Efficacy of glyceryl trinitrate in reducing cardiac events when given concomitantly with capecitabine for at least 3 months in various tumors

Pak J Pharm Sci. 2024 Sep;37(5):1129-1134.

Abstract

Capecitabine is an oral pro-drug of 5-flourouracil used in treatment of different cancers. It has cardiotoxicity incidence of 3-35%, which can be significant enough to cause myocardial infarction. To evaluate the efficacy of glyceryl trinitrate in reducing cardiac events when given concomitantly with capecitabine for at least 3 months in various tumors. A quasi-experimental study was conducted in Hameed Latif Hospital from January 2019 to December 2023. A total of 65 patients with various malignancies and ECOG 0-2 were included. Glyceryl trinitrate was given before capecitabine for at least 3 cycles with 2.6 mg dosage twice a day. Cardiotoxicity was assessed after each 21-days cycle by taking history and ECG. Echocardiogram was done at 3-month follow up Patients aged from 49 to 86 years. Adverse events were noted in 3 (4.6%) patients. Two patients (3.1%) suffered from angina (grade 2 cardiotoxicity) while 1 (1.5%) suffered from a myocardial infarction (grade 3 cardiotoxicity). On stratification, only treatment in adjuvant setting (p<0.001) was found to be a possible risk factor. Glyceryl trinitrate may have potential to be used concomitantly with capecitabine to reduce the frequency of serious cardiac events in cancer patients. However, further studies are needed.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antimetabolites, Antineoplastic / administration & dosage
  • Antimetabolites, Antineoplastic / adverse effects
  • Antimetabolites, Antineoplastic / therapeutic use
  • Capecitabine* / administration & dosage
  • Capecitabine* / adverse effects
  • Capecitabine* / therapeutic use
  • Cardiotoxicity*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / drug therapy
  • Nitroglycerin* / administration & dosage
  • Nitroglycerin* / adverse effects
  • Nitroglycerin* / therapeutic use

Substances

  • Capecitabine
  • Nitroglycerin
  • Antimetabolites, Antineoplastic