BMJ Oncology (Aug 2024)
Association of pre-existing cardiovascular disease with administration of fluoropyrimidine chemotherapy in patients with gastrointestinal malignancies
- Chris Gale,
- Li Wei,
- Adam Timmis,
- Michael D Peake,
- Lucy Elliss-Brookes,
- Peter Ludman,
- Alison Fielding,
- David Adlam,
- Francis Murgatroyd,
- Clive Weston,
- Theresa McDonagh,
- Lizz Paley,
- Alistair Ring,
- Charlotte Manisty,
- Mike Hawkins,
- Raoul Reulen,
- Abbas Khushnood,
- Sally Vernon,
- John Deanfield,
- Nadeem Fazal,
- Jem Rashbass,
- Andrew Goodwin,
- Chengsheng Ju,
- Sarah Slater,
- Brian Shand,
- Mark De Belder,
- Paul Lambert,
- Catherine A Welch,
- Andrew Harrison,
- Michael Sweeting,
- Jennifer Lai,
- Mick Peake,
- Paul C Lambert,
- Mark de Belder,
- Paul Charlton,
- Alexander Lyon,
- Sarah Darby,
- Freya Tyrer,
- Mark Rutherford,
- Aderonke Temilade Abiodun,
- Pinkie Chambers,
- Kai Keen Shiu,
- Sally Jeans,
- Andy Deutsch,
- James Chal,
- Akosua Donkor,
- Anil Gunesh
Affiliations
- Chris Gale
- reader
- Li Wei
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey VA Medical Center, Houston, Texas, USA
- Adam Timmis
- professor of clinical cardiology
- Michael D Peake
- Centre for Cancer Outcomes, North Central and North East London Cancer Alliances, University College London Hospitals NHS Foundation Trust, London, UK
- Lucy Elliss-Brookes
- 4 National Cancer Registration and Analysis Service, Public Health England, London, UK
- Peter Ludman
- Institute of Cardiovascular Sciences, Birmingham University, Birmingham, UK
- Alison Fielding
- 2 NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Mayfield West, New South Wales, Australia
- David Adlam
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Francis Murgatroyd
- Department of Cardiology, King’s College Hospital NHS Trust, London, UK
- Clive Weston
- 5Singleton Hospital, Swansea Bay University Health Board, UK
- Theresa McDonagh
- 4Kings College London, Cardiology, London.
- Lizz Paley
- National Cancer Registration and Analysis Service, National Disease Registration Service, NHS Digital, UK
- Alistair Ring
- Charlotte Manisty
- UCL Institute of Cardiovascular Sciences, Barts Heart Centre
- Mike Hawkins
- Raoul Reulen
- Abbas Khushnood
- Department of Cardiopulmonary Transplantation, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Sally Vernon
- 14 Public Health England, London, UK
- John Deanfield
- professor
- Nadeem Fazal
- 10 National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Jem Rashbass
- 3 NHS Digital, Leeds, UK
- Andrew Goodwin
- Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Sarah Slater
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Brian Shand
- 1 National Cancer Registration and Analysis Service, Public Health England, London, UK
- Mark De Belder
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Paul Lambert
- 2University of Wisconsin-Madison, Madison, WI, USA
- Catherine A Welch
- 1 Department of Epidemiology and Public Health, University College London, London, UK
- Andrew Harrison
- 3Department of Medicine, University of Otago, Wellington, New Zealand
- Michael Sweeting
- 2 Department of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
- Jennifer Lai
- 10No Stomach For Cancer, Inc., Madison, Wisconsin, USA
- Mick Peake
- 2University of Leicester
- Paul C Lambert
- senior lecturer in medical statistics
- Mark de Belder
- James Cook University Hospital
- Paul Charlton
- Patient Research Champion Team, National Institute for Health Research, Twickenham, UK
- Alexander Lyon
- 1Imperial College London and Royal Brompton/Harefield
- Sarah Darby
- professor
- Freya Tyrer
- Department of Health Sciences, University of Leicester, Leicester, UK
- Mark Rutherford
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
- Aderonke Temilade Abiodun
- University College London Institute of Cardiovascular Science, London, UK
- Pinkie Chambers
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
- Kai Keen Shiu
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
- Sally Jeans
- Andy Deutsch
- James Chal
- Akosua Donkor
- Anil Gunesh
- DOI
- https://doi.org/10.1136/bmjonc-2024-000323
- Journal volume & issue
-
Vol. 3,
no. 1
Abstract
Objective Fluoropyrimidine chemotherapy is a first-line treatment for many gastrointestinal (GI) cancers, however, cardiotoxicity concerns may limit administration in patients with pre-existing cardiovascular disease (CVD). This study investigated the association of pre-existing CVD with use of fluoropyrimidine chemotherapy in tumour-eligible GI cancer patients.Methods and analysis National cancer registry data from the Virtual Cardio-Oncology Research Initiative from England between 2014 and 2018 was used to identify GI cancer patients eligible to receive fluoropyrimidine chemotherapy. Linkage to Hospital Episode Statistics and CVD registry data were used to ascertain prior CVD and outcomes. Primary outcome was first administration of fluoropyrimidine chemotherapy following cancer diagnosis. Cox proportional hazard models determined HR and 95% CIs for the association between initiation of fluoropyrimidine treatment and prior CVD.Results 112 726 eligible patients were identified (median age 71 years (IQR 62–80), 39.7% female). 33 026 (29.3%) had pre-existing CVD. 73 392 (65.1%) patients had a diagnosis of colorectal, 23 208 (20.6%) oesophageal, 14 788 (13.1%) gastric and 1338 (1.2%) small bowel cancer. Individuals with pre-existing CVD had a 27% reduced rate of receiving fluoropyrimidine chemotherapy (HR, 0.73; 95% CI 0.70 to 0.75) on multivariable analysis. Significantly reduced rates of fluoropyrimidine administration were found across all subtypes of pre-existing CVD.Conclusions GI cancer patients with all types of pre-existing CVD are less likely to receive fluoropyrimidine chemotherapy despite eligibility. This suggests widespread caution regarding administration of fluoropyrimidines across this population; further research is needed to assess whether such conservatism is justified.
