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PubMed2005

Effect of hemodialysis on the metabolic clearance of 5-Fluorouracil in a patient with end-stage renal failure.

A 64-year-old man on chronic hemodialysis for end-stage renal disease developed peritoneal carcinomatosis, and palliative chemotherapy with fluorouracil was started. The drug was administered (325 mg/m as IV bolus, at 2 PM) on 2 separate occasions, ie, 1 hour after dialysis and 2 days later, 49 hours after dialysis. The time course of the fluorouracil plasma concentration was determined, and the main pharmacokinetic parameters were calculated. The slope of the monoexponential decay of plasma concentration was significantly greater 1 hour (0.161 minutes) than 49 hours after dialysis (0.127 minutes), and plasma clearance was correspondingly higher (1.78 L/min versus 1.46 L/min). The volume of distribution did not change (11.1 L versus 11.5 L). Because fluorouracil is minimally excreted by the renal route (about 10% of the dose) and is almost entirely metabolized by dihydropyrimidine dehydrogenase (DPD), it is suggested that plasma factors that accumulate during the interdialytic period and are removed by dialysis may inhibit DPD activity and, consequently, fluorouracil metabolic clearance.

Antimetabolites, Antineoplastic↗
PubMed2006

Reversible impairment of auditory callosal pathway in 5-fluorouracil-induced leukoencephalopathy: parallel changes in function and imaging.

OBJECTIVE: To report the course of functional and imaging recovery of the auditory callosal pathway in a patient with 5-fluorouracil-induced leukoencephalopathy. DESIGN: Case study. SETTING: University hospital. PATIENT: A 58-year-old man with hypopharyngeal cancer who developed 5-fluorouracil-induced leukoencephalopathy. MAIN OUTCOME MEASURES: Imaging (magnetic resonance imaging) and functional (dichotic listening test) evaluation on the auditory callosal pathway. RESULTS: The patient underwent systemic chemotherapy with pirarubicin, cisplatin, and 5-fluorouracil. On the last day of the regimen, the patient suddenly became restless and convulsive. On diffusion-weighted magnetic resonance images, the signal intensity at the splenium of the corpus callosum was very high. Fluid-attenuated inversion recovery images showed no abnormal findings at this time. Intravenous methylprednisolone sodium succinate and glycerin 10% was started immediately. On the ninth day after onset, the patient was free of neurologic symptoms. Although pure-tone audiograms and speech discrimination scores were normal, dichotic listening tests revealed significant left ear suppression, indicating severe injury of the auditory callosal pathway. On fluid-attenuated inversion recovery images, the signal intensity at the splenium was high, whereas the posterior trunk was normal. At 6 weeks after onset, dichotic listening test results returned to normal and hyperintensity at the splenium was much less marked on fluid-attenuated inversion recovery images. CONCLUSION: By using both functional and imaging modalities, this case study demonstrated, for the first time in a reversible manner, that the auditory callosal pathway runs through the most posterior part of the corpus callosum including the splenium. Diffusion-weighted magnetic resonance imaging was considered useful for early diagnosis of 5-fluorouracil-induced leukoencephalopathy.

Antimetabolites, Antineoplastic↗
PubMed1998

5-fluorouracil: a pharmacological paradigm in the use of cytotoxics.

