Anthracyclines

The incidence of cardiac failure in patients receiving an anthracycline is related to the cumulative dose of drug given. Cardiac failure develops in 5% of patients administered a cumulative dose of doxorubicin of 450 mg/m², epirubicin 900 mg/m², and mitoxantrone 160 mg/m². Daunorubicin carries a risk of heart failure of 1.5% at 600 mg/m² and 12% at 1000 mg/m². Idarubicin-related cardiomyopathy occurs in 5% of patients at between 150 and 290 mg/m². Idarubicin PO has a low risk of cardiac problems below 400 mg/m². Risk factors that may increase the patient’s sensitivity to anthracyclines include mediastinal radiation and previous cardiac disease with resultant myocardial dysfunction.

Prevention

A baseline LVEF measurement is recommended in all patients before they receive intensive chemotherapy.

LVEF Monitoring Protocol During Treatment

LVEF should be done subsequently if there is any clinical suspicion of cardiac dysfunction. This is regardless of the dose of anthracyclines received.

LVEF should be measured in patients who have received the following cumulative doses:

LVEF should then be measured before each subsequent cycle. Considerations should be given to cessation of anthracycline if LVEF:

Management of Established Cardiac Failure

Standard aggressive, anti-failure treatment should be pursued. While the prognosis of anthracycline-induced cardiomyopathy is often very poor, maximum clinical improvement can take up to 1 year.


About this Canterbury DHB document (5739):
Document Owner:	Timothy Vincent (see Who's Who)
Last Reviewed:	March 2020
Next Review:	March 2023
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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