{"doi":"10.1371/journal.pone.0265767","title":"The efficacy and safety of cardio-protective therapy in patients with 5-FU (Fluorouracil)-associated coronary vasospasm","abstract":"BACKGROUND: Coronary vasospasm is a known side effect of 5-FU (fluorouracil) therapy. Beyond switching to non-5FU-based chemotherapy, there are no established treatments for 5-FU associated coronary vasospam. Our objective was to assess the safety and efficacy of re-challenge with 5-FU after pre-treatment with calcium channel blockers (CCBs) and long-acting nitrates among patients 5-FU associated coronary vasospasm. METHODS: We conducted a retrospective study of patients with 5-FU coronary vasospasm at a single academic center. By protocol, those referred to cardio-oncology received pre-treatment with either combination [nitrates and CCBs] or single-agent therapy [nitrates or CCBs]) prior to re-challenge with 5-FU. Our primary outcome was overall survival. Other important outcomes included progression-free survival and safety. RESULTS: Among 6,606 patients who received 5-FU from January 2001 to Dec 2020, 115 (1.74%) developed coronary vasospasm. Of these 115 patients, 81 patients continued 5-FU therapy, while 34 stopped. Of the 81 who continued, 78 were referred to cardio-oncology and prescribed CCBs and/or nitrates prior to subsequent 5-FU, while the remaining 3 continued 5-FU without cardiac pre-treatment. Of the 78, 56.4% (44/78) received both nitrates and CCBs, 19.2% (15/78) received CCBs alone, and 24.4% (19/78) received nitrates alone. When compared to patients who stopped 5-FU, those who continued 5-FU after pre-treatment (single or combination therapy) had a decreased risk of death (HR 0.42, P = 0.005 [95% CI 0.23-0.77]) and a trend towards decreased cancer progression (HR 0.60, P = 0.08 [95% CI 0.34-1.06]). No patient in the pre-treatment group had a myocardial infarct after re-challenge; however, chest pain (without myocardial infarction) recurred in 19.2% (15/78) among those who received cardiac pre-treatment vs. 66.7% (2/3) among those who did not (P = 0.048). There was no difference in efficacy or the recurrence of vasospasm among patients who received pre-treatment with a single agent (nitrates or CCBs) or combination therapy (14.7% (5/34) vs. 25.0% (11/44), P = 0.26). CONCLUSION: Re-challenge after pre-treatment with CCBs and nitrates guided by a cardio-oncology service was safe and allowed continued 5-FU therapy.","journal":"PLoS ONE","year":2022,"id":251133,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":25,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9616,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":308168,"name":"Zsófia D. Drobni","orcid":"0000-0002-1355-5318","position":1,"is_corresponding":false},{"id":648188,"name":"Matthew Lei","orcid":"0000-0001-5348-6065","position":2,"is_corresponding":false},{"id":642942,"name":"Carlos A. Gongora","orcid":"0000-0002-0383-2086","position":3,"is_corresponding":false},{"id":642941,"name":"Thiago Quinaglia","orcid":"0000-0001-9099-3007","position":4,"is_corresponding":false},{"id":648189,"name":"Uvette Lou","orcid":"0000-0001-9220-3646","position":5,"is_corresponding":false},{"id":648187,"name":"Ramya Mosarla","orcid":"0000-0002-8486-6279","position":6,"is_corresponding":false},{"id":232172,"name":"Sean Murphy","orcid":"0000-0002-5928-5974","position":7,"is_corresponding":false},{"id":232175,"name":"Maeve Jones‐O’Connor","orcid":"0000-0002-0508-2493","position":8,"is_corresponding":false},{"id":893961,"name":"Ali Mahmood","orcid":"0000-0002-8989-114X","position":9,"is_corresponding":false},{"id":309885,"name":"Sarah Hartmann","orcid":null,"position":10,"is_corresponding":false},{"id":309886,"name":"Hannah Gilman","orcid":null,"position":11,"is_corresponding":false},{"id":43404,"name":"Colin D. Weekes","orcid":"0000-0001-6287-4334","position":12,"is_corresponding":false},{"id":260767,"name":"Ryan David Nipp","orcid":"0000-0002-4577-3248","position":13,"is_corresponding":false},{"id":635466,"name":"John R. Clark","orcid":null,"position":14,"is_corresponding":false},{"id":230274,"name":"Jeffrey W. Clark","orcid":"0000-0001-9524-3600","position":15,"is_corresponding":false},{"id":260766,"name":"Lawrence S. Blaszkowsky","orcid":"0000-0002-9437-2977","position":16,"is_corresponding":false},{"id":648190,"name":"Erica Tavares","orcid":"0009-0003-8780-4393","position":17,"is_corresponding":false},{"id":232198,"name":"Tomas G. Neilan","orcid":"0000-0002-1513-8833","position":18,"is_corresponding":false},{"id":308169,"name":"Amna Zafar","orcid":"0000-0003-2010-3018","position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":null,"created_at":"2026-07-19T00:24:37.429628Z","pmid":"35390017","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}