Adriamycin (doxorubicin) cardiotoxicity: a review

Adriamycin (doxorubicin hydrochloride) is an antineoplastic agent effective against a wide range of malignant conditions, although cardiac toxicity, especially dose-dependent cardiomyopathy, limits its long-term use. Previous mediastinal radiation therapy or left ventricular dysfunction and advanced age increase the risk of this complication developing. Unfortunately, there is no readily available, noninvasive method that can predict Adriamycin-induced congestive heart failure (CHF). However, both endomyocardial biopsy and radionuclide ejection-fraction measurement are promising techniques which may soon permit selection of patients who can safely receive this drug. At present, Adriamycin-induced CHF can best be prevented by limiting the total dose as follows: 400 to 450 mg per sq meter following mediastinal radiation and 500 to 550 mg per sq meter for patients without other significant risk factors. Consideration of dose-response data and use of a weekly schedule may soon permit the administration of Adriamycin for long-term antineoplasm therapy.