Question:
Among the following chemotherapeutic agents, which one carries the highest risk of causing cardiotoxicity?
Among the following chemotherapeutic agents, which one carries the highest risk of causing cardiotoxicity?
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To mitigate Doxorubicin cardiotoxicity, Dexrazoxane (an intracellular iron chelator) can be administered to reduce free radical formation.
Always obtain a baseline echocardiogram before initiating anthracycline therapy to document the initial LVEF.
Always obtain a baseline echocardiogram before initiating anthracycline therapy to document the initial LVEF.
Updated On: Sep 3, 2026
- Cisplatin
- Methotrexate
- Doxorubicin
- Paclitaxel
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The Correct Option is C
Solution and Explanation
Concept:
Cardiotoxicity is a well-recognized and major dose-limiting adverse effect of several classes of antineoplastic agents.
The most notorious and clinically significant agents responsible for irreversible chemotherapy-induced heart failure are the anthracyclines.
Explanation:
• Doxorubicin belongs to the anthracycline class of chemotherapeutic agents.
• Anthracyclines cause Type I cardiotoxicity, characterized by the generation of reactive oxygen species (free radicals) that directly cause oxidative stress, lipid peroxidation, and irreversible necrosis of cardiac myocytes.
• This toxicity manifests clinically as a dose-dependent, progressive, and often irreversible dilated cardiomyopathy leading to congestive heart failure. The risk increases exponentially when the cumulative lifetime dose exceeds 400-550 mg/m$^2$.
• Option (A), Cisplatin, is a platinum-based alkylating-like agent. Its most significant dose-limiting toxicities are nephrotoxicity and ototoxicity, not direct cardiotoxicity.
• Option (B), Methotrexate, is an antimetabolite (folate antagonist). Its primary major toxicities include myelosuppression, hepatotoxicity, and mucositis.
• Option (D), Paclitaxel, is a taxane (microtubule stabilizer). While it can occasionally cause arrhythmias (like bradycardia), its predominant severe toxicity is peripheral sensory neuropathy, and it is not universally recognized as a primary cause of severe heart failure like doxorubicin.
Final answer:
Doxorubicin, an anthracycline, carries the highest and most severe risk of dose-dependent, irreversible cardiotoxicity.
Cardiotoxicity is a well-recognized and major dose-limiting adverse effect of several classes of antineoplastic agents.
The most notorious and clinically significant agents responsible for irreversible chemotherapy-induced heart failure are the anthracyclines.
Explanation:
• Doxorubicin belongs to the anthracycline class of chemotherapeutic agents.
• Anthracyclines cause Type I cardiotoxicity, characterized by the generation of reactive oxygen species (free radicals) that directly cause oxidative stress, lipid peroxidation, and irreversible necrosis of cardiac myocytes.
• This toxicity manifests clinically as a dose-dependent, progressive, and often irreversible dilated cardiomyopathy leading to congestive heart failure. The risk increases exponentially when the cumulative lifetime dose exceeds 400-550 mg/m$^2$.
• Option (A), Cisplatin, is a platinum-based alkylating-like agent. Its most significant dose-limiting toxicities are nephrotoxicity and ototoxicity, not direct cardiotoxicity.
• Option (B), Methotrexate, is an antimetabolite (folate antagonist). Its primary major toxicities include myelosuppression, hepatotoxicity, and mucositis.
• Option (D), Paclitaxel, is a taxane (microtubule stabilizer). While it can occasionally cause arrhythmias (like bradycardia), its predominant severe toxicity is peripheral sensory neuropathy, and it is not universally recognized as a primary cause of severe heart failure like doxorubicin.
Final answer:
Doxorubicin, an anthracycline, carries the highest and most severe risk of dose-dependent, irreversible cardiotoxicity.
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