Cardio-oncology is a discipline based on early screening, monitoring, and treating chemotherapy-induced cardiotoxicity. There are many chemotherapeutics known for their cardiac toxic effects, including fluoropyrimidines. Fluoropyrimidine represents the cornerstone of many types of cancer and each year almost two million cancer patients undergo this treatment. Fluoropyrimidine-induced cardiotoxicity can be manifested in several forms, from angina pectoris to sudden death. This paper is a review of how the cardiotoxicity of fluoropyrimidines is presented, the mechanisms of its occurrence, its diagnosis, and management.

Fluoropyrimidines, after more than 50 years from their discovery, are still the treatment of many types of cancer, and it is estimated that two million patients receive fluoropyrimidine therapy annually. The toxicity associated with fluoropyrimidines affects 30-40% of patients and some adverse effects can be lethal. Dihydroypyrimidine dehydrogenase is the main enzyme in the catabolism of 5-FU and DPD activity deficiency can cause important toxicity. This is an important reason to determine DPD activity in order to improve patient safety and to limit potential life-threating toxicity. At presentmultiple phenotypic and genotypic methods are available for the determination of DPD activity, some of these methods have proven their usefulness in practice, and yet they are not routinely recommended in clinical practice. This review is another statement of the importance of the determination of DPD status, the phenotypic and genotypic methods that are available and can be used.

Cardiovascular diseases (CVD) are the leading cause of global morbidity and mortality. There are many well-known risk factors (dyslipidemia, atherosclerosis, diabetes mellitus, obesity) for these diseases, but there are also other factors with important implications in the pathogenesis of vascular diseases (VD). One of these is the gut microbiome, a metabolically active “organ” with many roles in physiological processes that are linked to VD. Moreover, in recent years, the microbiota has been studied as a “target” in the treatment of various diseases, from gastrointestinal diseases to cardiovascular or even neuropsychiatric diseases. Thus, nutraceuticals may have an important role in modulating the gut microbiota and preventing or treating VD. The aim of this review is to highlight the relationship between the intestinal microbiota and the development and progression of cardiovascular diseases, as well as the possible intervention by using nutraceuticals (vitamins, minerals, dietary supplements) to positively modulate the intestinal microbiota and thus to reduce the risk of VD.

Background: Rituximab, a monoclonal antibody targeting CD20, has revolutionized the management of B-cell lymphoproliferative disorders and some immune conditions, significantly improving disease control and patient survival. Beyond its indisputable therapeutic benefits, rituximab can cause serious pulmonary adverse events, particularly interstitial lung disease (R-ILD). Diagnosing R-ILD is challenging due to nonspecific clinical and imagistic features, and its true incidence is possibly underestimated. Methods: We conducted a systematic review to synthesize current evidence on R-ILD, focusing on its incidence, diagnostic approaches, management strategies and clinical outcomes. A comprehensive search of PubMed/MEDLINE was performed using the term “rituximab induced interstitial lung disease” through August 2025. Relevant abstracts were screened, and full-text articles meeting the inclusion criteria were analyzed. Results: A total of 40 studies were retained after the search and screening, including case reports, case series and cohort studies of R-ILD. This condition was identified in both malignant and autoimmune disorders receiving rituximab, more frequently for combination regimens. Radiological manifestations were heterogeneous, and ground-glass opacities were the dominant pattern. Most R-ILD cases were reversible, but progression to chronic interstitial disease and fatal outcomes are possible. Cohort studies demonstrated variability in incidence, reported instances of successful rituximab reintroduction and suggested a protective effect of prophylactic trimethoprim-sulfamethoxazole against opportunistic pneumonitis. Conclusions: Although rare, R-ILD is a clinically significant complication of rituximab therapy. Early recognition and multidisciplinary management are essential, as most patients respond to corticosteroids, while severe cases may progress to respiratory failure or fatal outcomes.

Background: This study investigates the role of Diffusion Tensor Imaging (DTI) in predicting the response to neoadjuvant chemotherapy (NAC) in patients with locally advanced breast cancer. Methods: A Diffusion Tensor Imaging magnetic resonance imaging (DTI MRI) sequence, evaluating water diffusion along tissue structures, was performed before and after two chemotherapy cycles. This study included 23 patients with 27 malignant masses, comparing changes in DTI parameters with Residual Cancer Burden (RCB) scores. Results: We found a significant correlation between changes in specific DTI parameters (e.g., λ2, FA, RA) and pathological response, suggesting that DTI could serve as a sensitive marker for early chemotherapy response. However, differences in sensitivity were observed between DTI sequences with 6 and 12 directions, indicating that 12-direction DTI may provide better diagnostic accuracy. The percentage change in DTI parameters, particularly FA, demonstrated a strong ability to predict pathological complete response (pCR) with high sensitivity. Conclusions: As a non-invasive tool, DTI has the potential to assess chemotherapy efficacy, although larger studies with standardized protocols are necessary to validate its clinical utility.

Fluoropyrimidines remain some of the most used chemotherapeutics, despite the appearance in the therapeutic arsenal of targeted therapy and immunotherapy. Fluropyrimidines related cardiotoxicity is an undesirable adverse event and affects almost 20% of patients. The mechanisms of fluoropyrimidine toxicity are closely related to deficient allelic variants of DPYD, but considering the low penetrance and interindividual variability, not all adverse reactions are explained by their presence. In this case, we report a patient with recurrent fluoropyrimidine toxicity without a deficient allelic variant and how this case was managed by the oncologist and cardiologist, considering the need to use fluoropyrimidine in the treatment.