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

DOI
https://doi.org/10.1136/bmjonc-2024-000323
Journal volume & issue
Vol. 3, no. 1

Abstract

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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.