Anthracyclines-mechanism of action and of cardiotoxicity, the role of dexrazoxane in the prevention of antracycline cardiomyopathy


Klin Onkol 1997; 10(3): 68-70.

Anthracycline cytostatics are a basic part of therapeutic combinations used in antitumour chemotherapy. Among the toxic effects are haematopoetic suppression and cardiotoxicity, the latter is often the limiting effect in therapy.

The current article describes the mechanisms of cytotoxic (intercalation, topoisomerase II inhibition) and cardiotoxic (creation of free oxygen radicals) effects of anthracyclines and shows the possibilities of cardiotoxicity inhibition. One of the possibilities is to use a cardioprotective agent. Dexrazoxane is a cardioprotective, chelating agent, which by catching iron ions (scavenger) inhibits the creation of free oxygen radical.

According to current clinical experience the main cardioprotective impact is the possibility of increasing the whole cumulative anthracycline dosis, which enables application of more therapeutic cycles without increased cardiotoxicity risk, and also enables application of anthracyclines in patients with contraindication due to heart disease. In both possibilities better treatment response can be obtained.
The dexrazoxane indication must be weighted not only from the therapeutic point of view, but also from the financial limits. The application must always be well thought over. According to our experience and the literature, it seems to be optimal in patients with curable tumours.