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Poster Display session 2

3446 - Fluoropyrimidine-induced cardiotoxicity in colorectal cancer patients: preliminary data from the prospective observational CHECKPOINT trial (NCT02665312)


29 Sep 2019


Poster Display session 2


Tumour Site

Colon and Rectal Cancer


Pasquale Lombardi


Annals of Oncology (2019) 30 (suppl_5): v198-v252. 10.1093/annonc/mdz246


P. Lombardi1, G. Aimar1, I. Depetris2, A. Bonzano3, R. Filippi1, E. Fenocchio1, V. Quarà1, M. Milanesio1, R. Ferraris4, C. Cagnazzo5, C. Peraldo Neia6, M. Basiricò1, G. Cavalloni1, M. Aglietta1, F. Leone7

Author affiliations

  • 1 Department Of Medical Oncology, Candiolo Cancer Insititute, FPO - IRCCS, 10060 - Candiolo/IT
  • 2 Department Of Clinical And Experimental Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology, Scientific Institute for Research and Healthcare, Padova/IT
  • 3 Cardiology Unit, Candiolo Cancer Institute, FPO - IRCCS, 10060 - Candiolo/IT
  • 4 Multidisciplinary Outpatient Oncology Clinic, Candiolo Cancer Institute, FPO - IRCCS, 10060 - Candiolo/IT
  • 5 Trial Office, AOU Città della Salute e della Scienza - Presidio Ospedaliero Infantile Regina Margherita, 10126 - Torino/IT
  • 6 Cancer Genomics Lab, Fondazione Edo ed Elvo Tempia Valenta, Biella/IT
  • 7 Departement Of Medical Oncology, ASL BI, Ospedale degli Infermi, 13900 - Biella/IT


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Abstract 3446


Fluoropyrimidines (FP) are the backbone chemotherapy (CT) for colorectal cancer (CRC). Although the most common toxicities have been extensively studied, FP-induced cardiotoxicity (FIC), an infrequent but potentially life-threatening toxicity, still lacks of a comprehensive characterization. The correlation between FIC and known cardiovascular (CV) risk factors remains controversial and based on retrospective observations.


CRC patients (pts) treated for the first time with FP at Candiolo Cancer Institute have been enrolled since January 2016. All pts were screened for potential CV risk factors; if needed, the treatment of preexisting CV comorbidities was optimized before starting CT. During the first 3 CT cycles, a monitoring with CV symptoms collection, seriated electrocardiograms and brain natriuretic peptide (BNP) measurements was performed. Primary objective was to assess the incidence of FIC. Secondary objectives included the analysis of the relationship of FIC with known CV risk factors and BNP levels.


An interim analysis was conducted on 101 pts (65% male, median age 71.6 years). We found high prevalence of CV risk factors (BMI ≥25 54.2%, smoker 50%, heavy drinker 23%, sedentary lifestyle 63.3%) and comorbidities (diabetes mellitus 19.2%, dyslipidemia 34.7%, arterial hypertension 54%, stroke 3%, coronary artery disease 6%, arrhythmias 8%, heart failure 4%). 19 pts (18.8%) experienced FIC: 1 acute coronary syndrome (ACS), 1 coronary vasospasm, 1 paroxysmal supraventricular tachycardia (PSVT), 1 complete left bundle branch block (LBBB), 2 syncope, 4 typical chest pain, 6 sudden dyspnea, 3 sudden palpitations. After treatment of the CV events, only 3 pts had to discontinue FP (ACS, LBBB and PSTV). Among symptomatic pts, only 47% had CV comorbidities and/or CV risk factors. BNP levels increased on average by 73% [CI 99%: +39% - +106%] after the first cycle.


A high incidence of CV events, with no apparent correlation with CV comorbidities or risk factors, was observed. Prompt identification and treatment of CV events allowed most pts to complete the treatment with FP.

Clinical trial identification


Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


M. Aglietta: Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Merck; Advisory / Consultancy: Roche. All other authors have declared no conflicts of interest.

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