{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:05:56Z","timestamp":1760234756763,"version":"build-2065373602"},"reference-count":59,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,12]],"date-time":"2021-06-12T00:00:00Z","timestamp":1623456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>In pre-hospital care, an accurate and quick diagnosis of ST-segment elevation myocardial infarction (STEMI) is imperative to promptly kick-off the STEMI network with a direct transfer to the cardiac catheterization laboratory (cath lab) in order to reduce myocardial infarction size and mortality. Aa atherosclerotic plaque rupture is the main mechanism responsible for STEMI. However, in a small percentage of patients, emergency coronarography does not reveal any significant coronary stenosis. The fluoropyrimidine agents such as 5-Fluorouracil (5-FU) and capecitabine, widely used to treat gastrointestinal, breast, head and neck cancers, either as a single agent or in combination with other chemotherapies, can cause potentially lethal cardiac side effects. Here, we present the case of a patient with 5-FU cardiotoxicity resulting in an acute coronary syndrome (ACS) with recurrent episodes of chest pain and ST-segment elevation.. Our case report highlights the importance of widening the knowledge among cardiologists of the side effects of chemotherapeutic drugs, especially considering the rising number of cancer patients around the world and that fluoropyrimidines are the main treatment for many types of cancer, both in adjuvant and advanced settings.<\/jats:p>","DOI":"10.3390\/ph14060563","type":"journal-article","created":{"date-parts":[[2021,6,14]],"date-time":"2021-06-14T22:25:46Z","timestamp":1623709546000},"page":"563","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["What the Cardiologist Needs to Consider in the Management of Oncologic Patients with STEMI-Like Syndrome: A Case Report and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7711-9905","authenticated-orcid":false,"given":"Aneta","family":"Aleksova","sequence":"first","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Gagno","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Pierri","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Todaro","sequence":"additional","affiliation":[{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"},{"name":"Department of Perioperative Medicine, Intensive Care and Emergency, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra Lucia","family":"Fluca","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6224-3783","authenticated-orcid":false,"given":"Valentina","family":"Orlando","sequence":"additional","affiliation":[{"name":"Oncology Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Guglielmi","sequence":"additional","affiliation":[{"name":"Oncology Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0679-2710","authenticated-orcid":false,"given":"Antonio Paolo","family":"Beltrami","sequence":"additional","affiliation":[{"name":"Department of Medicine (DAME), University of Udine, 33100 Udine, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianfranco","family":"Sinagra","sequence":"additional","affiliation":[{"name":"Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34149 Trieste, Italy"},{"name":"Department of Medical Surgical and Health Science, University of Trieste, 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1023\/A:1012294617392","article-title":"Relationship between 5-fluorouracil disposition, toxicity and dihydropyrimidine dehydrogenase activity in cancer patients","volume":"12","author":"Danesi","year":"2001","journal-title":"Ann. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1758835918780140","DOI":"10.1177\/1758835918780140","article-title":"5-fluorouracil and cardiotoxicity: A review","volume":"10","author":"Sara","year":"2018","journal-title":"Ther. Adv. Med. Oncol."},{"key":"ref_3","unstructured":"Casale, J., and Crane, J.S. (2021). Fluorouracil. StatPearls, StatPearls Publishing."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00280-005-0178-1","article-title":"Risk factors and prevention of cardiotoxicity induced by 5-fluorouracil or capecitabine","volume":"58","author":"Jensen","year":"2006","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1038\/sj.bjc.6690098","article-title":"Dihydropyrimidine dehydrogenase deficiency and fluorouracil-related toxicity","volume":"79","author":"Milano","year":"1999","journal-title":"Br. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1038\/s41416-019-0423-8","article-title":"The clinical relevance of multiple DPYD polymorphisms on patients candidate for fluoropyrimidine based-chemotherapy. An Italian case-control study","volume":"120","author":"Iachetta","year":"2019","journal-title":"Br. