氟嘧啶类化合物（FPs）是治疗转移性结直肠癌（CRC）系统方案的主要组成部分。欧洲药品管理局已批准口服FP S-1单药或与奥沙利铂或伊立替康联合使用，或者在没有手足综合征或心血管毒性的情况下与贝伐单抗联合使用，用于不能继续使用其他FP治疗的转移性CRC患者。随后，这一适应症被纳入2022年ESMO转移性CRC指南。目前没有关于日常实践中的使用建议。基于针对西方转移性CRC患者使用S-1的同行评审的已发表数据，一个由治疗转移性CRC专业的医学肿瘤学家和心脏肿瘤学家组成的国际小组制定了关于其使用的建议。对于由于手足综合征或心血管毒性而从5-氟尿嘧啶（5-FU）或卡培他滨转换至S-1的病人，无需事先减少卡培他滨/5-FU的剂量，建议切换至S-1。当手足综合征减轻到≤1级时，最好以全剂量启用S-1。对于存在心脏症状的患者，在不能排除与卡培他滨或infusional 5-FU治疗有关联的情况下，应停用卡培他滨/5-FU并建议切换至S-1。这些建议应指导临床医生在使用FP含量方案治疗转移性CRC患者的日常实践中。版权所有 © 2023 The Authors. 由Elsevier Ltd.出版。保留所有权利。

Fluoropyrimidines (FPs) are an essential part of the majority of systemic regimens in the treatment of metastatic colorectal cancer (CRC). The use of the oral FP S-1 has been approved by the European Medicines Agency as monotherapy or in combination with oxaliplatin or irinotecan, with or without bevacizumab, for the treatment of patients with metastatic CRC in whom it is not possible to continue treatment with another FP due to hand-foot syndrome (HFS) or cardiovascular toxicity (CVT). Subsequently, this indication has been included in the 2022 ESMO guidelines for metastatic CRC. Recommendations for use in daily practice are not available.Based on peer-reviewed published data on the use of S-1 in Western patients with metastatic CRC who switched from infusional 5-fluorouracil (5-FU) or capecitabine to S-1 for reasons of HFS or CVT, recommendations for its use were formulated by an international group of medical oncologists with expertise in the treatment of metastatic CRC and a cardio-oncologist.In patients who experience pain and/or functional impairment due to HFS during treatment with capecitabine or infusional 5-FU, a switch to S-1 is recommended without prior dose reduction of capecitabine/5-FU. S-1 should preferably be initiated at full dose when HFS has decreased to grade ≤1. In patients with cardiac complaints, in whom an association with capecitabine or infusional 5-FU treatment cannot be excluded, capecitabine/5-FU should be discontinued and a switch to S-1 is recommended.These recommendations should guide clinicians in daily practice in the treatment of patients with metastatic CRC with FP-containing regimens.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.