Preventing the cardiotoxicity of anthracyclines by dexrazoxaneBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7217.1085 (Published 23 October 1999) Cite this as: BMJ 1999;319:1085
A real breakthrough
- K Hellmann, medical oncologist
- Withyham, East Sussex TN7 4DB
Anthracyclines such as doxorubicin are among the most widely used anticancer drugs and are often given to children as part of curative regimens Yet long term cardiac damage is a major adverse effect that limits the effectiveness of these drugs, particularly in children. The introduction of dexrazoxane to limit the cardiotoxicity of anthracyclines is a real advance in the treatment of some forms of cancer.
Cardiotoxicity induced by anthracyclines primarily affects the myocardium and is dose related, cumulative, and irreversible. Each dose of the anthracycline doxorubicin produces an increment of myocardial damage The normal heart can compensate for this until a lifetime dose of some 450 mg/m2 has been reached, after which the compensatory cardiac mechanisms begin to fail. In childhood malignancies, which may be cured if sufficient anthracyclines can be given, cardiotoxicity is more erratic and severe than in adults.1 Each dose may unpredictably cause severe toxicity, or subclinical cardiotoxicity may become overt only in adolescence or early adulthood.2 A way of preventing cardiotoxicity in children taking anthracyclines will therefore prevent not …