A 14-year-old boy on the MAP protocol for osteosarcoma receives cumulative doxorubicin therapy. Which monitoring strategy and dose ceiling are correct for detecting its dose-limiting toxicity?

• A Serial echocardiography, ceiling of approximately 450 to 550 mg/m2 ✓
• B Serial audiometry, ceiling of 400 mg/m2
• C Serial liver function tests, ceiling of 300 mg/m2
• D Serial chest radiographs, ceiling of 600 mg/m2

Explanation

Doxorubicin causes cumulative, dose-dependent dilated cardiomyopathy through free radical injury to cardiac myocytes, and this is its dose-limiting toxicity. Cardiac function is monitored with serial echocardiography or MUGA scanning, and the cumulative dose is kept below approximately 450 to 550 mg/m2, beyond which the risk of heart failure rises sharply. Ototoxicity belongs to cisplatin, and hepatotoxicity is not the classical dose limiter here.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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