The total cumulative lifetime dose of doxorubicin is 450 to 500 mg/m2.
Reduce the total cumulative lifetime dose to 400 to 450 mg/m2 if elderly, prior mediastinal radiation, hypertensive cardiomegaly, concurrent therapy with high dose cyclophosphamide and some other cytotoxic drugs (e.g. dacarbazine, dactinomycin, etoposide, mitomycin, melphalan, vincristine and bleomycin).
Baseline clinical assessment, echocardiogram (ECHO) or gated heart pool scan (GHPS) and electrocardiogram (ECG) evaluation. Patients with normal baseline cardiac function (left ventricular ejection fraction (LVEF) > 50%) and low risk patients require LVEF monitoring when greater than 70% of anthracycline threshold is reached or if patient displays symptoms of cardiac impairment. Post treatment cardiac monitoring is recommended for patients who have received high levels of total cumulative doses of doxorubicin at the clinicians discretion.