1. Painstaking progress in drug development is well illustrated by 5-fluorouracil (5FU), originally designed 40 years ago as a fluorinated analogue of the naturally occurring base uracil. Innovative pharmacokinetic and pharmacodynamic strategies have seen significant clinical improvements for cancer patients over the past decade. 2. 5-Fluorouracil acts by three main mechanisms. Principally, the intermediate metabolite fluorodeoxyuridine monophosphate inhibits a key enzyme in pyrimidine biosynthesis, namely thymidylate synthase (TS). Additionally, 5FU is metabolized to ribo- and deoxy-ribonucleotides, which act as false bases for incorporation into RNA and DNA. 3. Biomodulation of 5FU has been attempted with methotrexate (MTX), folinic acid, interferons, cisplatin and radiotherapy. Methotrexate augments the actions of 5FU by inhibiting dihydrofolate reductase and decreasing the folate pool required for pyrimidine biosynthesis, inhibiting TS via MTX-polyglutamate and directly inhibiting purine biosynthesis. Interferons increase steady state concentrations of 5FU. 5-Fluorouracil enhances the cytotoxicity of cisplatin and radiotherapy by inhibiting DNA repair. Folinic acid enhances TS inhibition by increasing the intracellular pool of folates that stabilize the 5FU-TS complex. 4. 5-Fluorouracil has a short plasma half-life. Thymidylate synthase inhibition is limited to the S-phase of the cell cycle and only a small fraction of most cancer cells are in S-phase at any one time. Increased response rates seen with infusional protocols may reflect the effective recruitment of additional mechanisms of cytotoxicity, not dependent on cell cycle, including effects on RNA synthesis. 5. Patients with localized metastatic disease may benefit from locoregional treatments. These include hepatic intra-arterial therapy with related compounds, such as floxuridine, which reach high concentrations at sites of tumour, while systemic toxicities are minimized by efficient hepatic clearance. 6. Recent developments include orally bioavailable formulations, such as ftorafur, capecitabine and the combination of 5FU with the dihydropyrimidine phosphate dehydrogenase inhibitor ethynyluracil. Recognition of diurnal variation in the activity of such key enzymes as DPD has led to the administration of 5FU at regulated, variable infusion rates (chronomodulation). These promising pharmacological approaches may further improve clinical outcomes in common cancers.

Antimetabolites, Antineoplastic↗
PubMed1995

Short-term intensive 5-fluorouracil treatment of actinic keratoses.

BACKGROUND: 5-Fluorouracil therapy is an efficacious treatment for actinic keratoses. However, the prolonged courses of therapy traditionally prescribed are unpleasant, uncomfortable, and can lead to noncompliance. OBJECTIVE: To treat patients with shorter courses of 5-fluorouracil therapy. METHODS: 5-Fluorouracil cream or solution is applied four times daily for periods varying between 7 and 21 days, depending upon the body location. RESULTS: The same brisk inflammatory reaction and clearing of the majority of actinic keratoses associated with longer courses of application twice daily is realized. CONCLUSION: 5-Fluorouracil can be applied four times daily for shorter periods of time, resulting in clearing of actinic keratoses and patient acceptability.

Administration, Topical↗
PubMed1998

First-pass metabolism of 5-fluorouracil in rats.

The first-pass metabolism of 5-fluorouracil has been investigated in rats to compare systemic bioavailability after administration by different routes, the bioavailability after intravenous bolus administration being defined as unity. Bioavailability after oral administration (F(po)) was compared with that after intraintestinal administration into the closed loop (F(loop)) in conscious rats. F(po) was very low and variable (0.28 +/- 0.30, mean +/- s.d.), in agreement with earlier studies in man, but comparable with F(loop) (0.33 +/- 0.05), suggesting insignificant loss of 5-fluorouracil by degradation in the gastrointestinal lumen or by faecal excretion. The bioavailability after intraportal vein administration (F(ipv)) was compared with F(loop) in rats anaesthetized with pentobarbital, anaesthesia being used to maintain a stable portal drug infusion that mimics the sustained input of drug into the portal blood flow after intra-intestinal administration. F(ipv) was smaller than unity (0.68 +/- 0.03), suggesting significant hepatic first-pass metabolism, but higher than F(loop) (0.31 +/- 0.10), suggesting significant first-pass metabolism in the intestinal mucosa. The intestinal bioavailability for passage through the epithelial mucosa (Fi) was estimated, from the ratio of F(loop) to F(ipv) to be 0.46. The study revealed that both the liver and intestinal mucosa are responsible for the extensive first-pass metabolism of 5-fluorouracil after oral administration. This first-pass metabolism might be similar to that in man, in which the oral bioavailability is reportedly similar to that in the rats used in this study. The findings in this study should be of help in monitoring ways of improving oral 5-fluorouracil therapy.

Administration, Oral↗
PubMed1979

Enhanced 5-fluorouracil nucleotide formation after methotrexate administration: explanation for drug synergism.

Exposure of L1210 leukemia cells first to 0.1 to 100 micromolar methotrexate and then to 10 micromolar 5-fluorouracil produces a synergistic effect on the number of cells killed in culture. Methotrexate dose-related increases occur in the concentrations of intracellular 5-fluorouracil ribonucleotides and 5-fluoro-2'-deoxyuridylate and in the incorporation of 5-fluorouracil into RNA. These increases are correlated with increased concentrations of intracellular phosphoribosylpyrophosphate. It is proposed that the enhanced formation of ribonucleotides of 5-fluorouracil and the subsequent incorporation of these compounds into RNA in methotrexate-treated cells may account for synergism between these agents.

