Download Maximum Anthracycline Doses Guidance

Maximum Anthracycline Doses Guidance
The following recommendations are for adult patients and are based on information from various
sources, including the drug manufacturers and the references below.
They are typically based at or below the cumulative dose at which the incidence of chronic
cardiotoxicity has been shown to reach 5%.
Also included is one possible method of calculating the anthracycline exposure of a patient who has
received two or more different anthracyclines.
Table 1 - Recommended cumulative maximum anthracycline doses
Maximum recommended cumulative dose
(mg/m2)
Drug
1
600
2,3
450
4
900
Daunorubicin
Doxorubicin
Epirubicin
5
150
6
400
Idarubicin – IV
Idarubicin – PO
Mitoxantrone
7
160
NB Aside from the cumulative anthracycline dose, other risk factors for cardiotoxicity should be taken
into account. These include any underlying cardiovascular disease, prior mediastinal irradiation and
older age.
Example calculation:
A patient with NHL has previously received 6 x CHOP-R and 2 x IVE.
How much of their anthracycline “allowance” have they used?
6 x CHOP-R
2
= 6 x 50mg/m doxorubicin
2
= 300mg/m doxorubicin
= ~ 2/3 cumulative anthracycline allowance
2 x IVE
2
= 2 x 50mg/m epirubicin
2
= 100mg/m epirubicin
= ~ 1/9 cumulative anthracycline allowance
Total
= 2/3 + 1/9
= ~ 7/9 of anthracycline allowance
Originally authored by: Simon Cheesman, Aoife Shields, Sept 2004, 2010, 2013
Version 1
Re-reviewed and Updated: January 2014
Review Date: January 2016
Patient has around ~ 2/9 of their cumulative anthracycline allowance left.
Table 2 - Commonly used chemotherapy regimens and their anthracycline content:
Regimen
Anthracycline
ABVD
AC
AML 17 AIDA Induction
AML 17 AIDA 1st Consolidation
AML 17 AIDA 2nd Consolidation
AML 17 AIDA 3rd Consolidation
Baseline BEACOPP
CHOP
Cisplatin/Epirubicin
CODOX-M
D(90)A 3+10
D(60)A 3+10
DA 3+8
DA 2+5
DAE
DClo
Esc BEACOPP
EC90
Epi-CEM
Doxorubicin
Doxorubicin
Idarubicin (IV)
Idarubicin (IV)
Mitoxantrone
Idarubicin (IV)
Doxorubicin
Doxorubicin
Epirubicin
Doxorubicin
Daunorubicin
Daunorubicin
Daunorubicin
Daunorubicin
Daunorubicin
Daunorubicin
Doxorubicin
Epirubicin
Epirubicin
Dose per course
2
(mg/m )
50
60
48
20
50
12
25
50
90
40
270
180
150
100
150
150
35
90
150
FEC75
FEC100
FlA(G)-Ida
FMD
Hyper-CVAD
Ida/Ara-c
IDARAM
IVE
MAXI-CHOP
MCD
MiDAC
PAD
PMitCEBO
Stanford V
UKALL 14 Phase I induction
UKALL 14 Cycle 3 Consolidation
UKALL 2011 Regimen A Delayed
Intensification
UKALL 2011 Regimen B
Induction
UKALL 2011 Regiman B Delayed
Intensification
UKALL 2011 Regiman C
Induction
Epirubicin
Epirubicin
Idarubicin (IV)
Mitoxantrone
Doxorubicin
Idarubicin (IV)
Idarubicin (IV)
Epirubicin
Doxorubicin
Mitoxantrone
Mitoxantrone
Doxorubicin
Mitoxantrone
Doxorubicin
Daunorubicin
Daunorubicin
Doxorubicin
75
100
24
12
50
30
20
50
75
12
50
36
7
25
120
100
75
AML 17
PADIMAC
Each 2-week cycle
Each 2-week cycle
UKALL 14
UKALL 14
UKALL2011
Daunorubicin
100
UKALL 2011
Doxorubicin
75
UKALL 2011
Daunorubicin
90
UKALL 2011
Originally authored by: Simon Cheesman, Aoife Shields, Sept 2004, 2010, 2013
Version 1
Re-reviewed and Updated: January 2014
Review Date: January 2016
Note
Per 28 day cycle
AML 17
AML 17
AML 17
AML 17
Per 21 day cycle
AML 17
AML 17
AML 17
AML 18
AML 18
AML 17 & 18
Per single HD
Treatment
AML 17
Nordic MCL-2
UKALL 2011 Regiman C Delayed
Intensification
VAD
Z-DEX
Doxorubicin
75
Doxorubicin
Idarubicin (PO)
36
40
UKALL 2011
References
1)
2)
3)
4)
Daunorubicin. Summary of Product Characteristics. Winthrop pharmaceuticals, June 2010
A clinicopathologic analysis of adriamycin toxicity. Lefrak et al. Cancer, 1973; 32: 302-314
Cardiotoxicity of Cancer Therapy. Floyd et al J Clin Oncol, 2005; 23: 7685-7696
Epirubicin cardiotoxicity: an analysis of 469 patients with metastatic breast cancer. Ryberg et
al. J Clin Oncol, 1998; 16: 3502-3508
5) Idarubicin cardiotoxicity: A retrospective study in acute myeloid leukaemia and
myelodysplasia. Anderlini et al. J Clin Oncol, 1995; 13: 2827-2834
6) Zavedos capsules. Summary of Product Characteristics. Pharmacia, November 2010
7) Mitoxantrone. Summary of Product Characteristics. Mayne Pharma plc. March 2007
Originally authored by: Simon Cheesman, Aoife Shields, Sept 2004, 2010, 2013
Version 1
Re-reviewed and Updated: January 2014
Review Date: January 2016