Chemotherapy and cardiotoxicity
Very common: ≥10% incidence
Common: 1% to <10% incidence
Uncommon: 0.1% to <1% incidence
Rare: <0.1% incidence
Anthracycline equivalence dose
Drugs
Cardiotoxicity dose ratio
Isoequivalent dose
Doxorubicin
1
100 mg/m²
Epirubicin
0.8
125 mg/m²
Daunorubicin
0.6
167 mg/m²
Mitoxantrone
10.5
9.5 mg/m²
Idarubicin(a)
5
20 mg/m²
(a)Data on idarubicin are based on an estimated anticancer efficacy ratio, not on cardiotoxicity.
The CV toxicity dose ratio provides the value that should be used to multiply the dose of the anthracycline of interest to convert to isoequivalent doses of doxorubicin; e.g. to convert 125 mg/m2 of epirubicin to doxorubicin isoequivalent, multiply the dose by 0.8 (125 mg/m²× 0.8 = 100 mg/m² of doxorubicin).
VEGFi-related cardiovascular toxicities
Drugs
HT
HF
QTc prolongation
VTE/PE
ATE
CAD/MI
Aflibercept
Bevacizumab
Ramucirumab
Axitinib
Cabozantinib
Lenvatinib
Pazopanib
Regorafenib
Sorafenib
Sunitinib
Vandetanib
HT: hypertension, HF: heart failure, QTc: corrected QT interval, VTE: venous thromboembolism, PE pulmonary embolism, ATE: arterial embolism, CAD: coronary artery disease, MI: myocardial infarction
BCR-ABL TKI-related cardiovascular toxicities
Drugs
HT
QTc prolongation
AF
HF
HG
DL
Imatinib
Peric-E
Pleu-E
PH
Vasc Tox
Drugs
HT
QTc prolongation
AF
HF
HG
DL
Nilotinib
Peric-E
Pleu-E
PH
Vasc Tox
Drugs
HT
QTc prolongation
AF
HF
HG
DL
Dasatinib
Peric-E
Pleu-E
PH
Vasc Tox
Drugs
HT
QTc prolongation
AF
HF
HG
DL
Bosutinib
Peric-E
Pleu-E
PH
Vasc Tox
Drugs
HT
QTc prolongation
AF
HF
HG
DL
Ponatinib
Peric-E
Pleu-E
PH
Vasc Tox
HT: hypertension, QTc: corrected QT interval, AF: Atrial fibrillation, HF: Heart failure, HG: Hyperglycemia, DL: dyslipidemia, Peric-E: Pericardial effusion, Pleu-E: Pleural effusion, PH: Pulmonary hypertension, Vasc Tox: Vascular toxicity: PAD, stroke
Multiple myeloma drugs-related cardiovascular toxicities
Drugs
HT
DM
HF
AF
MI
VTE
PH
ATE
Cyclophosphamide
Melphalan
Lenalidomide
Pomalidomide
Thalidomide
Bortezomib
Carfilzomib
Daratumumab
Elotuzumab
Isatuximab
HT: hypertension, DM: diabetes mellitus, HF: heart failure, AF: atrial fibrillation, MI: myocardial infarction, VTE: venous thromboembolism, PH: pulmonary hypertension, ATE: arterial thromboembolism
RAF inhibitor- and MEK inhibitor-related cardiovascular toxicities
Drugs
HT
HF
DM
SVT/ SBr
QTc
prolongation
Bleed
VTE/PE
Dabrafenib
Encorafenib
Vemurafenib
Binimetinib
Cobimetinib
Trametinib
HT: hypertension, HF: heart failure, DM: diabetes mellitus, SVT: supraventricular tachycardia, SBr: sinus bradycardia, QTc : corrected QT interval, VTE: venous thromboembolism, PE: pulmonary embolism
Androgen deprivation therapy-related cardiovascular toxicities
Drugs
HT
DM
HF
IHD
AF
QTc
prolongation
Goserelin
Histrelin
Leuprorelin
Triptorelin
Degarelix
Relugolix
Bicalutamide
Nilutamide
Apalutamide
Darolutamide
Enzalutamide
Abiraterone
HT: hypertension, DM: diabetes mellitus, HF: heart failure, IHD: ischemic heart disease, AF: atrial fibrillation, QTc: corrected QT interval
ALK inhibitor- and EGFR inhibitor-related cardiovascular toxicities
Drugs
HT
DM
DL
HF
SBr
QTc
prolongation
AF
VTE
Alectinib
Brigantinib
Ceritinib
Crizotinib
Lorlatinib
Osimertinib
HT: hypertension, DM: diabetes mellitus, DL: dyslipidemia, HF: heart failure, SBr: sinus bradycardia, AF: atrial fibrillation, QTc: corrected QT interval, VTE: venous thromboembolism
References
Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). European Heart Journal. 2022 Nov 1;43(41):4229–361.