Animals↗
PubMed1985

Mechanism of selective inhibition of human cytomegalovirus replication by 1-beta-D-arabinofuranosyl-5-fluorouracil.

Four kinds of 1-beta-D-arabinofuranosyl-5-halogenouracil were examined for inhibition of human cytomegalovirus (HCMV) and herpes simplex virus type 1 (HSV-1) and 2 (HSV-2) replication. 1-beta-D-Arabinofuranosyl-5-fluorouracil (ara-FU) was the most effective against HCMV, whereas 1-beta-D-arabinofuranosyl-5-bromouracil was the most effective against HSV-1 and HSV-2. The mechanism of action of ara-FU on HCMV replication was also studied. The dTTP pool size in human embryonic fibroblasts was increased 33-fold by HCMV infection. However, treatment with ara-FU decreased the size of the dTTP pool by approximately 50%. On the other hand, 1-beta-D-arabinofuranosyl-5-fluorouracil-5'-triphosphate inhibited HCMV DNA polymerase activity competitively with dTTP. These results suggest that ara-FU acts as a bifunctional inhibitor of HCMV replication. Ara-FU is phosphorylated by cellular thymidine kinase to 1-beta-D-arabinofuranosyl-5-fluorouracil-5'-monophosphate, which inhibits cellular thymidylate synthetase, which in turn decreases the dTTP pool size in infected cells. As the dTTP pool size is reduced, inhibition of viral DNA polymerase by 1-beta-D-arabinofuranosyl-5-fluorouracil-5'-triphosphate becomes more efficient.

Antiviral Agents↗
PubMed1990

5-fluorouracil in the treatment of scleroderma: a randomised, double blind, placebo controlled international collaborative study.

A six month controlled study of 5-fluorouracil in the treatment of scleroderma showed a modest benefit in skin scores, Raynaud's phenomenon, and patients' global assessment. Visceral organ and hand function were unaffected. Mild to moderate toxicity was common in the 5-fluorouracil treated patients but usually responded to dose reduction. Two patients receiving 5-fluorouracil died from causes seemingly unrelated to treatment. Significant clinical improvement in scleroderma was not noted in the first six months of treatment with 5-fluorouracil.

Adult↗
PubMed2004

Phase I study of concomitant chemoradiotherapy with paclitaxel, fluorouracil, gemcitabine, and twice-daily radiation in patients with poor-prognosis cancer of the head and neck.

PURPOSE: We previously demonstrated high locoregional control, in patients with poor-prognosis head and neck cancer (HNC), using paclitaxel, 5-fluorouracil, hydroxyurea, and concomitant hyperfractionated radiotherapy. In the present phase I trial, gemcitabine, a novel antimetabolite with strong radiation-enhancing activity, replaces hydroxyurea. We sought to determine the recommended phase II dose and clinical efficacy in poor-prognosis HNC patients. EXPERIMENTAL DESIGN: Seventy-two patients enrolled. Eligibility criteria included recurrent or second primary HNC, metastases or expected 2-year survival <20%. Chemoradiotherapy consisted of 5-fluorouracil, 600 mg/m(2)/d, for 5 days; paclitaxel, 100 mg/m(2) on Day 1; and concurrent 1.5 Gy twice-daily radiation for 5 days. Gemcitabine was dose escalated, 50-300 mg/m(2) on day 1. Cycles repeated every 14 days until the completion of chemoradiation. Dose-limiting toxicities (DLTs) included: neutropenic fever; grade > or =4 neutropenia or thrombocytopenia for >4 days; grade > or =4 mucositis or dermatitis for >7 days; or grade 3 toxicity necessitating chemotherapy dose reductions. Non-DLT dose reductions in 5-fluorouracil and/or paclitaxel were allowed. RESULTS: Seventy-nine percent of assessable patients experienced a clinical response. Five-year actuarial survival is 33.0%, and locoregional control is 61.4%. The recommended phase II dose of gemcitabine in this regimen is 100 mg/m(2) during cycles 1-5 (1 of 7 patients with DLT) or 200 mg/m(2) delivered only during cycles 3-5 (3 of 19 with DLT). Grades 3 and 4 mucositis (56 and 21%, respectively) and dermatitis (25 and 21%, respectively) were common. CONCLUSIONS: Gemcitabine, 5-fluorouracil, paclitaxel, and twice-daily radiation, delivered on alternating weeks, is active in patients with poor-prognosis HNC, although severe mucositis limits the clinical applicability of this regimen. Refinements in radiotherapy, including intensity-modulated radiation therapy, may improve the tolerance for this regimen.

