Fluoropyrimidines are commonly included in a colorectal cancer chemotherapy regimen², however, cardiotoxic events have been associated with the use of 5-fluourouracil (5-FU) and capecitabine^3-5. Cardiotoxicity can be defined as per CTCAE⁶ and the most common manifestations of cardiotoxicity associated with fluoropyrimidines are chest pain, angina and acute coronary syndromes including myocardial infarction³. 

Trials have not shown evidence of cardiotoxicity associated with raltitrexed treatment¹. Consider TOMUDEX as an alternative treatment option when fluoropyrimidine treatment is not tolerated¹.

Risk Factors for Fluoropyrimidine Cardiotoxicity⁸

• Older age 
• Concurrent radiotherapy
• Concurrent administration of cardiotoxic drugs
• History of cardiac disease
• Cardiovascular risk factors such as hypertension, dyslipidaemia and smoking

The continuous infusion of 5-FU compared with bolus administration is associated with a higher incidence of cardiac adverse events^8,9. Symptomatic cardiotoxicity usually appears in the first 12 hours during the first cycle of 5-FU, but can develop any time during treatment and has been reported up to 2 days after infusion⁸.