Capecitabine-induced cardiotoxicity: More evidence or clinical approaches to protect the patients' heart?

Fluoropyrimidines, such as capecitabine and 5-fluorouracil, may cause cardiac toxicity. In recent years, the incidence of this side effect has increased and it is expected to further rise due to the population aging and the disproportionate incidence of breast and gastrointestinal cancers in older individuals. The spectrum of cardiac manifestations includes different signs and symptoms and the diagnosis may be difficult. Here, we report the case of a 43-year-old woman with advanced breast cancer who was rechallenged with a capecitabine-based regimen after experiencing a cardiac adverse event during the first fluoropyrimidine exposure. This real-practice case serves as a springboard for discussion about the current evidence on differential diagnosis of capecitabine-related cardiac toxicity, its risk factors, and the underpinning mechanisms of early onset. Moreover, we discussed whether a rechallenge with fluoropyrimidines could be safe in patients who had experienced a previous cardiac adverse even

Validation and improvement of Risk-UE LM2 capacity curves for URM buildings with stiff floors and RC shear walls buildings

This paper addresses seismic vulnerability assessment at an urban scale and more specifically the capacity curves involved for building damage prediction. Standard capacity curves are a function of predefined building typology and are proposed in the Risk-UE LM2 method for computation of the corresponding damage grades. However, these capacity curves have been mainly developed for building stock of southern European cities and the accuracy of their application with different building features, such as the ones of cities of northern Europe should be assessed. A recent research project of seismic scenarios for the cities of Sion and Martigny in Switzerland provided the opportunity to check the capacity curves of Risk-UE LM2 method. Within the framework of this project, a detailed analysis was achieved for more than 500 buildings. These buildings were typical Swiss buildings and were composed of both unreinforced masonry buildings with stiff floors and reinforced concrete buildings. The construction drawings of each building were collected in order to have the most accurate information about their main structural characteristics. The typological classification that has been adopted was developed in a recent research project. Based on the individual features of the buildings, individual capacity curves were defined. Results of the seismic assessment applied to the 500 buildings compare very well with those obtained by using Risk-UE LM2 method for unreinforced masonry buildings with stiff floors. A slight improvement may be proposed for buildings with three stories through their introduction to the category of low-rise instead of mid-rise buildings. By contrast, accuracy for reinforced concrete buildings with shear walls is very poor. Damage prediction using related capacity curves of Risk-UE LM2 method does not correspond to reality. Prediction is too pessimistic and moreover damage grades increase with the height category (low-rise, mid-rise and high-rise) of these buildings which is in contradiction with the observed damages for this type of buildings. Improvements are proposed to increase the accuracy of the seismic vulnerability assessment for northern European building stock. For unreinforced masonry buildings, a slight modification of the limits of the height category of buildings using the ones defined for RC buildings improves the damage prediction. For reinforced concrete buildings with shear walls improved capacity curves derived from the typological curves of the specific typology C are proposed

Neoplastic pericardial disease: Old and current strategies for diagnosis and management

The prevalence of neoplastic pericardial diseases has changed over time and varies according to diagnostic methods. The diagnostic factor is usually the detection of neoplastic cells within the pericardial fluid or in specimens of pericardium, but the diagnosis may be difficult. Accurate sampling and cytopreparatory techniques, together with ancillary studies, including immunohistochemical tests and neoplastic marker dosage, are essential to obtain a reliable diagnosis. The goals of treatment may be simply to relieve symptoms (cardiac tamponade or dyspnea), to prevent recurrent effusion for a long-term symptomatic benefit, or to treat the local neoplastic disease with the aim of prolonging survival. Immediate relief of symptoms may be obtained with percutaneous drainage or with a surgical approach. For long term prevention of recurrences, various approaches have been proposed: extended drainage, pericardial window (surgical or percutaneous balloon pericardiostomy), sclerosing local therapy, local and/or systemic chemotherapy or radiation therapy (RT) (external or with intrapericardial radionuclides). The outcomes of various therapeutic approaches vary for different tumor types. Lymphoma and leukemias can be successfully treated with systemic chemotherapy; for solid tumors, percutaneous drainage and the use of systemic and/or local sclerosing and antineoplastic therapy seems to offer the best chance of success. The use of “pure” sclerosing agents has been replaced by agents with both sclerosing and antineoplastic activity (bleomycin or thiotepa), which seems to be quite effective in breast cancer, at least when associated with systemic chemotherapy. Local chemotherapy with platinum, mitoxantrone and other agents may lead to good local control of the disease, but the addition of systemic chemotherapy is probably relevant in order to prolong survival. The surgical approach (creation of a pericardial window, even with the mini-invasive method of balloon pericardiostomy) and RT may be useful in recurring effusions or in cases that are refractory to other therapeutic approaches

Trastuzumab adjuvant chemotherapy and cardiotoxicity in real-world women with breast cancer

Adjuvant trastuzumab therapy improves survival of human epidermal growth factor receptor 2 (HER2)-positive women with early breast cancer (EBC). A careful monitoring of cardiac function is needed due to potential trastuzumab cardiotoxicity (Tcardiotox). To date, the incidence, timing, and phenotype of patients with Tcardiotox in clinical practice are not well known

Role of hypertension on new onset congestive heart failure in patients receiving trastuzumab therapy for breast cancer

Adjuvant trastuzumab therapy improves survival of Human Epidermal growth factor receptor 2 (HER2)-positive women with early breast cancer (EBC). Trastuzumab-induced cardiotoxicity is not uncommon. In the setting of community patients, the incidence, timing and phenotype of new onset congestive heart failure (CHF) is unknown