Adolescent↗
PubMed2003

An in vitro study on the active conversion of flucytosine to fluorouracil by microorganisms in the human intestinal microflora.

BACKGROUND: Investigation of the rate of active conversion of flucytosine to fluorouracil by microorganisms in the intestinal microflora. METHODS: Active conversion of flucytosine was investigated using viable and nonviable Escherichia coli at different flucytosine concentrations. Additionally, flucytosine conversion was studied in fecal specimens from 3 neutropenic patients at the start of the antimicrobial/antifungal prophylaxis (C/A regimen) and 1 week later. RESULTS: Flucytosine levels decreased by an average of 72, 71 and 72% flucytosine after incubation for 48 h of 10(10) viable E. coli /ml suspension in broth containing 13, 130 and 1300 mg/l flucytosine, respectively. The decreasing flucytosine levels corresponded approximately to an identical increase in fluorouracil levels. Also, a 44% decrease of flucytosine levels occurred when nonviable E. coli were used, indicating that bacterial viability is not necessary for this conversion. When fecal specimens of 2 patients were investigated prior to the C/A regimen, significant flucytosine conversion occurred, whereas this conversion was not observed in the corresponding fecal specimens after 1 week of C/A regimen. CONCLUSION: These in vitro experiments showed that extensive flucytosine conversion can occur in the human intestinal microflora by E. coli. Consequently, fluorouracil exposure and fluorouracil-related toxicity may occur in the flucytosine-treated patient.

Antifungal Agents↗
PubMed1986

Comparison of oral ftorafur and intravenous 5-fluorouracil in patients with advanced cancer of the stomach, colon or rectum.

In this prospective randomized study the effect of oral Ftorafur was compared with that of intravenous 5-fluorouracil in patients with advanced adenocarcinoma of the stomach, colon or rectum. Forty-five patients were evaluable. The overall response rates were 26.9% in the 5-fluorouracil group, 26.7% in the Ftorafur group. The median duration of response was 6 months in both groups. Survival in the 5-fluorouracil group was slightly better than in the Ftorafur group, but the difference was not statistically significant. The myelosuppressive effect of 5-fluorouracil was significantly stronger than that of Ftorafur. Gastrointestinal side effects were more pronounced in the Ftorafur group, but the difference was not statistically significant.

Actuarial Analysis↗
PubMedDate not supplied

Mitoxantrone, fluorouracil plus L-leucovorin, and vinorelbine in pretreated advanced breast cancer.

The combination chemotherapy including mitoxantrone, fluorouracil and leucovorin has proven to be effective and well-tolerated in advanced breast cancer (ABC). No data are available on the association with navelbine, a new vinka alkaloid, which has demonstrated high activity in ABC. The trial was designed to evaluate feasibility and efficacy of the association of vinorelbine to mitoxantrone, fluorouracil and L-leucovorin in patients who failed a previous regimen for ABC or who relapsed within 6 months of adjuvant chemotherapy. The schedule was as follows: mitoxantrone 6 mg/m2 days 1 and 8; L-leucovorin 250 mg/m2 days 1 and 8, fluorouracil 600 mg/m2 days 1 and 8, vinorelbine 25 mg/m2 days 1 and 8, cycles being repeated every 21 days. Twenty-five patients were enrolled and are evaluable for response and side effects. One hundred cycles of therapy have been delivered (median/patient, 4 cycles). In 41 cycles a delay was required and in 38 cycles it was necessary to administer granulocyte colony-stimulating factor for neutropenia. Seven partial remissions (28%; 95% confidence interval, 12-49%), 10 stabilizations of disease and 8 progressions were observed. Although grade 4 neutropenia was observed in 44% of the patients, no grade 3-4 infections were observed. Nonhematologic toxicities were mild or moderate and included alopecia, mucositis and phlebitis. In conclusion, the schedule employed, although correlated with a moderate activity, does not seem to be superior to other regimens with mitoxantrone, fluorouracil, and leucovorin.

