JACC CardioOncol

Fluoropyrimidine chemo for GI cancers: Weighing mortality benefit against CV risks

April 21, 2025

Study details: This observational cohort study used a target trial emulation framework to analyze data from 103,110 adults with GI cancer and compare all-cause mortality and acute cardiovascular events between patients treated with fluoropyrimidine-based chemotherapy and those receiving alternative treatments. Data were sourced from national cancer, cardiac, and hospitalization registries.

Results: Fluoropyrimidine-treated patients had a significantly lower risk difference (RD) of death at one year (RD: -7.7%; 95% confidence interval [CI]: -8.7% to -6.7%). However, there was a small increased risk of acute cardiovascular events (RD: 0.9%; 95% CI: 0.0% - 1.9%), primarily arrhythmias (RD: 0.8%; 95% CI: 0.1% - 1.6%) and cardiac arrest (RD: 0.3%; 95% CI: 0.1% - 0.5%). Notably, patients with pre-existing coronary artery disease didn't show an increased risk of acute coronary syndromes.

Clinical impact: The substantial survival benefit of fluoropyrimidine chemotherapy in GI cancer patients outweighs the small risk of cardiovascular events. Oncologists should consider these findings in treatment decisions, particularly for patients with cardiovascular disease, to avoid unnecessary clinical conservatism.

Source:

Abiodun AT, et al. (2025, March 28). JACC CardioOncol. Fluoropyrimidine Chemotherapy and the Risk of Death and Cardiovascular Events in Patients With Gastrointestinal Cancer. https://pubmed.ncbi.nlm.nih.gov/40202479/