The clinical use of anthracyclines like doxorubicin and daunorubicin can be viewed as a sort of double-edged sword. On the one hand, anthracyclines play an undisputed key role in the treatment of many neoplastic diseases; on the other hand, chronic administration of anthracyclines induces cardiomyopathy and congestive heart failure usually refractory to common medications. Second-generation analogs like epirubicin or idarubicin exhibit improvements in their therapeutic index but the risk of inducing cardiomyopathy is not abated. It is because of their janus behaviour (activity in tumors vis-à-vis toxicity in cardiomyocytes) that anthracyclines continue to attract the interest of preclinical and clinical investigations in spite of their longer than 40 years record of longevity. Here we review recent progresses which may serve a framework for reappraising the activity and toxicity of anthracyclines on basic and clinical pharmacology grounds. We review (i) new aspects of anthracycline-induced DNA damage in cancer cells; (ii) the role of iron and free radicals as causative factors of apoptosis or other forms of cardiac damage; (iv) molecular mechanisms of cardiotoxic synergism between anthracyclines and other anticancer agents; (v) the pharmacologic rationale and clinical recommendations for using cardioprotectants while not interfering with tumor response; (vi) the development of tumor-targeted anthracycline formulations; (vii) the designing of third-generation analogs and their assessment in preclinical or clinical settings. An overview of these issues confirms that anthracyclines remain “evergreen” drugs with broad clinical indications but still an improvable therapeutic index.

Anthracyclines: molecular advances and pharmacological developments in antitumor activity and cardiotoxicity

MINOTTI G;MENNA P;SALVATORELLI E;
2004-01-01

Abstract

The clinical use of anthracyclines like doxorubicin and daunorubicin can be viewed as a sort of double-edged sword. On the one hand, anthracyclines play an undisputed key role in the treatment of many neoplastic diseases; on the other hand, chronic administration of anthracyclines induces cardiomyopathy and congestive heart failure usually refractory to common medications. Second-generation analogs like epirubicin or idarubicin exhibit improvements in their therapeutic index but the risk of inducing cardiomyopathy is not abated. It is because of their janus behaviour (activity in tumors vis-à-vis toxicity in cardiomyocytes) that anthracyclines continue to attract the interest of preclinical and clinical investigations in spite of their longer than 40 years record of longevity. Here we review recent progresses which may serve a framework for reappraising the activity and toxicity of anthracyclines on basic and clinical pharmacology grounds. We review (i) new aspects of anthracycline-induced DNA damage in cancer cells; (ii) the role of iron and free radicals as causative factors of apoptosis or other forms of cardiac damage; (iv) molecular mechanisms of cardiotoxic synergism between anthracyclines and other anticancer agents; (v) the pharmacologic rationale and clinical recommendations for using cardioprotectants while not interfering with tumor response; (vi) the development of tumor-targeted anthracycline formulations; (vii) the designing of third-generation analogs and their assessment in preclinical or clinical settings. An overview of these issues confirms that anthracyclines remain “evergreen” drugs with broad clinical indications but still an improvable therapeutic index.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12610/10476
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