Incidence of myocardial ischemia during treatment with capecitabine: a cohort study with Holter recording and cardiac biomarkers

Authors

  • Anne Dyhl-Polk Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0003-2335-8219
  • Morten Schou Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0002-4271-2466
  • Kirsten K. Vistisen Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
  • Anne-Sophie Sillesen Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0001-7993-1016
  • Stig E. Bojesen Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Biochemistry, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0002-4061-4133
  • Jens Faber Department of Medicine, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  • Merete Vaage-Nilsen Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
  • Dorte L. Nielsen Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark https://orcid.org/0000-0002-8766-8729

DOI:

https://doi.org/10.2340/1651-226X.2025.43089

Keywords:

capecitabine, cardiotoxicity, myocardial ischemia, colorectal cancer, breast cancer

Abstract

Background and purpose: Treatment with fluoropyrimidines can lead to cardiotoxicity. For 5-fluorouracil, silent myocardial ischemia and effort-related myocardial ischemia have been demonstrated. We investigated the incidence of myocardial ischemia and clinical cardiotoxicity during treatment with capecitabine, a pro-drug of 5-fluorouracil.

Patients and methods: We included patients with breast- or colorectal cancer, who received first-time treatment with capecitabine. Holter recording, clinical evaluation, 12-lead electrocardiogram, and measurement of plasma cardiac troponin I and copeptin were performed before and during treatment.

Results: A total of 42 patients with breast cancer and 39 with colorectal cancer were included. Seven patients (9%) experienced clinical cardiotoxicity; five with unstable angina, one with dyspnoea, ST elevations and anterolateral hypokinesia, and one with cardiac arrest. Six patients (8%) had myocardial ischemia on Holter recording during treatment. Among these were two with clinical cardiotoxicity, and four (5.0%) with silent myocardial ischemia. More patients had myocardial ischemia on Holter recording during treatment compared to before, but the difference was not statistically significant (1st cycle: p = 0.22, 3rd/4th cycle: p = 0.50). Plasma copeptin increased during 1st cycle (p = 0.004), while cardiac troponin I remained unchanged (p = 0.92). More patients had non-sustained ventricular tachycardia during 1st cycle of treatment than before (p = 0.020).

Interpretation: Treatment with capecitabine was associated with an incidence of myocardial ischemia of 8%, an incidence of clinical cardiotoxicity of 9%, and an increase in plasma copeptin and the frequency of non-sustained ventricular tachycardia episodes. Increases in cardiac troponin I were rare. The incidence of myocardial ischemia was lower than previously reported for 5-fluorouracil.

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2025-07-02

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Dyhl-Polk, A., Schou, M., Vistisen, K. K., Sillesen, A.-S., Bojesen, S. E., Faber, J., … Nielsen, D. L. (2025). Incidence of myocardial ischemia during treatment with capecitabine: a cohort study with Holter recording and cardiac biomarkers. Acta Oncologica, 64, 837–847. https://doi.org/10.2340/1651-226X.2025.43089

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Vol. 64 (2025): Acta Oncologica

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Copyright (c) 2025 Anne Dyhl-Polk, Morten Schou, Kirsten K. Vistisen, Anne-Sophie Sillesen, Stig E. Bojesen, Jens Faber, Merete Vaage-Nilsen, Dorte L. Nielsen

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