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Perth Haematology :: Dr Steven Ward

Anthracycline Cardiac Monitoring

 

Anthracyclines & Cardiac Toxicity

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Anthracyclines can cause cardiac toxicity including cardiomyopathy and cardiac failure (CCF).

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 The toxicity is related to the total cumulative dose of drug.

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Risk factors:

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Previous anthracycline treatment

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Mediastinal irradiation

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Pre-existing heart disease, hypertension or diabetes

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Increasing age

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Malnutrition (?vitamin E deficiency)

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Previous treatment with other potentially cardiotoxic drugs (taxol, streptomycin, cyclosporin, dacarbazine(DTIC), etoposide, cyclophophamide, melphalan, vincristine).

 

 

Monitoring for cardiac toxicity:

 

 anthracyclie

 

Drug and Maximum Cumulative Dose

Dose Reductions

Daunorubicin

550mg/m2

400-450 if elderly, DXT, other risks

Doxorubicin

550mg/m2

400-450 if other risks

Epirubicin

900mg/m2

Reduce in elderly; caution >650mg/m2

Idarubicin

IV 160mg/m2
PO 400mg/m2

NA

Mitozantrone

140mg/m2

100mg/m2 if risk factors

Liposomal Daunorubicin

NA

Monitor EF after 320mg/m2, at 480mg/m2 and every 160mg/m2 after

Liposomal Doxorubicin

600 mg/m2

Monitor EF each dose after 450mg/m2