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Variant angina pectoris associated with FOLFOX4 therapy

Author(s): Hiromichi Yamane | Minoru Matsubara | Shigeki Umemura | Toshimitsu Suwaki | Haruhito Kamei | Nagio Takigawa | Katsuyuki Kiura | Mitsune Tanimoto

Journal: World Journal of Gastrointestinal Oncology
ISSN 1948-5204

Volume: 3;
Issue: 11;
Start page: 165;
Date: 2011;
Original page

Keywords: FOLFOX4 | Acute coronary syndrome | Variant angina | Allergy

The patient was a 71-year-old man who underwent a right hemicolectomy for ascending colon cancer (pT3, pN1, pM0) and who opted not to receive adjuvant chemotherapy. Eight months later, multiple liver metastases occurred. He therefore received FOLFOX4 (5-fluorouracil/leucovorin and 85 mg/m2 oxaliplatin) therapy, up to a total of 5 courses, and showed a partial response. While receiving the sixth course of FOLFOX4, he complained of chest pain and systemic itching approximately 15 min after the start of chemotherapy. An electrocardiogram revealed typical signs of ischemia. Coronary arteriography showed that the coronary arteries were intact. Believing the chest pain to be merely coincidental, we continued with the same therapy. However, he again developed the same chest pain during the seventh cycle of FOLFOX4 and treatment was stopped. We concluded that the patient’s symptoms were due to acute coronary syndrome (ACS) associated with the FOLFOX4 regimen. Variant angina as a type of ACS is a rare adverse effect of FOLFOX4. Clinicians should be aware of this potential adverse effect when monitoring patients receiving FOLFOX4.
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