Pharmaceutical Measures to Prevent Doxorubicin-Induced Cardiotoxicity

The anthracycline doxorubicin (DOX) has proved to be one of the most widely used and most effective antitumor drugs since its emergence in the 1960s. However, the utility of DOX is compromised by its potential lethal cardiotoxicity. In this review we summarize development in prevention and management of DOX-induced cardiotoxicity comprehensively.

Strategies to enhance DOX efficacy in cancer cells while minimizing associated cardiotoxicity may prove clinically valuable. Employment of DOX derivatives, including currently available mitoxantrone and epirubicin, has been testified in several clinical trials. Several cardioprotective agents, including dexrazoxane, statins, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and etc., have been developed and tested in animal and clinical trials.

Several strategies have been reported on the prevention and management of DOX-elicited cardiotoxicity, and many of them await verification from large scale clinical trials. Dexrazoxane has been approved to prevent and treat side effects of DOX, although concerns still exist that it might increase incidence of some kind of malignant tumors. Promising findings in autophagy, RNA binding protein quaking and statins encourage further research developing strategies by which heart protection and cancer cell killing are achieved simutaneously.