A practical approach to adriamycin (NSC 123127) toxicology

The significant complications of adriamycin therapy, discovered during the initial therapeutic trials, are myelosuppression, mucositis, cardiomyopathy, and local tissue necrosis. Risk factors for myelosuppression include infiltration of tumor into bone marrow, prior irradiation therapy (and chemotherapy only when associated with cumulative myelosuppression), and liver disease. The dangers of myelosuppression are minimized by scheduling intermittent doses, repeated no more frequently than at 3 week intervals. Guidelines for dosage reduction in the presence of liver disease are presented. Mucositis is an unusual side effect of intermittent single dose administration. Cardiac toxicity is not usually seen if the cumulative dose of adriamycin is less than 550 mg/m² in most patients and less than 450 mg/m² in patients with risk factors of mediastinal irradiation and/or simultaneous cyclophosphamide. Local tissue necrosis is minimized by intermittent administration of single doses since fewer injections are given, and in addition, by meticulous care in drug administration. Minor toxic effects of adriamycin are described as well. Some of these can also be ameliorated or eliminated by care in drug administration.