Work

Risk of myocardial infarction following capecitabine treatment in patients with gastrointestinal cancer – a nationwide registry-based study

Year: 2025

Type: article

Abstract: BACKGROUND: Myocardial infarction (MI) is an adverse event potentially associated with capecitabine treatment, potentially impacting the continuation of cancer therapy. However, data on its incidence remain limited. METHODS: Using Danish nationwide registries, we identified patients with gastrointestinal (GI) cancer treated with capecitabine (2004–2016) and compared them to age- and sex-matched controls without cancer. Patients with prior ischemic heart disease were excluded but were subsequently analyzed as a separate secondary cohort. Cumulative incidences of MI and competing risks were calculated, and multivariable regression analyses were performed. RESULTS: A total of 23,820 patients with GI cancer treated with capecitabine and 47,640 controls without cancer were included. Differences in comorbidities and antianginal medications were not significantly different (P > 0.05 for all). At 6 months, the cumulative incidence of MI was significantly higher for patients treated with capecitabine at 0.6% (95% CI: 0.5%-0.7%) versus 0.3% (95% CI: 0.3%-0.4%) in controls, with a competing risk of death of 15.2% versus 0.7%. At 1 year, the cumulative incidence of MI for patients receiving capecitabine was 0.7% (95% CI: 0.6%-0.9%) versus 0.6% (95% CI: 0.5%-0.6%) among controls, with a competing risk for death of 29.7% versus 1.6%. After accounting for competing risks, the sub distribution hazard ratios indicated an increased risk of MI for patients receiving capecitabine compared with control subjects at both 6 months (hazard ratio: 2.02; 95% CI: 1.57–2.60; P < 0.001) and 12 months (hazard ratio: 1.28; 95% CI: 1.05–1.57; P = 0.015). CONCLUSION: Capecitabine treatment in GI cancer patients was associated with an increased MI risk at 6 and 12 months compared to controls, though absolute risks were low. Given the high competing mortality, the clinical relevance of this increased MI risk appears limited. In a secondary analysis of patients with known ischemic heart disease, our findings suggest that cardiovascular risk assessment and monitoring is warranted during capecitabine therapy, rather than routine avoidance of treatment.

Source: Cardio-Oncology

DOI: 10.1186/s40959-025-00401-x