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DRUG INFORMATION ROUNDS

Monitoring of Anthracycline-Induced Cardiotoxicity

at time of writing, Pharmacy Practice Resident, Department of Pharmaceutical Services, William Beaumont Hospital, Royal Oak, MI; now, Oncology Specialty Resident, Evanston Northwestern Healthcare, Evanston, IL

Janet Hoffman, PharmD

Drug Information Specialist, Department of Pharmaceutical Services, William Beaumont Hospital

Mark Lutz, PharmD

Drug Information Specialist, Department of Pharmaceutical Services, William Beaumont Hospital

Reprints: Dr. Jannazzo, Evanston Northwestern Healthcare, 2650 Ridge Ave., Evanston, IL 60201, fax 847/733-5226, jannazzo{at}gmail.com

OBJECTIVE: To review the literature regarding the appropriate monitoring for anthracycline-induced cardiotoxicity.

DATA SOURCES: A MEDLINE search of the literature was performed (1966-August 2007). Search terms included anthracycline, cardiotoxicity, and monitoring. Additional references were identified through bibliographic reviews.

DATA SYNTHESIS: Anthracycline medications are effective in the treatment of many malignancies but their use is limited by their associated cardiotoxicity. The focus of anthracycline-induced cardiotoxicity prevention has been on monitoring cardiac function during treatment; however, a consensus on the most appropriate way to monitor patients is not available. Most guidelines lack specific details on the appropriate methods of cardiac evaluation and schedule. One guideline that does provide specific recommendations on both the method of evaluation and schedule has been criticized for being too restrictive, costly, and lacking in evidentiary support. The literature is insufficient in evaluation of the predictive value of cardiac function monitoring by echocardiography or radionuclide angiography during anthracycline therapy and the future development of cardiotoxicity, the necessity of baseline cardiac function monitoring, the optimal follow-up cardiac evaluation schedule, and the addition of risk stratification to monitoring schemes.

CONCLUSIONS: Although guidelines are inadequate to predict and prevent anthracycline-induced cardiotoxicity, until further research is available, following one of the existing guidelines to monitor for this adverse effect is a practical solution.

Key Words: anthracycline, cardiotoxicity, detection, monitoring, prevention

Published Online, December 19, 2007. www.theannals.com, DOI 10.1345/aph.1K359

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