Table 1 High risk features for anthracycline induced cardiotoxicity in case study and recommended cardiotoxicity monitoring strategy

ASCO (2017)

Followed at time of case

Classify as high risk if.

Patient-related factors^a

Treatment-related factor

Older age at treatment (≥ 60 years) (X)

Multiple cardiovascular risk factors (e.g. smoking, hypertension, diabetes, obesity) (X)

Underlying cardiovascular disease (X)

Reduced or low-normal LVEF (50–54%) before anticancer treatment (X)

High-dose anthracycline ≥ 250 mg/m² (Y)

High dose thoracic irradiation ≥ 30 Gy (X)

Cardiotoxicity risk: high

Follow up recommendation: echocardiogram before start of treatment. In case of clinical signs of cardiac dysfunction echocardiogram in conjunction with serum cardiac biomarkers. Routine surveillance imaging may be offered

ESMO (2020)

Published after case

Patient related factors

Baseline risk exam

Age < 10 or > 75 years (X)

Previous anthracycline-based treatment and/or chest radiotherapy (X)

Previous combined treatment trastuzumab and anthracyclines (X)

Prevalent hypertension, smoking, diabetes (X)

Elevated cardiac biomarkers before initiation of anticancer therapy (X)

Baseline LVEF < 50% (X)

Cardiotoxicity risk: low

Follow up-recommendations: periodic measurement of cardiac biomarkers (every 3–6 weeks or after each cycle), echocardiogram beyond doxorubicin cumulative dose 250 mg/m² and at end of therapy