Cardio Oncology

Question 1

Anthracycline “Doxorubicin” Cardiotoxicity

Answer 1

Risk Factors

Cumulative dose 
IV bolus 
Higher doses 
H/O mediastinal radiation 
Concomitant use with other toxic agents 
Female 
CVD 
Extreme age 
Length of time since completion

Prevent
Dexrazoxane
Liposomal anthracycline
Prolonged infusion

Question 2

Type 1 Cardiotoxicity

Answer 2

Irreversible
Cumulative dosing

Anthracyclines
Cyclophosphamide
Mitoxantrone

Question 3

Type II Cardiotoxicity

Answer 3

Reversible Cardiotoxicity
Cellular Dysfunction
Alter mitochondrial and protein function

Trastuzumab

Question 4

Anthracycline Toxicity Pathophysiology

Answer 4

Type 1 Cardiotoxicity

Topoisomerase II

Top 2a in tumors
Top 2b in heart

Double strand breaks
Cell death
Reactive oxygen species

Question 5

Pre Anthracycline Evaluation

Answer 5

H&P
EKG
Echo

Do not use of LVEF < 40%

Question 6

Anthracycline Monitoring

Answer 6

Eval cardiac function
3,6 and 9 months during

12 and 18 months after initiation

Question 7

Anthracycline and LVEF <45%

Answer 7

Hold chemo
Start ACEi and BB
Eval after 1 month

Question 8

Anthracycline and LVEF 45-49%

Answer 8

Start ACEi and BB

Question 9

Anthracycline and LVEF decrease >10% from baseline

Answer 9

Hold chemo and te eval in one month