Cardiotoxicity of doxorubicin and other anthracycline derivatives

Abstract

Doxorubicin cardiotoxicity has posed a formidable challenge in the fields of oncology, cardiology, pharmacology, biochemistry, pathology, and molecular biology Whereas development of a noncardiotoxic doxorubicin analogue has eluded scientists so far, careful monitoring of left ventricular ejection fraction with radionuclide angiocardiography during the course of doxorubicin therapy has substantially reduced the incidence and severity of overt congestive heart failure. Use of intracellular iron chelating agents and liposomal doxorubicin have the potential for substantially improving the safety margin of doxorubicin and for allowing the use of higher cumulative doses of doxorubicin. However, the current guidelines for left ventricular ejection fraction monitoring using equilibrium radionuclide angiocardiography should still be followed until a large volume of experience is accumulated with iron chelating agents and liposomal doxorubicin used either alone or in combination.