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In a prospective study of 120 patients treated for advanced breast cancer, epirubicin induced a slowly progressing decrease of cardiac function continuing years after treatment cessation, 20% of patients progressed into chronic heart failure in 3 years after cumulative dose 8501,000 mg/m 2 of epirubicin ( Chronic cardiotoxicity represents a growing concern, especially in childhood cancer survivor cohort

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The weakest part of the argument is that no clinical trial has ever tested this specific combination, the additive effect of levocarnitine on top of tirzepatide substantial metabolic impact may be negligible, and the cost premium is not clearly justified by the expected benefit