and carboplatin wit...

Medical Oncologist at St. Luke's Episcopal Hospital
You have 2 choices of therapy under the present ci...

Answer from: Medical Oncologist at Community Practice

I'm not sure if this is helpful to you in this situation, but in a different GI cancer, I was pleased to learn recently that it is the infusional 5 FU that causes vasospasm that is also seen with capecitabine; bolus 5 FU may be safe to use. See the reference below: Safety and tolerability of th...

Answer from: Radiation Oncologist at Community Practice

If the cancer is early staged or non bulky, consider forgoing further 5FU and finish with mitomycin as planned and slightly higher radiation boost dose. If the cancer is bulky/advanced stage, I would change the regimen to perhaps carbo/tax. Both options would allow a safe alternative.

Related Questions