Anthracycline-Induced Cardiotoxicity – A Review

Anthracyclines are frequently an indispensable cytostatic component of chemotherapy. The cardiotoxicity occurring with these drugs is reviewed. Anthracycline-induced cardiotoxicity causes characteristic histopathological changes, which are the same for all the anthracyclines. The degree of these changes is dose-related. The pathogenesis is multifactorial, with the formation and action of free radicals triggered off by the anthracyclines constituting one of the major factors. The clinical symptoms are similar to those of CHF. Risk factors such as the cumulative dose, irradiation of the heart and childhood increase the probability of cardiotoxicity. The clinical course of the condition varies widely in individual patients, and it has so far proved impossible to find a method of predicting it. However, it seems possible that an integrated monitoring program can diminish the risk of development of anthracycline-induced cardiotoxicity.Close attention to risk factors, the selection of the anthracycline to be used, the mode of administration of the anthracycline and, in future, also the substance ADR 529, are all important factors in the prevention of anthracycline-induced cardiotoxicity. Comparative studies show that generally anthracyclines with lower potential cardiotoxicity are clinically less effective. Epirubicin and idarubicin are either equally or more effective than doxorubicin or daunorubicin, respectively and at the same time less cardiotoxic.