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Lookup NU author(s): Professor Roderick Skinner
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2025 The Authors. Anthracycline and anthraquinone agents are major contributors to cancer therapy–related cardiac dysfunction in childhood cancer. However, evidence-based equivalence ratios for estimating individual risk have not been incorporated into international surveillance guidelines. The International Late Effects of Childhood Cancer Guideline Harmonization Group systematically reviewed the literature on equivalence ratios for doxorubicin, daunorubicin, epirubicin, idarubicin, and mitoxantrone. Based on available evidence, benefit–harm considerations, and expert consensus, the panel concluded that the risk of cardiac dysfunction is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin (moderate-quality evidence; strong recommendation). The panel recommends using an approximate ratio of 0.6 to convert daunorubicin to a doxorubicin-equivalent dose and a ratio of 10.5 for mitoxantrone (low-quality evidence; moderate recommendation). No recommendation was made for epirubicin or idarubicin due to inconclusive evidence.
Author(s): Kouwenberg TW, van Dalen EC, Mulder RL, Armenian S, Feijen EAM, Chow EJ, Kosmidis H, Vormoor-Burger BJ, Kiyotani C, Nathan PC, Kapusta L, Grotenhuis HB, Engels FK, Teske AJ, Tragiannidis A, Slieker MG, Ozono S, Nohria A, Slama T, Skinner R, Hudson MM, Kremer LCM, Ehrhardt MJ, Mavinkurve-Groothuis AMC
Publication type: Review
Publication status: Published
Journal: JACC: CardioOncology
Year: 2025
Pages: Epub ahead of print
Online publication date: 20/06/2025
Acceptance date: 17/05/2025
ISSN (electronic): 2666-0873
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.jaccao.2025.05.009
DOI: 10.1016/j.jaccao.2025.05.009
