The cardiotoxicity of chemotherapeutic drugs.

Abstract

Doxorubicin (DOX; Adriamycin, ADRIA Laboratories, Dublin, OH) is used in a wide variety of malignancies.* Its cardiotoxicity is primarily related to cumulative dose, although it can also cause acute cardiac dysfunction. DOX cardiotoxicity can present in three ways3: (1) Acute effects. These occur during and shortly (within hours) after bolus administration, and consist primarily of supraventricular tachyarrhythmias4 ECG changes occurring most commonly include: ST-T segment changes; decrease in voltage; T-wave flattening; and atria1 and ventricular ectopy.5 Rarely, fatal ventricular dysrhythmias occur.6 These effects are transient and occur in up to 40% of patients being administered bolus DOX. The dysrhythmias do not appear to be dosage or schedule dependent, and do not appear to be related to the development of cardiomyopathy. With the exception of the documentation of malignant cardiac dysrhythmias, the development of transient ECG changes is usually not an indication to discontinue DOX. (2) Subacute effects. These are noted within days or weeks of administration, are rare, and consist of toxic myocarditis or pericarditis.3 This has been primarily documented with daunorubicin.4a7 (3) Chronic ef-