Bolus 5-Fluorouracil as an alternative modality to infusion 5-Fluorouracil in a patient with rectal cancer and capecitabine-induced cardiotoxicity.

5-Fluorouracil (5-FU) is the backbone of the chemotherapy regimens approved for treatment of colorectal cancer. Incidence of cardiotoxicity associated with 5-FU ranges between 1.5% to 18%; 48% as anginal symptoms and 2% as cardiogenic shock. Cardiotoxicity is unpredictable and no alternatives have been defined so far. A 35-year-old man treated for stage III A rectal cancer developed chest pain typical of angina on treatment with capecetabine initially and 5-FU infusion afterwards. Scheduled dosing of 5-FU was changed from infusion to a bolus type. He was asymptomatic with no electrocardiographic (ECG) changes on 24-h Holter monitoring after changing the mode of administration to bolus 5-FU. Here, we report the first case in the English literature where a change in the mode of 5-FU administration to bolus is an alternative to infusion 5-FU-induced cardiotoxicity. In conclusion, Bolus 5-FU can be used in patients developing cardio-toxicity due to 5-FU infusion.