Risk
Recommendation 1.1
➤ It is recommended that cancer patients who meet any of the following
criteria should be considered at increased risk for developing cardiac
dysfunction. (Moderate Recommendation; EB-B-I)
Treatment that includes any of the following:
• High dose anthracycline (e.g. ≥250 mg/m
2
doxorubicin, ≥600 mg/m
2
epirubicin)
• High dose (≥30 Gy) radiotherapy where the heart is in the treatment field
• Lower dose anthracycline (e.g. <250 mg/m
2
doxorubicin, <600 mg/m
2
epirubicin) in
combination with lower dose radiotherapy (<30 Gy) where the heart is in the treatment
field
• Treatment with lower dose anthracycline (e.g. <250 mg/m
2
doxorubicin, <600 mg/m
2
epirubicin) or trastuzumab alone, and presence of any of the following risk factors:
▶ Multiple (≥2) cardiovascular risk factors, including : smoking, hypertension, diabetes,
dyslipidemia, obesity during or after completion of therapy
▶ Older (≥60 years) age at cancer treatment
▶ Compromised cardiac function (e.g. borderline low LVEF [50–55%], history of
myocardial infarction, ≥moderate valvular heart disease) at any time prior to or
during treatment
• Treatment with lower dose anthracycline (e.g. <250 mg/m
2
doxorubicin, <600 mg/m
2
epirubicin) followed by trastuzumab (sequential therapy)
Recommendation 1.2
➤ No recommendation can be made on the risk of cardiac dysfunction in
cancer patients with any of the following treatment exposures: (EB-L)
• Lower dose anthracycline (e.g. <250 mg/m
2
doxorubicin, <600 mg/m
2
epirubicin) or
trastuzumab alone, and no additional risk factors (as defined in RISK)
• Lower dose radiotherapy (<30 Gy) where the heart is in the treatment field, and no
additional cardiotoxic therapeutic exposures or risk factors (as defined in RISK)
• Kinase inhibitors
