Incidence of Vasospasm with Xeloda (Capecitabine)

Reported Incidence Rates

The European Society of Cardiology notes that fluoropyrimidines, including capecitabine and 5-fluorouracil, cause myocardial ischemia in up to 10% of patients, with the incidence varying based on dosing regimen and administration route 1
Manifest myocardial ischemia occurs in up to 18% of patients treated with fluoropyrimidines, according to the European Journal of Heart Failure 1
Silent myocardial ischemia has been documented in 6-7% of patients on fluoropyrimidine therapy when evaluated with stress testing, suggesting the clinical problem may be underestimated, as reported by the European Journal of Heart Failure 1

The pathophysiology of capecitabine-induced coronary vasospasm is multifactorial and includes direct coronary vasospasm and endothelial injury, as noted by the European Journal of Heart Failure 1
Chest pain and ischemic ECG changes typically occur at rest rather than during exercise, usually within days of drug administration and sometimes persist even after treatment cessation, according to the European Journal of Heart Failure 1

Patients with traditional cardiovascular risk factors may be at higher risk for capecitabine-induced vasospasm, as suggested by the American Heart Association, with a trend toward increased prevalence in cases 2

The American College of Cardiology recommends that calcium channel blockers and nitrates are the mainstay treatment for coronary vasospasm, as reported by Arteriosclerosis, Thrombosis, and Vascular Biology 2