[Anthracycline-induced cardiotoxicity]

Abstract

Anthracyclines are topoisomerase II inhibitors that are used for various malignancies, but their usefulness is limited by cardiotoxicity. Three types of cardiotoxicity are distinguished: acute, sub-acute, and chronic. The chronic toxicity is related to the peak plasma concentration and the cumulative dose. Generation of free radicals appears to be the main cause of myocardial damage in late-onset cardiotoxicity. Anthracycline toxicity is exacerbated in pediatric and elderly population. An increased toxicity is also observed after heart irradiation and with some chemotherapy combinations. Myocardial damages are asymptomatic for a long time, but echocardiography detects a reduction of left ventricular ejection fraction. Endomyocardial biopsy is the only specific test for early diagnosis of anthracycline-induced toxicity. This cardiotoxicity can be reduced by anthracycline administration modifications, pharmacological cardioprotection, and doxorubicin analogues with a better tolerance profile, as epirubicin or liposomal anthracyclines.