ABSTRACT
The treatment of malignant disease with antineoplastic agents has become more widespread with the availability of additional active drugs and treatment regimens. Adjuvant treatment programs attempting to eradicate microscopic disease are commonplace for breast, colon, osteosarcoma, and testicular tumors, and investigational in a number of other solid tumors. Neoadjuvant chemotherapy programs preceding definitive local treatment are now used in the therapy of locally advanced breast cancer, osteosarcomas, head and neck tumors, and, in some cases, non-smallcell lung cancer. Patients with advanced testicular tumors, small-cell lung cancer, lymphomas, myeloma, and leukemias can experience prolonged survival and, in some cases, are cured with chemotherapy as the primary treatment. Many patients with metastatic and/or advanced disease will receive successful palliative treatment with antineoplastics. The gains of these treatment programs are not without risks of complications because of the toxic nature of the agents used. Late abnormalities of left ventricular performance have been reported in survivors of childhood cancers (Hancock et al., 1993; Lipshultz et al., 1995; Sorensen et al., 1997; Nysom et al., 1998). Late cardiotoxicity has been observed in bone marrow transplant patients who received anthracyclines (Lele et al., 1996). Cardiac failure and dysrhythmias have occurred from 6 to 19 years after anthracycline therapy in some patients (Steinherz et al., 1995). This chapter is a review of the cardiotoxic effects of the commonly used anthracyclines, a discussion of possible mechanisms of action and prevention, as well as additional discussion of other antineoplastics with cardiotoxic effects.
