Version June 2023
| Perform baseline radionuclide angiocardiography at rest for calculation of left ventricular ejection fraction (LVEF) prior to administration of 100 mg/m2 doxorubicin. |
| Subsequent studies are performed at least three weeks after the indicated total cumulative doses have been given, before consideration of the next dose. |
| Patients with normal baseline LVEF (≥50 percent) |
| Perform a second study after 250 to 300 mg/m2. Repeat study after 400 mg/m2 in patients with known heart disease, radiation exposure, abnormal electrocardiographic results, or cyclophosphamide therapy; or after 450 mg/m2 in the absence of any these risk factors. |
| Perform sequential studies thereafter prior to each dose. |
| Discontinue doxorubicin therapy once functional criteria for cardiotoxicity develop, eg, absolute decrease in LVEF ≥10 percent (EF Units) associated with a decline to a level of ≤50 percent (EF Units). |
| Patients with abnormal baseline LVEF (≤50 percent) |
| Doxorubicin therapy should not be initiated with baseline LVEF ≤30 percent. |
| In patients with LVEF >30 percent and <50 percent, sequential studies should be obtained prior to each dose. |
| Discontinue doxorubicin with cardiotoxicity: absolute decrease in LVEF ≥10 percent (EF units) and/or final LVEF ≤30 percent. |
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