The analysis of cardiac effects in patients who use oral fluoropyrimidin

Our study include the patients who made applicated Dokuz Eylül Üniversity Internal Medicine Main Department, Medical Oncology Department between June 2009 and June 2010 for the cancer treatment and for this purpose in our country using approved the oral fluoroprimidin the capesitabine planned.Patients who had received previous capesitabine treatment could not be evaluated. Of patients already have a history of any cardiac disease, were not seen as obstacles to treatment.Capesitabine applied 52 patients were studied and the mean age was 59. 39 of patients (%75) was female and 13 of patients(%25) were male. 32 of patients(% 61,5) were metastatic breast cancer, 18 of patients (%34,6) were metastatic colon cancer and 2 of patients(% 3,9) were metastatic gastric cancer.Of the patients followed, 18 patients(% 34,6) applied single agent capesitabine, 34 patients (% 65,4) applied capesitabine in combination with other chemotherapeutic drugs . 29 of the patients (%55,7) had previously received radiotherapy to the chest. 30 of the patients (% 55,7) previously treated with antracycline regimen chemotherapy. 9 of the patients (% 17,3) previously treated with monoclonal anticor,transtuzumab, for the breast cancer therapy.Before capesitabine treatment, patients were evaluated for abnormalities, particularly cardio-vascular system. 12 of all patients (%23) the symptoms in the cardiovascular system before capesitabine treatment was observed and 16 of all patients (%30,8) with a history of prior cardiovascular disease was observed. 10 of the patients with cardiovascular disease history used antihypertensive medication, and 3 of the patients used both antihypertensive medication and antihiperlidemic.Before treatment, in 16 of all patients (%26,9) in the physical examination findings were detected of the cardiovascular system. Before starting the treatment of patients electrocardiographic examinations made and 37 of all patients (%71,8) revealed significant electrocardiography symptoms. In case of need, the patients was consulted with cardiology department. Upon necessary, patients 11 had echocardiographic examinations were performed. Important cardiac pathologies were detected in 5 of these patients. However, the book was applied to all patients.Patient follow-up, capesitabine treatment before, getting started, after the start; capesitabine treatment began an hour after the treatment of the fourth day, the twenty-first day, and twenty-fourth day; cardiovascular system were controlled. The monitoring of all patients, 18 patients (%34,6)developed new symptoms of the cardiovascular system, physical changes in 6 ( %11,5), 17(%32,6) echocardiographic changes were observed. Echocardiography tests results configure that the corrected QT interval (QTc) were prolonged at all of 10 patients (%19,2). The first evaluations of ECG, 6 of all patients (%11,5) PR distance was long, while the short PR distances were observed in any patients. After capesitabine treatment, in 3 of all patients (%5,8) , depending on capasitabine usage PR prolongation seen in the distance. On the fourth day of follow-up in two of these patients, both prolonged QTc interval and PR distance were observed.Of patients receiving capesitabine treatment before and during treatment outcome evaluation showed no significant change in cardiovascular system complaints, physical examination of cardiovascular system symptoms. ECG findings between before capesitabine treatment and during treatment, showed that significant results at the new developed ECG findings. However, during the capesitabine treatment of patients who developed complaints, physical examination findings and ECG findings were more significant at the observation of the fourth day of treatment.When the patients followed during capesitabine use assessed; especially cardiovascular complaints of development, the formation of ECG changes, QTc interval prolongation detection, a bad cardiac effection, the causes of this ill-effects as resulted with half-cut of treatment; -the patients who has detected abnormalities in echo results before treatment, have the more of the new complaints in cardiovascular system,- the patients who apllied radiotherapy to the chest area earlier, developed more new ECG changes,- In patients with breast cancer, QTc prolongation was statistically at borderline, whereas previously treated of these patients with transtuzumab had more QTc prolongation was observed.Capesitabine has severe cardiac involvement and three patients (%5,8) has been discontinuation of treatment due to this involvement. After discontinuation of capesitabine treatment , all abnormal findings were observed to be normal in these patients. In this study, importance of follow-up of cardiovascular system in the patients used capesitabin revealed. The patients who had discontinued the treatment were all female.Developed severe cardiac involvement in patients due capesitabine rate was 5,8%. Angina pectoris, myocardial ischemia, and arrhythmias were noted serious cardiac effect . Such as cardiac death, myocardial infarction and other serious impacts, not found in any patients.