Adjuvant Treatment with5-Fluorouraciland Oxaliplatin Does Not Influence Cardiac Function, Neurovascular Control, and Physical Capacity in Patients with Colon Cancer

Author(s):Show less -

Groehs, Raphaela V. ^{[1, 2]} ; Negrao, Marcelo V. ^[3] ; Hajjar, Ludhmila A. ^{[2, 4]} ; Jordao, Camila P. ^[2] ; Carvalho, Bruna P. ^[2] ; Toschi-Dias, Edgar ^[2] ; Andrade, Ana C. ^[2] ; Hodas, Fabiana P. ^[2] ; Alves, Maria J. N. N. ^[2] ; Sarmento, Adriana O. ^[2] ; Testa, Laura ^{[5, 4]} ; Hoff, Paulo M. G. ^{[5, 4]} ; Negrao, Carlos E. ^{[2, 6]} ; Kalil Filho, Roberto ^{[7, 2]}

Affiliation

^[1] Hosp Israelita Albert Einstein, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Coracao InCor, Sao Paulo, SP - Brazil

^[3] Univ Texas MD Anderson Canc Ctr, Dept Thoracic Head & Neck Med Oncol, Houston, TX 77030 - USA

^[4] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Canc Estado Sao Paulo, Sao Paulo, SP - Brazil

^[5] DOr Inst Res & Educ IDOR, Sao Paulo - Brazil

^[6] Univ Sao Paulo, Escola Educ & Fis Esporte, Sao Paulo, SP - Brazil

^[7] Sirio Libanes Hosp, Sao Paulo - Brazil

• Document type: Journal article
• Source: ONCOLOGIST; v. 25, n. 12 AUG 2020.
• Web of Science Citations: 0

Abstract

Background Adjuvant chemotherapy with 5-fluorouracil (5-FU) and oxaliplatin increases recurrence-free and overall survival in patients with colon adenocarcinoma. It is known that these drugs have been associated with cardio- and neurotoxicity. We investigated the effects of 5-FU +/- oxaliplatin on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer. Methods Twenty-nine patients with prior colectomy for stage II-III adenocarcinoma and clinical indication for adjuvant chemotherapy were allocated to receive 5-FU (n= 12) or 5-FU + oxaliplatin (n= 17), according to the oncologist's decision. All the analyses were performed just before and after the end of chemotherapy. Cardiac function was assessed by echocardiography and speckle tracking, and cardiac autonomic control was assessed by heart rate variability (HRV). Vascular endothelial function was assessed by flow-mediated dilation (FMD). Muscle sympathetic nerve activity (MSNA) was directly recorded by microneurography technique, and muscle blood flow by venous occlusion plethysmography. Physical capacity was evaluated by cardiopulmonary exercise test. Results Chemotherapy (pooled data) did not significantly change left ventricular ejection fraction (58 +/- 1 vs. 55 +/- 2%,p= .14), longitudinal strain (-18 +/- 1 vs. -18 +/- 1%,p= .66), and HRV. Likewise, chemotherapy did not significantly change FMD, muscle blood flow, and MSNA (33 +/- 2 vs. 32 +/- 1 bursts/min,p= .31). Physical capacity was not significantly changed in both groups. Similar findings were observed when the patients were subdivided in 5-FU and 5-FU + oxaliplatin treatment groups. 5-FU and 5-FU + oxaliplatin did not significantly change cardiac function, HRV, vascular responses, MSNA, and physical capacity. Conclusion This study provides evidence that adjuvant treatment with 5-FU +/- oxaliplatin is well tolerated and does not promote changes compatible with long-term cardiotoxicity. Implications for Practice Adjuvant chemotherapy with 5-fluorouracil (5-FU) and oxaliplatin increases recurrence-free and overall survival in patients with colon adenocarcinoma; however, these drugs have been associated with cardio- and neurotoxicity. This study investigated the effects of these drugs on cardiac function, vascular responses, neurovascular control, and physical capacity in patients with colon cancer. It was found that 5-FU and oxaliplatin did not significantly change cardiac function, cardiac autonomic control, vascular endothelial function, muscle sympathetic nerve activity, and physical capacity. This study provides evidence that adjuvant treatment with 5-FU +/- oxaliplatin is well tolerated and does not promote changes compatible with long-term cardiotoxicity. (AU)

• FAPESP's process: 13/07651-7 - Prognostic value of the oscillatory pattern of muscle sympathetic nerve activity in patients with heart failure
• Grantee: Edgar Toschi Dias
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 15/22814-5 - Cancer and heart: new paradigms of diagnosis and treatment
• Grantee: Carlos Eduardo Negrão
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 15/05427-8 - Impact of adjuvant chemotherapy in autonomic cardiovascular regulation in patients with colon cancer
• Grantee: Raphaela Vilar Ramalho Groehs Miranda
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 15/17642-0 - A multisystem pathophysiological approach to heart failure with preserved ejection fraction in the elderly: searching for new therapeutic strategies
• Grantee: Edgar Toschi Dias
• Support Opportunities: Scholarships abroad - Research Internship - Post-doctor