Table 3.

American Society of Clinical Oncology (ASCO) guidelines on patients at high cardiac dysfunction risk.¹⁰

Risk	Example
High-dose anthracycline	≥ 250 mg/m2 doxorubicin
High-dose radiotherapy	≥ 30 Gy radiation with the heart in the treatment field
Low-dose anthracycline + low dose radiotherapy	< 250 mg/m2 doxorubicin in combination with < 30 Gy radiation with the heart in the treatment field
Low-dose anthracycline + ≥ 2 CVD risk factors	< 250 mg/m2 doxorubicin in combination with smoking, hypertension, diabetes, dyslipidemia, and/or obesity
Low-dose anthracycline + older age	< 250 mg/m2 doxorubicin in combination with ≥ 60 years at cancer treatment
Low-dose anthracycline + comprised cardiac function	< 250 mg/m2 doxorubicin in combination with history of myocardial infarction, moderate valvular disease, LVEF between 50% and 55%
Trastuzumab + ≥ 2 CVD risk factors	Trastuzumab in combination with smoking, hypertension, diabetes, dyslipidemia, and/or obesity
Trastuzumab + older age	Trastuzumab in combination with ≥ 60 years at cancer treatment
Trastuzumab + comprised cardiac function	Trastuzumab in combination with history of myocardial infarction, ≥ moderate valvular disease, LVEF between 50% and 55%
Low-dose anthracycline followed by trastuzumab	Sequential therapy of < 250 mg/m2 doxorubicin and trastuzumab

Abbreviations: CVD, cardiovascular disease; Gy; Gray; LVEF, left ventricular ejection fraction.