Cumulative dose of which class of chemotherapy agents should be monitored?

• A. antimetabolites
• B. alkylating agents
• C. antiangiogenesis inhibitors
• D. anthracyclines

Answer: (D)

Anthracyclines have a dose-related, cumulative risk of heart damage. The more total exposure a patient has over their lifetime, the higher the chance of developing cardiomyopathy or heart failure. This toxicity is largely irreversible, so clinicians closely track the cumulative dose (often across all cycles and even past treatments) and may limit further use or switch therapies as the total approaches a predefined threshold. That’s why monitoring cumulative dose is emphasized for this class.

Other classes have different dominant toxicities that aren’t tied to a single lifelong dose limit in the same way. Antimetabolites and alkylating agents can cause cumulative marrow suppression and other organ toxicities, but not a clear, universal cardiotoxicity threshold driven by total dose. Antiangiogenesis inhibitors present risks like hypertension and thrombosis, rather than a well-defined cumulative-dose limit for a specific organ.