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Caution: cumulative anthracycline dose and the heart
Every dose of doxorubicin adds to a lifetime total; above roughly 450 mg/m2 heart failure risk rises steeply, so sarcoma and lymphoma regimens are capped and hearts are monitored.
Cardiomyopathy incidence ~5% at 400 mg/m2, ~26% at 550 mg/m2; risk higher with chest radiotherapy, trastuzumab, age extremes. Dexrazoxane, liposomal doxorubicin, continuous infusion, and echocardiographic surveillance mitigate.
Rationale
Topoisomerase IIβ-mediated cardiomyocyte damage is dose-dependent and irreversible.
Evidence
Decades of cohort data; dexrazoxane RCTs.
Pages like this
not linked directly; found by shared links- TrialANNOUNCE
- TrialINT-0091 (Ewing sarcoma)
- TermAnthracyclines (doxorubicin, epirubicin)
Shares Cardio-oncology, Doxorubicin, Sarcomas (soft tissue, bone, GIST), Diffuse large B-cell lymphoma.
- IdeaA risk-stratified cardio-oncology pathway for everyone receiving heart-toxic cancer therapy
- IdeaBiomarker-guided cardioprotection for everyone on cardiotoxic cancer therapy
- IdeaLet adolescents from age 12 into adult trials when the cancer biology is the same
Shares Hodgkin lymphoma, Sarcomas (soft tissue, bone, GIST).
- IdeaFertility preservation offered and funded by default before gonadotoxic treatment
Shares Hodgkin lymphoma, Triple-negative breast cancer (TNBC).
- IdeaStop over-excluding people who could become pregnant; study pregnancy exposure
Shares Hodgkin lymphoma, Triple-negative breast cancer (TNBC).