Table 3.
Identification of the Patient at Increased Risk of Cardiotoxicity
| Lower Risk | Increased Risk | |
|---|---|---|
| Therapy-related risk factors | ||
| Lower lifetime dose of anthracycline <Doxorubicin 250 mg/m2 or equivalent No previous anthracycline/trastuzumab-related cardiotoxicity Absence of sequential anthracycline and trastuzumab therapy Low-dose radiation therapy to central chest including heart in radiation field <30 Gy |
Increased lifetime dose of anthracycline >Doxorubicin 250 mg/m2 or equivalent—high risk >400 mg/m2 or equivalent—very high risk Prior anthracycline/trastuzumab-related cardiotoxicity Sequential anthracycline and trastuzumab therapy High-dose radiation therapy to central chest including heart in radiation field ≥30 Gy |
|
| Patient-related risk factors | ||
| Male Age <50 yrs Absence of traditional cardiovascular risk factors: Hypertension, smoking, obesity, dyslipidemia, insulin resistance Past medical history: Normal baseline LVEF Absence of pre-existing cardiovascular disease (e.g., CAD, PAD, cardiomyopathy, severe valvular heart disease, heart failure, or diabetes) Normal kidney function or chronic kidney disease stage 1 Biomarkers: Normal baseline troponin and/or NT-proBNP Normal cardiac troponin or NT-proBNP during cancer therapy |
Female Age 50 to 64 yrs—high risk and ≥65 yrs—highest risk Presence of traditional cardiovascular risk factors: Hypertension, smoking, obesity, dyslipidemia, insulin resistance Past medical history: Reduced or low-normal LVEF (50% to 54%) pre-treatment Presence of pre-existing cardiovascular disease (e.g., CAD, PAD, cardiomyopathy, severe valvular heart disease, heart failure, or diabetes) Chronic kidney disease stage 2 (eGFR <78 ml/min/1.73 m2) (84) Biomarkers: Elevated∗ baseline troponin and/or NT-proBNP Elevated∗ cardiac troponin or NT-proBNP during cancer therapy |
|
CAD = coronary artery disease; eGFR = estimated glomerular filtration rate; LVEF = left ventricular ejection fraction; NT-proBNP = N-terminal pro–B-type natriuretic peptide; PAD = peripheral arterial disease.
∗
Elevated above the upper limit of normal for local laboratory reference range.