What is a major toxicity of doxorubicin and how is it mitigated?

• A. Cardiotoxicity; mitigated by limiting cumulative dose and monitoring cardiac function.
• B. Nephrotoxicity; mitigated by hydration and diuretics.
• C. Neurotoxicity; mitigated by dose adjustments.
• D. Hepatotoxicity; mitigated by liver function tests.

Answer: (A)

Doxorubicin’s major toxicity is dose-related cardiotoxicity, meaning the heart is at risk of damage that grows as the total amount given increases. This can lead to cardiomyopathy and, in severe cases, heart failure. The best way to mitigate this risk is to keep the cumulative dose within safe limits and to monitor heart function regularly during treatment, using tools like echocardiography or MUGA scans to detect early changes. In some situations, a protective agent called dexrazoxane may be used to further reduce cardiac injury when high cumulative doses are necessary.

Other listed toxicities—nephrotoxicity, neurotoxicity, and hepatotoxicity—are not the primary concerns with doxorubicin, and the suggested mitigation strategies for those adverse effects do not address the main, dose-dependent cardiac risk associated with this drug.