Adult↗
PubMed1979

Effects of 5-fluorouracil on the thiamin status of adult female rats.

The effect of 5-fluorouracil on the thiamin status of normal female adult rats has been investigated. Pre-treatment of the animals with the cytotoxic drug daily for 3 successive days resulted in a significant decrease in hepatic concentrations of thiamin concomitant with a decrease in thiamin-dependent transketolase enzyme activity and an increase in thiamin-pyrophosphate-(TPP-)stimulating effect in whole blood when compared with those of pair-fed control animals. The TPP effect of transketolase enzyme activity was also increased by 5-fluorouracil in vitro. Furthermore, the treatment with 5-fluorouracil resulted in decreased liver and spleen concentrations without affecting the urinary excretory levels of thiamin in animals supplemented with large doses of the vitamin. Giving a dose comparable to a human therapeutic dose caused a similar increase in the TPP effect. These results indicate that treatment with 5-fluorouracil may be associated with thiamin deficiency by increasing either the utilization or the breakdown of thiamin.

Animals↗
PubMedDate not supplied

Compatibility of 5-fluorouracil and total parenteral nutrition solutions.

The physicochemical stability and availability of 0.1% 5-fluorouracil solutions in D5W and a typical total parenteral nutrition solution (hypertonic dextrose and crystalline amino acids) were studied in both glass and Viaflex delivery systems. Serial samples collected over a 48-hour period were assayed for 5-fluorouracil concentration using a high performance liquid chromatographic technique. Changes in the pH as well as precipitate formation were also investigated. There was no reduction in the amount of 5-fluorouracil at 48 hours in either the glass or plastic system, regardless of whether the drug was added to D5W or to the total parenteral nutrition solution. No pH changes or precipitates were observed. These findings indicate that 5-fluorouracil is compatible with and available from total parenteral solutions of hypertonic dextrose and amino acid in both plastic and glass containers. Use of such a system would allow for (1) a reduction in vascular access in patients receiving both treatments and (2) continued administration of nutritional support without the requirement for additional fluid volume.

Amino Acids↗
PubMedDate not supplied

Is an antiemetic prophylactic treatment needed for patients submitted to consecutive days of 5-fluorouracil? An observational study.

AIMS AND BACKGROUND: The necessity of an antiemetic prophylaxis in patients treated with chemotherapy of low emetogenic potential, such as 5-fluorouracil +/- folinic acid fractionated over several consecutive days, is controversial. The aim of the study was to evaluate the therapeutic behavior of oncologists on this issue. METHODS: All consecutive in and out patients who started chemotherapy in 33 Italian oncological departments from June 24 to July 6,1996, were studied. The antiemetic prescription pattern and its effectiveness, in patients submitted to 5-fluorouracil +/- folinic acid were evaluated. RESULTS: Of the 1956 patients submitted to cancer chemotherapy, 259 patients received 5-fluorouracil +/- folinic acid. Of these, 186 patients were treated for 5 consecutive days, 47 for 4 days, 20 for 3 days and 6 for 2 days. A total of 219 (84.5%) received an antiemetic prophylaxis: 43.4% a 5-HT3 antagonist +/- steroids, 37.5% an antidopaminergic drug, 10.9% a steroid +/- antidopaminergic drug, and 8.2% other drugs. Only 40 patients (15.5%) did not receive an antiemetic prophylaxis. Overall complete protection from vomiting/nausea was 225/259 (86.9%)/163/259 (62.9%). The complete protection from vomiting/nausea during the 5 days in the 186 patients was not significantly different among patients receiving or not an antiemetic prophylaxis (88.1%/64.9% vs 88.9%/55.6%). At unifactorial analysis, the previous experience of vomiting/nausea caused by chemotherapy was found to be a significant prognostic factor. In fact, overall complete protection from vomiting/nausea was significantly inferior in patients who had previous experience of vomiting/nausea (65.1%/35.0%) with respect to those who did not (91.2%/75.4%, P < 0.001/ > 0.001, respectively). CONCLUSIONS: The study showed that in clinical practice patients submitted to 5-fluorouracil +/- folinic acid obtained a similar high protection from vomiting and nausea regardless of whether or not antiemetic prophylaxis was given. It would be therefore reasonable not to treat patients undergoing such chemotherapy, whereas patients with previous experience of vomiting/nausea caused by chemotherapy should be given an antiemetic prophylaxis.