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/cpt.911","article-title":"Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 Update","volume":"103","author":"Amstutz","year":"2018","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1200\/JCO.2015.63.1325","article-title":"Upfront Genotyping of DPYD*2A to Individualize Fluoropyrimidine Therapy: A Safety and Cost Analysis","volume":"34","author":"Deenen","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_9","first-page":"1149","article-title":"Lethal outcome of a patient with a complete dihydropyrimidine dehydrogenase (DPD) deficiency after administration of 5-fluorouracil: Frequency of the common IVS14+1G>A mutation causing DPD deficiency","volume":"7","author":"Muller","year":"2001","journal-title":"Clin. Cancer Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.jemermed.2015.09.001","article-title":"A Case of 5-Fluorouracil-Induced Cardiac Arrest","volume":"50","author":"Ray","year":"2016","journal-title":"J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40880-018-0292-1","article-title":"Cardiotoxicity of 5-fluorouracil and capecitabine in Chinese patients: A prospective study","volume":"38","author":"Peng","year":"2018","journal-title":"Cancer Commun."},{"key":"ref_12","first-page":"PI51","article-title":"Cardiotoxicity following different doses and schedules of 5-fluorouracil administration for malignancy\u2014A survey of 427 patients","volume":"8","author":"Tsavaris","year":"2002","journal-title":"Med. Sci. Monit."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1177\/030089168206800609","article-title":"Cardiac toxicity of 5-fluorouracil: A study on 1083 patients","volume":"68","author":"Labianca","year":"1982","journal-title":"Tumori"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.ejca.2017.02.009","article-title":"Incidence of capecitabine-related cardiotoxicity in different treatment schedules of metastatic colorectal cancer: A retrospective analysis of the CAIRO studies of the Dutch Colorectal Cancer Group","volume":"76","author":"Kwakman","year":"2017","journal-title":"Eur. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1136\/bmj.1.6112.547","article-title":"Fluorouracil cardiotoxicity","volume":"1","author":"Pottage","year":"1978","journal-title":"Br. Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/0277-5379(88)90062-4","article-title":"Circulating drug levels in patients presenting cardiotoxicity to 5-FU","volume":"24","author":"Thyss","year":"1988","journal-title":"Eur. J. Cancer Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"910","DOI":"10.1016\/j.biopha.2018.07.029","article-title":"Assessment of dose-response relationship of 5-fluorouracil to murine intestinal injury","volume":"106","author":"Zhang","year":"2018","journal-title":"Biomed. Pharm."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1159\/000339573","article-title":"Acute Reversible Heart Failure Caused by Coronary Vasoconstriction due to Continuous 5-Fluorouracil Combination Chemotherapy","volume":"5","author":"Dechant","year":"2012","journal-title":"Case Rep. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yeddi, A., Adam, O., Khalid, M., Farah, Y., Yeddi, O., Shereef, H., Yassin, A., Yeddi, M., Ghandour, M., and Omer, M. (2019). 5-Fluorouracil-Associated Cardiogenic Shock. Am. J. Ther.","DOI":"10.1097\/MJT.0000000000001129"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1592\/phco.31.2.226","article-title":"5-Fluorouracil-induced Tako-Tsubo-like syndrome","volume":"31","author":"Basselin","year":"2011","journal-title":"Pharmacotherapy"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Iskandar, M.Z., Quasem, W., and El-Omar, M. (2015). 5-Fluorouracil cardiotoxicity: Reversible left ventricular systolic dysfunction with early detection. BMJ Case Rep.","DOI":"10.1136\/bcr-2015-209347"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e230499","DOI":"10.1136\/bcr-2019-230499","article-title":"Acute reversible left ventricular systolic dysfunction associated with 5-fluorouracil therapy: A rare and increasingly recognised cardiotoxicity of a commonly used drug","volume":"12","author":"Mishra","year":"2019","journal-title":"BMJ Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5280","DOI":"10.1200\/JCO.2009.27.3953","article-title":"Fluorouracil induces myocardial ischemia with increases of plasma brain natriuretic peptide and lactic acid but without dysfunction of left ventricle","volume":"28","author":"Jensen","year":"2010","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1517\/14740330902733961","article-title":"Fluoropyrimidine-associated cardiotoxicity: Revisited","volume":"8","author":"Saif","year":"2009","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"637","DOI":"10.2459\/01.JCM.0000237914.12915.dd","article-title":"Severe ventricular dysrhythmias and silent ischemia during infusion of the antimetabolite 5-fluorouracil and cis-platin","volume":"7","author":"Hrovatin","year":"2006","journal-title":"J. Cardiovasc. Med. (Hagerstown)"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.ctrv.2013.03.005","article-title":"Cardiotoxicity in cancer patients treated with 5-fluorouracil or capecitabine: A systematic review of incidence, manifestations and predisposing factors","volume":"39","author":"Polk","year":"2013","journal-title":"Cancer Treat. