Among anthracycline and anthraquinone agents, the risk of cancer therapy-related cardiac dysfunction (CTRCD) after treatment for childhood cancer is lower with daunorubicin and higher with mitoxantrone compared with doxorubicin, according to guidance from the International Late Effects Childhood Cancer Guideline Harmonization Group (IGHG) presented at the Fourth International Symposium on Late Complications after Childhood Cancer Conference (ISLCCC) and simultaneously published in JACC: CardioOncology.

The Expert Panel was convened to determine evidence-based equivalence ratios for estimating individual risk of CRTCD for doxorubicin, daunorubicin, epirubicin, idarubicin and mitoxantrone based on a systematic literature review.

For calculating the CTRCD risk-equivalent dose, the Panel states it is reasonable to use 0.6 for daunorubicin-to-doxorubicin and 10.5 for mitoxantrone-to-doxorubicin. They note that estimates vary depending on cumulative dose. No recommendations were made for epirubicin or idarubicin because of insufficient quality evidence.

"These risk-equivalent doses should inform cardiac surveillance guidelines for childhood cancer survivors," writes the Expert Panel. Future research should focus on prevention strategies as well as the cardiotoxicity of novel agents.

The guidance, which JACC: CardioOncology's Editor-in-Chief, Bonnie Ky, MD, MSCE, FACC, called "impactful," was one of two papers from the journal presented at ISLCCC. The other focused on using DNA methylation clocks to better understand the complex relationship between epigenetic age acceleration, childhood cancer treatments, and the development of cardiometabolic risk factors and cardiovascular diseases.

"This innovative study provides strong scientific premise that targeting accelerated aging could be a promising strategy to reduce long-term treatment-related health risks in childhood cancer survivors," writes Ky.