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Anthracycline Cardiotoxicity — RACP Adult Medicine MCQ

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ModerateHaematologyAnthracycline CardiotoxicityRACP Adult Medicine

A 55-year-old woman on doxorubicin-based chemotherapy for breast cancer has received a cumulative dose of 450 mg/m². Pre-treatment LVEF was 60%. Current LVEF is 48% (decline of 12 percentage points). She is asymptomatic. What is the most appropriate management?

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Correct answer: E — Hold doxorubicin — cardiotoxicity threshold reached

Cumulative doxorubicin dose approaching 450-550 mg/m² with LVEF decline >10 percentage points to below 50% indicates anthracycline cardiotoxicity. Doxorubicin should be held/ceased. The cumulative dose-toxicity relationship is well-established (risk increases steeply above 400-450 mg/m²). Cardioprotective management: ACE inhibitor + beta-blocker (OVERCOME trial) may partially reverse early cardiotoxicity. Serial echocardiography monitoring. Consider cardio-oncology referral.

Reference: ASCO – 2024 – Cardio-Oncology; ESC Cardio-Oncology 2022