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1200\/JCO.1989.7.4.509","article-title":"Continuous ambulatory ECG monitoring during fluorouracil therapy: A prospective study","volume":"7","author":"Rezkalla","year":"1989","journal-title":"J. Clin. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.critrevonc.2018.02.002","article-title":"Fluoropyrimidine-induced cardiotoxicity","volume":"124","author":"Depetris","year":"2018","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/1097-0142(19880101)61:1<36::AID-CNCR2820610108>3.0.CO;2-6","article-title":"5-Fluorouracil-associated cardiotoxicity","volume":"61","author":"Freeman","year":"1988","journal-title":"Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11912-016-0521-1","article-title":"Fluoropyrimidine-Induced Cardiotoxicity: Manifestations, Mechanisms, and Management","volume":"18","author":"Layoun","year":"2016","journal-title":"Curr. Oncol. Rep."},{"key":"ref_31","first-page":"154","article-title":"[Cardiotoxicity of 5-fluorouracil]","volume":"91","author":"Teixeira","year":"2004","journal-title":"Bull. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2174\/187152506775268785","article-title":"Cardiotoxicity of 5-fluorouracil","volume":"4","author":"Alter","year":"2006","journal-title":"Cardiovasc. Hematol. Agents Med. Chem."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"461","DOI":"10.5152\/akd.2010.147","article-title":"Two cases of coronary vasospasm induced by 5-fluorouracil","volume":"10","author":"Atar","year":"2010","journal-title":"Anadolu Kardiyol. Derg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1007\/BF03086268","article-title":"Acute chest pain in a patient treated with capecitabine","volume":"17","author":"Camaro","year":"2009","journal-title":"Neth. Heart J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"E111","DOI":"10.15420\/ahhj.2010.8.2.111","article-title":"Angina induced by 5-fluorouracil infusion in a patient with normal coronaries","volume":"8","author":"Tajik","year":"2010","journal-title":"Am. Heart Hosp. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1093\/oxfordjournals.eurheartj.a059919","article-title":"Coronary artery spasm induced by 5-fluorouracil","volume":"12","author":"Luwaert","year":"1991","journal-title":"Eur. Heart J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/1078155211399164","article-title":"Ventricular fibrillation as a likely consequence of capecitabine-induced coronary vasospasm","volume":"18","author":"Shah","year":"2012","journal-title":"J. Oncol. Pharm. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/annonc\/mdu055","article-title":"Effort myocardial ischemia during chemotherapy with 5-fluorouracil: An underestimated risk","volume":"25","author":"Lestuzzi","year":"2014","journal-title":"Ann. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.3390\/cancers2031717","article-title":"5-fu metabolism in cancer and orally-administrable 5-fu drugs","volume":"2","author":"Miura","year":"2010","journal-title":"Cancers"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1524-4741.2011.01120.x","article-title":"Capecitabine (and 5 fluorouracil) cardiotoxicity. Metabolic considerations","volume":"17","author":"Lestuzzi","year":"2011","journal-title":"Breast J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/0002-9343(87)90465-7","article-title":"Prinzmetal\u2019s angina during 5-fluorouracil chemotherapy","volume":"82","author":"Kleiman","year":"1987","journal-title":"Am. J. Med."},{"key":"ref_42","first-page":"3028","article-title":"In vitro evidence that myocardial ischemia resulting from 5-fluorouracil chemotherapy is due to protein kinase C-mediated vasoconstriction of vascular smooth muscle","volume":"53","author":"Mosseri","year":"1993","journal-title":"Cancer Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1007\/s12032-009-9226-8","article-title":"5-Fluorouracil induces arterial vasoconstrictions but does not increase angiotensin II levels","volume":"27","author":"Salepci","year":"2010","journal-title":"Med. