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Anthracycline Cardiotoxicity — RACP Adult Medicine MCQ

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ModerateMedical OncologyAnthracycline CardiotoxicityRACP Adult Medicine

A 55-year-old woman with breast cancer develops new-onset atrial fibrillation with rapid ventricular rate while receiving doxorubicin-based chemotherapy. Her LVEF is 40% (baseline 60%). What is the most likely cause of her reduced LVEF?

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Correct answer: D — Doxorubicin-induced cardiomyopathy

Doxorubicin (anthracycline) cardiotoxicity is dose-dependent and can cause irreversible cardiomyopathy. Risk increases significantly above cumulative doses of 400 mg/m². It causes myocyte death via oxidative stress and topoisomerase IIβ inhibition. Unlike trastuzumab cardiotoxicity (which is usually reversible), anthracycline cardiotoxicity is often permanent. LVEF should be monitored before each cycle. If LVEF drops >10% to below 50%, doxorubicin should be ceased.

Reference: eTG – 2025 – Haematology; ESC – 2022 – Cardio-Oncology Guidelines