5-Fluorourasil İlişkili Semptomatik Bradikardi Gelişen Bir Metastatik Kolorektal Kanser Hastasında XELİRİ-Aflibercept Kombinasyonunun Etkinlik ve Tolerabilitesi: Bir Olgu Sunumu ve Kısa Literatür Derlemesi

Öz

5-Fluorouracil (5-FU) ve oral floropirimidinler kolorektal kanser (CRC) kemoterapisinde temel yapıtaşı ilaçlardan olmasına rağmen, bu ilaçların pek çok geleneksel ve kardiyotoksik yan etkileri bulunmaktadır. Oluşabilecek yüksek mortalite riskinden dolayı genellikle iskemik belirtiler ve diğer kardiyak yan etkilerden sonra bu ilaçların yeniden kullanımları önerilmemekle birlikte, bazı hastalarda başka bir floroprimidin ya da bolus 5-FU ile devam edilmesi düşünülebilir. Aflibercept ve FOLFIRI rejimi kombinasyonu metastatik kolorektal kanserli (mCRC) hastaların ikinci basamak tedavisinde kullanılan onaylı bir tedavidir. XELIRI, bir başka etkili ve kullanılması kolay bir irinotekan ve floropirimidin kombinasyonu rejimi olmasına rağmen FOLFIRI rejiminden daha toksik oldğundan artık rutin olarak önerilmemektedir. Buna rağmen, XELIRI rejiminin modifiye doz formunun (mXELIRI), FOLFIRI ile kıyaslandığında daha az etkin olmadığı ve tolerabl olduğu saptanmıştır. Ancak henüz mXELIRI ve aflibercept kombinasyonunun etkinliği araştırılmamıştır. Bu yazıda infüzyonel 5-FU sonrası semptomatik sinüs bradikardisi gelişen ve bu kardiyak yan etki nedenli FOLFIRI-aflibercept rejimine devam edilemeyen bir hasta sunulmuştur. Hastada infüzyonel 5-FU yerine azaltılmış doz kapesitabin ve irinotekan ile mXELIRI rejimi şeklinde verilmiş ve aflibercept ile kombine edilmiştir. Hasta bu tedaviyi kardiyak ya da ciddi gastrointestinal yan etkiler olmadan iyi bir şekilde tolere etmiş, ve 12 aylık progresyonsuz sağkalım süresi sağlanmıştır. İnfüzyonel 5-FU ilişkili sinüs bradikardisinde, infüzyonel 5-FU yerine kapesitabin kullanmak bazı hastalar için bir seçenek olabilir. Ancak, yine de onkoloji uzmanları bu durumlarda mutlaka tedavi planını yarar/zarar oranına göre düzenlemelidir. Aflibercept ve mXELIRI kombinasyonu port katater takılmasını istemeyen ya da yan etki nedenli infüzyonel 5-FU alamayan hastalarda alternatif bir rejim olabilir.

Anahtar Kelimeler

• XELIRI
• Aflibercept
• Bradycardia
• 5-Fluorouracil
• Capecitabine

The Efficacy and Tolerability of Xeliri-Aflibercept Combination in A Metastatic Colorectal Cancer Patient After 5-Fu- Induced Symptomatic Bradycardia: A Case Report and A Brief Review of Literature

Öz

5-Fluorouracil (5-FU) and oral fluoropyrimidines are the backbone of colorectal cancer (CRC) chemotherapy, but these have many traditional and cardiotoxic side effects. Rechallenge is usually not recommended due to high mortality rates after ischemic symptoms and other cardiac side effects, but replacing these drugs with another fluropyrimidine, or bolus 5-FU, can be considered for some patients. Aflibercept combined with a FOLFIRI regimen is an accepted second-line therapy for metastatic colorectal cancer (mCRC) patients. XELIRI is another effective and feasible irinotecan and fluoropyrimidine combination, which is more toxic than the FOLFIRI regimen and is not routinely recommended. However, modified doses of XELIRI (mXELIRI) were found to be non-inferior to FOLFIRI. The efficacy of the mXELIRI and aflibercept combination has not investigated yet. We present a patient with infusional 5-FU-induced sinus bradycardia that we could not continue FOLFIRI-aflibercept due to this cardiac side effect. We replaced infusional 5-FU with reduced dosages of capecitabine and irinotecan as in the mXELIRI regimen and combined those with aflibercept. The patient tolerated this regimen well without cardiac or severe gastrointestinal side effects, and had 12 months of progression-free survival. Replacing capecitabine with infusional 5-FU might be an option for some patients experiencing 5-FU-related sinus bradycardia. However, oncologists should arrange the treatment plan according to the risk/benefit ratio. Aflibercept combined with mXELIRI may be an alternative regimen for patients who refuse port catheter placement or who are not able to receive infusional-5-FU due to adverse side effects.

Anahtar Kelimeler

• XELIRI
• Aflibercept
• Bradycardia
• 5-Fluorouracil
• Capecitabine

Kaynakça

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