Aged↗
PubMedDate not supplied

5-fluorouracil-carboplatin continuous infusion as salvage chemotherapy in advanced cancer.

AIMS AND BACKGROUND: 5-fluorouracil given by continuous infusion allows higher dose delivery, causes less myelosuppression and may interfere with repair of DNA damage caused by carboplatin. With this rationale, we conducted a phase II study to test the activity and toxicity of 5-fluorouracil and carboplatin given in continuous infusion to patients with advanced cancer and pretreated with at least two chemotherapy regimens. METHODS: Forty patients with advanced tumors (21 colon, 4 stomach, 3 breast, 3 bladder, 3 ovary, and 6 at other sites) were entered in the trial. 5-fluorouracil (200 mg/m2) and carboplatin (20 mg/m2) were administered by continuous infusion from days 1 to 20, every 4 weeks. RESULTS: All patients were assessable for response and toxicity. A total of 138 courses of chemotherapy were administered, with a mean of 3.5 per patient (range, 2-9). Toxicity, assessed using WHO criteria, was as follows: nausea and vomiting grade 2-3 in 34% of patients, alopecia grade 2-3 in 96%, and neutropenia grade 3-4 in 26%. One patient (2.5%) had a complete response to therapy and 7 (17.5%) had a partial response (response rate 20%; 95% Cl, 9.06-35.68%). Disease stability and progression occurred in 12 (30%) and 20 (50%) patients, respectively. Median time to progression was 5.6 months (range, 2.8-45.9+), with a median survival time of 7.7 months (range, 1.5-45.9+). CONCLUSIONS: Outpatient treatment with a combination of 5-fluorouracil and carboplatin in continuous infusion was active as salvage treatment for advanced tumors and may give prolonged palliation of symptoms with manageable toxicity.

Adult↗
PubMedDate not supplied

Acceptance of external infusion pumps in patients with advanced breast cancer receiving continuous infusion fluorouracil.

BACKGROUND: We investigated the physical and psychological adaptation to a protracted continuous infusion system in a series of patients receiving protracted continuous infusion of 5-fluorouracil for advanced breast cancer. PATIENTS AND METHODS: The protracted continuous infusion of 5-fluorouracil was administered by means of a portable elastomeric pump (Baxter Seven-Day Infusor, 0.5 mL/hr) via an indwelling Groshong catheter. Patients were asked to complete a questionnaire exploring the impact of the continuous infusion system upon various aspects of daily life, the overall level of disturbance, the general judgement on its quality, and their willingness to resume the same kind of treatment in the future. All items were graded on a 4-point scale from 0 = not at all, to 4 = very much. RESULTS: Seventy-one patients were evaluated. All patients received 5-fluorouracil at the dose of 250 mg/m2/day as a protracted continuous infusion alone (n = 14) or in combination with vinorelbine (n = 45) or Taxol (n = 12). The median duration of the protracted continuous infusion before evaluation was 9 months (3-31). The mean level of disturbance to daily activities was 0.86 points. The activities most frequently disturbed by treatment included daily personal care (mean, 1.76 points) and sexual activity (mean, 1.20 points). Twenty-one patients required medical intervention because of problems related to the protracted continuous infusion system. The overall level of disturbance was rated at a mean level of 0.72 points, whereas the overall merits of the protracted continuous infusion system and the willingness of the patient to resume protracted continuous infusion in the future were rated at a mean level of 2.90 and 2.55 points, respectively. CONCLUSIONS: The system for the protracted continuous infusion of 5-fluorouracil was well tolerated by the patients, who were able in most cases to perform their daily activities with little or no disturbance, needing only occasional help, and were willing to resume the same treatment modality if necessary.

Activities of Daily Living↗
PubMedDate not supplied

5-Fluorouracil-induced severe but reversible cardiogenic shock: a case report.

5-fluorouracil cardiotoxicity is increasingly recognized with variable presentation. We report a patient who developed cardiogenic shock due to high-dose 5-fluorouracil infusion (1,000 mg/m2 every 24 hr for 96 hr). There was no evidence of myocardial necrosis. The patient recovered completely without any residual cardiac dysfunction. The exact cause of 5-fluorouracil toxicity remains to be determined. The case highlights the need for careful monitoring of patients who receive high-dose 5-fluorouracil for the development of cardiotoxicity.

Adult↗