Adriamycin-induced myocardial toxicity: new solutions for an old problem?

Full Abstract

Adriamycin is a potent and broad-spectrum antineoplastic agent that plays a major role in cancer chemotherapy. Unfortunately, its use has been hampered by conventional toxicities and cardiotoxicity manifested by congestive cardiomyopathy. Adriamycin is particularly toxic to heart tissue and constitutes a major cause of morbidity and mortality due to its complex pathogenesis. In this review, the different forms of cardiotoxicity produced by adriamycin as well as the biochemical changes induced by this drug are summarized. Secondly, the current hypotheses proposed to explain adriamycin-induced myocardial damage (the iron and free-radical hypothesis, the metabolic hypothesis, the "unifying hypothesis" and apoptosis) and the attempts to reduce adriamycin-induced myocardial toxicity are discussed (e.g. dose limitation, close cardiac monitoring, alteration of dosage schedules, development of new anthracycline analogs, and the administration of protective agents and liposomal encapsulation). Finally, we summarized our own experimental and clinical experience in ameliorating and or preventing adriamycin-induced cardiotoxicity and the latest attempts to prevent and/or monitor cardiac function. According to this, a combination of usual doses of calcium antagonist drugs plus vitamins A and E seems advisable.

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Author information

Author/s: Outomuro, Delia (D); Grana, Daniel R (DR); Azzato, Francisco (F); Milei, José (J);

Affiliation: Instituto de Investigaciones Cardiológicas, Universidad de Buenos Aires-Conicet, Argentina.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't; Review

Journal: International journal of cardiology (Int J Cardiol), published in Netherlands. (Language: eng)

Reference: 2007-Apr; vol 117 (issue 1) : pp 6-15

Dates: Created 2007/03/19; Completed 2007/05/01;

PMID: 16863672, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Animals
Antibiotics, Antineoplastic - adverse effects
Cardiomyopathies - chemically induced; diagnosis; physiopathology; prevention & control
Disease Models, Animal
Dose-Response Relationship, Drug

Doxorubicin - adverse effects
Drug Evaluation - methods
Drug Toxicity - physiopathology; prevention & control
Humans
Neoplasms - complications; drug therapy

Associated Chemicals: Antibiotics, Antineoplastic (0) ; Doxorubicin (23214-92-8)

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