5-FU Cardiotoxicity: Mechanisms and Management Strategies

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Cardiovascular disease and cancer are leading contributors to the global disease burden. 5 fluorouracil (5-FU) is a commonly used drug in gastrointestinal cancers with known cardiotoxicity.

The proposed mechanisms underlying cardiotoxicity induced by 5-fluorouracil (5-FU) are vascular endothelial damage followed by thrombus formation, ischaemia secondary to coronary artery vasospasm, direct toxicity on myocardium and thrombogenicity.

Pharmacogenomic studies and genetic profiling may help predict the occurrence and streamline the treatment of 5-FU-induced coronary artery vasospasm.

This webinar focuses on the mechanisms of 5-FU cardiotoxicities and current management strategies. Future potential treatments will also be reviewed.


Arjun K Ghosh

Arjun K Ghosh

Mark Westwood

Mark Westwood

Key Learning Objectives

  • Understand the common cardiac complications associated with 5-FU administration;
  • Understand mechanisms of cardiac toxicities;
  • Have an overview of current management options (investigative and therapeutic);
  • Understand potential management approaches currently in development.

Target Audience

  • All cardiologists who would manage these patients (interventional cardiologists in the cath lab, general cardiologists in the acute medical unit and outpatients).
  • Equally applicable to consultants and trainees.
  • Specialist nurses and allied health professionals involved in the management of these patients.
  • Oncologists and oncology allied health professionals involved in the management of these patients.

Faculty Biographies

Arjun K Ghosh

Arjun K Ghosh

Dr Arjun Ghosh MBBS, MRCP (UK), MRCP (Card), MSc, PhD, FHEA, FACC, is a Consultant Cardiologist at Barts Heart Centre (BHC), St. Bartholomew’s Hospital, London and at University College London Hospital (UCLH).

He is the first Cardiologist in the UK to be appointed specifically in Cardio-Oncology and helped establish Cardio-Oncology services at both these hospitals. The services deal with screening for cardiotoxicity, monitoring patients on potentially cardiotoxic therapy and managing cardiac complications of cancer therapy. Alongside the clinical service, Cardio-Oncology research is undertaken at both sites and there is a thriving educational component to the service with fellows from the UK and across the world.

Arjun is also actively involved in developing Cardio-Oncology guidelines and changing practice through the British Society of Echocardiography, British Cardio-Oncology Society and International Cardio-Oncology Society. He also runs the UK’s only national Cardio-Oncology Study Day and is organizing the first European Cardio-oncology Symposium which will be held in Barcelona in October 2019.

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Mark Westwood

Mark Westwood

Dr Mark Westwood was educated at St John’s College, Oxford and St Bartholomew’s Hospital, London. His interest in cardiac MRI (CMR) started in 2001 with his thesis of CMR.

He was appointed as a Consultant Cardiologist at the London Chest Hospital in 2008 where he was lead clinician for CMR. He set up, led and developed from scratch the CMR service into one of the largest UK CMR services with a particular focus on the assessment of coronary artery disease.

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Key References

1. Chong J, Ghosh AK. 5-fluorouracil-induced coronary artery vasospasm – proposed mechanisms, existing management options and future directions. Interventional Cardiology Review 2019;21;14(2):89-94.

2. Giza DE, Boccalandro F, Lopez-Mattei J, et al. Ischemic heart disease: special considerations in cardio-oncology. Curr Treat Options Cardiovasc Med 2017;19:37.

3. Chung R, Ghosh AK, Banerjee A. Cardiotoxicity: precision medicine with imprecise definitions. Open Heart 2018;5:e000774.

4. Iliescu CA, Grines CL, Herrmann J, et al. SCAI expert consensus statement: evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the Cardiological Society of India, and Sociedad Latinoamericana de Cardiología Intervencionista). Catheter Cardiovasc Interv 2016;87:E202–23.

5. Jensen SA, Sorensen JB. 5-fluorouracil-based therapy induces endovascular injury having potential significance to development of clinically overt cardiotoxicity. Cancer Chemother Pharmacol 2012;69:57–64.