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IGHG Recommendations for Anthracycline and Anthraquinone Cardiac Dysfunction Equivalence Ratios After Childhood

Theodorus W Kouwenberg1, Elvira C van Dalen1, Renée L Mulder1

  • 1Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.

JACC. Cardiooncology
|June 21, 2025
PubMed

Insights

Childhood cancer survivors face cardiac risks from anthracycline and anthraquinone drugs. This study provides equivalence ratios for daunorubicin and mitoxantrone, aiding in managing cancer therapy-related cardiac dysfunction risk.

Area of Science:

  • Oncology
  • Cardiology
  • Pharmacology

Background:

  • Anthracycline and anthraquinone chemotherapy agents are linked to cardiac dysfunction in childhood cancer survivors.
  • Current international guidelines lack standardized equivalence ratios for these cardiotoxic agents.
  • Accurate risk assessment is crucial for long-term survivor health.

Purpose of the Study:

  • To systematically review and establish evidence-based equivalence ratios for key anthracycline and anthraquinone agents.
  • To inform international surveillance guidelines for managing cancer therapy-related cardiac dysfunction.
  • To compare the relative cardiotoxicity of doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone.

Main Methods:

  • Systematic literature review by the International Late Effects of Childhood Cancer Guideline Harmonization Group.
  • Analysis of evidence on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone.
  • Expert consensus and benefit-harm assessment to determine recommendations.

Main Results:

  • Daunorubicin poses a lower risk of cardiac dysfunction compared to doxorubicin.
  • Mitoxantrone presents a higher risk of cardiac dysfunction compared to doxorubicin.
  • Recommended equivalence ratios: 0.6 for daunorubicin and 10.5 for mitoxantrone (relative to doxorubicin).

Conclusions:

  • Established ratios for daunorubicin and mitoxantrone can aid in estimating individual risk for cardiotoxicity.
  • No definitive recommendation for epirubicin or idarubicin due to insufficient evidence.
  • Implementation of these ratios may improve surveillance and management of cardiac dysfunction in childhood cancer survivors.

Keywords:
anthracyclinecancer survivorshipdosedoxorubicinepirubicinguidelinesheart failuremitoxantronerisk factorscreening

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