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should be considered in mild asymptomatic CTRCD while anthracycline chemotherapy continues uninterrupted (Figure 25).1,14,102,424 The beneficial effects of aerobic exercise before and during anthracycline chemotherapy have been demonstrated and is recommended for patients with cancer who develop CTRCD.11 A MDT is recommended to discuss restarting anthracycline chemotherapy in patients who developed mild or moderate symptomatic CTRCD, or moderate or severe asymptomatic CTRCD, after recovery of LV function under HF treatment. If there is a compelling reason to continue anthracycline chemotherapy, three other strategies exist in addition to continuing ACE-I/ARB and beta-blockers at target doses for HF.14 First, minimizing the dose of anthracycline chemotherapy administered. Second, switching to liposomal anthracycline preparations. Third, pre-treatment

Disconti n ue

A C (Class I) Inte r rupt

A C (Class I) MDT a pp r oach

r ega r ding inte r ruption

vs . conti

. n uation

of A C (Class I) Inte r rupt

A C (Class I) Conti n ue

A C with CV monitoring

(Class I)

Symptomatic CTRCD a

V e V V r y s e v e r e/s e v e r e

Oncological strategy

CV strategy Moderate

MDT b Mild S e v e r e/moderate Mild

GLS dec r ease >15%

or cTn inc r ease

A CE-I/ARB and/or BB (Class IIb)

A CE-I/ARB and/or BB (Class IIa)

HF ther a p y

p p (Class I) NP inc r ease

Asymptomatic CTRCD a

Management of patients with A C- r elated ca r diac dysfunction

AND

MDT c

AND

MDT c

AND

Figure 25 Management of anthracycline chemotherapy-related cardiac dysfunction. AC, anthracycline chemotherapy; ACE-I, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; BB, beta-blockers; cTn, cardiac troponin; CTRCD, cancer therapy-related cardiac dysfunction; CV, cardiovascular; GLS, global longitudinal strain; HF, heart failure; LV, left ventricular; LVEF, left ventricular ejection fraction; MDT, multidisciplinary team; NP, natriuretic peptides. aSee Table 3 (Section 3) for complete definition (symptomatic CTRCD: symptomatic confirmed HF syndrome; asymptomatic severe CTRCD: LVEF , 40%; asymptomatic moderate CTRCD: LVEF 40–49%; asymptomatic mild CTRCD: LVEF . 50%). bIn rare exceptions, anthracycline chemotherapy may be restarted after recovery of LV function with optimal HF therapy. cA MDT discussion is recommended before restarting anthracycline chemotherapy after recovery of LV function. Downloaded from academic.oup.com/eurheartj/article/43/41/4229/6673995 by guest on 07 October 2026