Reactions 575 - 4 Nov 1995

SAntineoplastics

Heart disorders: case reportA 14-year-old boy developed heart disorders following

treatment with fluorouracil in combination with calciumfolinate [folinic acid], cisplatin and methotrexate fornasopharyngeal cancer.

The boy received a bolus dose of IV methotrexate 120mg/m2 on day 1, a 6-hour infusion of cisplatin 100 mg/m2 onday 1 with hydration and fluorouracil 1000 mg/m2/day as acontinuous infusion from days 2–6. He was also given 6 IVbolus doses of calcium folinate 25 mg/m2 beginning 6 hoursafter the cisplatin infusion. On the third day of treatment heexperienced retrosternal pain following extensive vomitingand he was given antacids and H2-antagonists.

On the third day of the fluorouracil infusion the boyexperienced a generalised seizure and tachycardia,hypotension and peripheral hypoxia were noted. An ECG taken12 hours after the seizure revealed marked dilatation of hismyocardium and reduced contractility; his shortening fractionwas 4%. Chest x-rays showed cardiomegaly. He receivedtreatment with catecholamines and diuretics.

After 2 days of conservative treatment, the boy’s conditionwas stable. His cardiac function recovered; his shorteningfraction was 29.7% 6 days after his clinical deterioration.Antineoplastic therapy was discontinued and the boy went intoremission following radiation therapy. At follow-up 6 monthsafter the cessation of antineoplastic therapy, his cardiacparameters were normal.Blutters-Sawatzki R, et al. Severe cardiotoxicity of high-dose 5-fluorouracil incombination with folinic acid, cisplatin and methotrexate in a 14-year-old boy withnasopharyngeal carcinoma (Schmincke tumor). Oncology 52: 291-294, Jul-Aug1995 - Germany 807081180

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Reactions 4 Nov 1995 No. 5750114-9954/10/0575-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved