Monitoring a Patient Receiving an Anthracycline

 

Parameters:

(1) body surface area in square meters

(2) cumulative dose of anthracycline in doxorubicin equivalents

(3) risk status

 

A patient is considered high risk for cardiotoxicity if the patient has any of the following:

(1) pre-existing heart disease

(2) radiation therapy to left lung or mediastinum

(3) hypertension

 

Monitoring is done with:

(1) echocardiography

(2) radionuclide angiography

 

Monitoring	High Risk	Low Risk
start monitoring	200 mg per square meter	300 mg per square meter
need for closer monitoring (monitor after every 2 cycles)	300 mg per square meter	400 mg per square meter
need for very close monitoring (monitor after every cycle)	400 mg per square meter	NA (consider after 500 mg per square meter)
followup after therapy completed	every 3 months	every 3 months

 

Endpoint to stop anthracycline therapy based on cardiotoxicity is based upon the left ventricular ejection fraction

(1) caution should be used if < 50%

(2) anthracycline chemotherapy should be discontinued when < 45%