Hematological toxicity: experience with anthracyclines and anthracenes

Documented is hemopoietic toxicity encountered in patients with primary liver cancer (PLC), metastatic breast cancer, and colorectal cancer treated with various anthracyclines (doxorubicin [adriamycin, ADR], 4-'epidoxorubicin [4-'epiADR], and esorubicin) or anthracenes (mitoxantrone and bisantrene, as single agents as well as different combinations). Mitoxantrone, 14 mg/m2 three times weekly, was significantly more toxic than ADR, 60 mg/m2 three times weekly, for patients with PLC (P less than 0.01). In patients with colon cancer the toxicity of esorubicin did not differ significantly from that of 4-'epiADR. There was a tendency toward cumulative leukopenia with mitoxantrone and esorubicin, and cumulative thrombocytopenia with mitoxantrone and ADR. Although nadir counts for cycles 1 and 3 were similar, the percentage of patients receiving the full planned dose by the third cycle differed with the different drugs and in the different disease categories. Doxorubicin can be effectively combined with other cytostatics (e.g., cyclophosphamide + ADR + fluorouracil) to give improved results without undue hemopoietic toxicity in patients with breast cancer.