Canterbury DHB

Context

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.

In This Section

Prevention

Management of Established Cardiac Failure

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:

Note:

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:

Steve Gibbons and Fiona Stone (see Who's Who)

Issue Date:

March 2017

Next Review:

March 2020

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5739