Anthracycline-induced cardiotoxicity: Comparison of recommendations for monitoring cardiac function during therapy in paediatric oncology trials

The use of anthracyclines is limited by a dose-dependent cardiotoxicity (A-CT). The aim of this study was to gain insight in the currently available guidelines for monitoring cardiotoxicity during anthracycline therapy in children and in the monitoring recommendations currently used in European paediatric oncology trials. An extensive literature search to identify guidelines was performed and one guideline was identified. Twelve protocols including anthracycline therapy were evaluated. With regard to the minimally required diagnostic tests, parameters and definitions of A-CT most protocols roughly followed the guideline. However, both monitoring schedules and recommendations to prevent further cardiac damage in case A-CT was diagnosed varied widely between protocols and only a minority of the protocols followed the recommendations of the guideline. In conclusion, despite an existing guideline, there is a wide variation in the recommendations for monitoring cardiac function during anthracycline therapy in the currently used European paediatric oncology protocols. A possible explanation could be the lack of rigorous evidence on the most optimal way to monitor cardiac function in children treated with anthracyclines. There is a strong need for evidence from clinical research which can support recommendations for monitoring cardiac function during anthracycline therapy for childhood cancer. In the meantime, it is important to uniformise the used cardiac monitoring schedules.