Anthacyclines in 1L MBC
Norris et al JCO 2000; Andersson et al Cancer Treat Rep 1986; Joensuu et al JCO 1998; Ejlertsen et al JCO 2004; Nielsen et al Cancer Chemother Pharmacol 2000; Patt et al JCO 2007:
Suter et al Eur Heart J 2013
Toxicity profile:
•
Alopecia
•
Extravasation (vesicant)
•
Mucositis
•
Emesis
•
Mielosupression
•
AML
•
Cardiac damage induced:
direct myocyte death irreversible
•
Nature of damage:
permanent myocyte injury beginning from
1
st
dose
•
Biopsy:
vacuole formation, myofibril disarray and
necrosis/apoptosis
•
Cumulative dose-effect
•
Risk factors:
any condition that has damaged or strained
myocardium, genetic sensitivity to the agent, cumulative
dose, age (children and >65), mediastinal radiation,
combination CT
Type I cardiac dysfunction
q3w
Sched.
qw ¾
Sched.
ORR
Cumulative dose
(5% risk CD tox)
Doxorubicin 60-75
mg/m2
20
mg/m2
30-47% 450 mg/m2
Epirubicin
75-100
mg/m2
20-30
mg/m2
42-50% 935 mg/m2
