What is the clinical evidence from this study?

Study design: Cohort. Population: Fluoropyrimidine-induced cardiotoxicity (n=141). Intervention: Fluoropyrimidine reintroduction vs. Switch to alternative chemotherapy. Primary outcome: Overall survival (HR 1.77, 95% CI 0.92-3.42, p=0.088).

What question did this study set out to answer?

To assess the safety of reintroducing fluoropyrimidine chemotherapy in patients with a history of cardiotoxicity.

March 9, 2026Supportive Care in Cancer2 citationsOpen Access

Fluoropyrimidine-induced cardiotoxicity: outcomes and safety of chemotherapy reintroduction in a retrospective cohort study

OROcéane Rea ABAnissa C. Bouali MSM. Serraille

Key Result

Fluoropyrimidine reintroduction after cardiotoxicity showed a trend toward higher overall survival compared to alternative chemotherapy (HR 1.77), without significantly increasing hospitalizations.

Key Points

To assess the safety of reintroducing fluoropyrimidine chemotherapy in patients with a history of cardiotoxicity.
Conducted a retrospective cohort study on patients with fluoropyrimidine-induced cardiotoxicity.
Implemented a multidisciplinary evaluation for candidate selection.
Applied cardiovascular management strategies and close monitoring during reintroduction.
Reintroduction of fluoropyrimidine demonstrated favorable outcomes for selected patients.
The benefit/risk balance was considered favorable under guided evaluations and management.

Study Design

Type

Cohort (n=141)

Multicenter

Yes

Structured PICO

Does fluoropyrimidine reintroduction improve survival compared to alternative chemotherapy or palliative care in patients who experienced fluoropyrimidine-induced cardiotoxicity?

Population

141 patients (median age 69, 31.9% female) with cancer who experienced a cardiovascular event during fluoropyrimidine treatment, followed for 2 years to assess outcomes of chemotherapy reintroduction.

Exposure

Fluoropyrimidine reintroduction (n=54) guided by multidisciplinary evaluation, cardiovascular management, and close monitoring.

Comparator

Switch to a non-fluoropyrimidine alternative chemotherapy (n=25) or transition to palliative care (n=36).

Outcome

All-cause mortality and unplanned hospitalization over a 2-year follow-up period from the index cardiac event.hard clinical

Fluoropyrimidine reintroduction after cardiotoxicity appears feasible and may offer a survival benefit over alternative therapies when guided by multidisciplinary management, with an acceptable recurrence rate.

Main Result

Hazard Ratio: 1.77 (95% CI 0.92–3.42)

Absolute Event Rate: 62.3% vs 36%

p-value: p=0.088

Limitations

Retrospective nature leading to potential selection and information bias
Conducted in only two tertiary centers, which may limit generalizability
Small sample size in some subgroups reduces statistical power
Survival analyses were performed without adjustment for confounders such as age, comorbidities, or tumor burden
Heterogeneity in reintroduction protocols limits reproducibility

Abstract

Our findings suggest that fluoropyrimidine reintroduction-guided by multidisciplinary evaluation, cardiovascular management, and close monitoring-appears to have a favorable benefit/risk balance for selected patients.

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