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1093\/oxfordjournals.annonc.a058084","article-title":"Very high endothelin plasma levels in patients with 5-FU cardiotoxicity","volume":"3","author":"Thyss","year":"1992","journal-title":"Ann. Oncol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/clc.4960210403","article-title":"Prinzmetal\u2019s variant angina","volume":"21","author":"Mayer","year":"1998","journal-title":"Clin. Cardiol."},{"key":"ref_46","first-page":"861","article-title":"5-Fluorouracil related toxic myocarditis: Case reports and pathological confirmation","volume":"10","author":"Sasson","year":"1994","journal-title":"Can. J. Cardiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"257.E1","DOI":"10.1016\/j.ajem.2010.10.025","article-title":"Initial dose effect of 5-fluorouracil: Rapidly improving severe, acute toxic myopericarditis","volume":"30","author":"Calik","year":"2012","journal-title":"Am. J. Emerg. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/CAD.0b013e3283165f27","article-title":"The spectrum of 5-fluorouracil cardiotoxicity","volume":"20","author":"Dalzell","year":"2009","journal-title":"Anticancer Drugs"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Focaccetti, C., Bruno, A., Magnani, E., Bartolini, D., Principi, E., Dallaglio, K., Bucci, E.O., Finzi, G., Sessa, F., and Noonan, D.M. (2015). Effects of 5-fluorouracil on morphology, cell cycle, proliferation, apoptosis, autophagy and ROS production in endothelial cells and cardiomyocytes. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0115686"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"39","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jjcc.2016.09.012","article-title":"Overview of the pharmacological spasm provocation test: Comparisons between acetylcholine and ergonovine","volume":"69","author":"Sueda","year":"2017","journal-title":"J. Cardiol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.3109\/02841869009091790","article-title":"Failure of preventing 5-fluorouracil cardiotoxicity by prophylactic treatment with verapamil","volume":"29","author":"Eskilsson","year":"1990","journal-title":"Acta Oncol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1097\/00000441-198710000-00004","article-title":"5-Fluorouracil cardiotoxicity: Left ventricular dysfunction and effect of coronary vasodilators","volume":"294","author":"Patel","year":"1987","journal-title":"Am. J. Med. Sci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/S0002-9343(88)80268-7","article-title":"Prophylaxis of 5-fluorouracil-induced coronary vasospasm with calcium channel blockers","volume":"85","author":"Oleksowicz","year":"1988","journal-title":"Am. J. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"970","DOI":"10.21037\/jgo.2017.09.07","article-title":"Fluoropyrimidine-induced cardiac toxicity: Challenging the current paradigm","volume":"8","author":"Clasen","year":"2017","journal-title":"J. Gastrointest Oncol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.amjcard.2012.07.026","article-title":"Capecitabine-induced chest pain relieved by diltiazem","volume":"110","author":"Ambrosy","year":"2012","journal-title":"Am. J. Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.21037\/jgo.2019.07.04","article-title":"Successful 5-fluorouracil (5-FU) infusion re-challenge in a metastatic colorectal cancer patient with coronary artery disease who experienced symptoms consistent with coronary vasospasm during first 5-FU infusion","volume":"10","author":"Redman","year":"2019","journal-title":"J. Gastrointest. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1016\/j.clcc.2015.10.004","article-title":"Successful Completion of Adjuvant Chemotherapy in a Patient With Colon Cancer Experiencing 5-Fluorouracil-Induced Cardiac Vasospasm","volume":"15","author":"Vargo","year":"2016","journal-title":"Clin. Colorectal Cancer"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.clcc.2012.09.003","article-title":"Alternative treatment options in colorectal cancer patients with 5-fluorouracil- or capecitabine-induced cardiotoxicity","volume":"12","author":"Deboever","year":"2013","journal-title":"Clin. Colorectal Cancer"}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/14\/6\/563\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:13:41Z","timestamp":1760163221000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/14\/6\/563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,12]]},"references-count":59,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["ph14060563"],"URL":"https:\/\/doi.org\/10.3390\/ph14060563","relation":{},"ISSN":["1424-8247"],"issn-type":[{"type":"electronic","value":"1424-8247"}],"subject":[],"published":{"date-parts":[[2021,6,12]]}}}