Anthracycline Cardiomyopathy — SCE Medical Oncology MCQ
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Correct answer: A — 450-550 mg/m² lifetime cumulative dose
Anthracycline cardiomyopathy risk increases sharply above a lifetime cumulative doxorubicin dose of approximately 450-550 mg/m² (or equivalent for other anthracyclines: epirubicin ~900 mg/m²). At 550 mg/m², the risk of clinical heart failure is approximately 7-26%. Cardiac monitoring (LVEF by echocardiogram) is recommended before starting and periodically during treatment. Risk factors for anthracycline cardiotoxicity include: age >65, pre-existing cardiac disease, concurrent trastuzumab, mediastinal radiation and cumulative dose. Dexrazoxane is the only approved cardioprotectant.
Reference: BNF Doxorubicin; ESMO 2024 Cardio-Oncology Guidelines; Swain et al NEJM 2003