Upfront S-1-based chemotherapy in GI cancer patients with severe cardiac comorbidity: a European case series

In this video, Dr Gertjan Rasschaert discusses with Prof Dr Pia Österlund the use of upfront S-1-based chemotherapy in patients with gastrointestinal (GI) cancers and severe cardiac comorbidities.¹ Fluoropyrimidines remain central to the treatment of GI cancers, but 5-FU and capecitabine can be contraindicated in patients at high risk of cardiotoxicity. Previous real-world data supported the use of S-1 after fluoropyrimidine-related cardiotoxicity, and this analysis explored whether S-1 could also be used upfront in patients considered unsuitable for standard fluoropyrimidines.

The retrospective case series included 14 patients from seven European centres with colorectal or gastro-oesophageal cancer and severe recent or ongoing cardiac disease, including myocardial infarction, heart failure, cardiomyopathy and arrhythmias. Patients received S-1 either as monotherapy or combined with other agents such as oxaliplatin, irinotecan, bevacizumab or cetuximab, across adjuvant, neoadjuvant/conversion and metastatic treatment settings.

Overall, 13 of 14 patients received S-1-based treatment without recurrent or worsening cardiotoxicity. One patient developed asymptomatic deterioration of left ventricular ejection fraction, leading to treatment discontinuation. Three further patients discontinued due to non-cardiac adverse events. Prof Österlund highlights that S-1 may offer a valuable fluoropyrimidine alternative for patients with a strong oncological need for treatment but a high cardiac risk, while emphasising the importance of continued real-world data collection and international collaboration.