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Consider TOMUDEX (raltitrexed) in patients with advanced colorectal cancer where 5-fluorouracil and folinic acid based regiments are not tolerated1.

Fluoropyrimidines are commonly included in a colorectal cancer chemotherapy regimen2, however, cardiotoxic events have been associated with the use of 5-fluourouracil (5-FU) and capecitabine3-5. Cardiotoxicity can be defined as per CTCAE6 and the most common manifestations of cardiotoxicity associated with fluoropyrimidines are chest pain, angina and acute coronary syndromes including myocardial infarction3

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Image adapted from Polk A, et al. 2013.

Trials have not shown evidence of cardiotoxicity associated with raltitrexed treatment1. Consider TOMUDEX as an alternative treatment option when fluoropyrimidine treatment is not tolerated1.

Risk Factors for Fluoropyrimidine Cardiotoxicity8

  • Older age 
  • Concurrent radiotherapy
  • Concurrent administration of cardiotoxic drugs
  • History of cardiac disease
  • Cardiovascular risk factors such as hypertension, dyslipidaemia and smoking

The continuous infusion of 5-FU compared with bolus administration is associated with a higher incidence of cardiac adverse events8,9. Symptomatic cardiotoxicity usually appears in the first 12 hours during the first cycle of 5-FU, but can develop any time during treatment and has been reported up to 2 days after infusion8.

Click here for more information on patients who could be considered for treatment with TOMUDEX due to fluoropyrimidine intolerance. 


CTCAE, Common Terminology Criteria for Adverse Events


  1. TOMUDEX® Summary of Product Characteristics
  2. National Institute for Health and Care Excellence (2020) Colorectal Cancer (NICE Guideline 151), Updated 29 January 2020. Available at [Accessed 12/05/2021].
  3. Sara JD, Kaur J, Khodadadi R, et al. Ther Adv Med Oncol 2018;10:1758835918780140. 
  4. Fluorouracil. Summary of Product Characteristics
  5. Capecitabine. Summary of Product Characteristics
  6. U.S. Department of Health and Human Services, National Cancer Institute. (2017). Common Terminology Criteria for Adverse Events (CTCAE).[v5.0]. Available at 
  7. Polk A, Vaage-Nilsen M et al. Cancer Treatment Reviews 2013; 39:8:974-984.
  8. Kanduri J, More LA et al. Cardiology Clinics 2019; 37:4:399-405.
  9. Kosmas C, Kallistratos M.S et al. J Cancer Res Clin Oncol 2008; 134:75–82.