Anthracycline Cardiotoxicity

Anthracyclines like adriamycin and epirubicin are good chemotherapeutic agents which improve the long term survival, especially in breast cancer. But a small number of them develop cardiotoxicity, which is less with epirubicin than with doxorubicin (adriamycin) on a milligram per milligram basis. The chance for cardiotoxicity is more in the elderly and those with pre-existing heart disease. Concomitant radiotherapy and use of cyclophosphamide also increases the risk of adriamycin induced cardiomyopathy. The total cumulative dose is also an important determinant of risk. Conventional risk factors for heart disease like hypertension and diabetes mellitus also increase the risk of congestive heart failure with anthracycline therapy. A recent surgery found the risk of congestive heart failure with epirubicin to about 5%. The risk becomes more significant in those with early stages of cancer who are likely to be cured of the illness.