chapter  7
34 Pages

Chapter 7

University of Cincinnati College of Pharmacy, Cincinnati, Ohio, U.S.A.


The treatment of malignant disease with antineoplastic agents has become more

widespread with the availability of additional active drugs and treatment regi-

mens. Adjuvant treatment programs attempting to eradicate microscopic disease

are now commonplace for breast, colorectal, lung, osteosarcoma, and testicular

tumors, and investigational in a number of other solid tumors. Neoadjuvant

chemotherapy regimens 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-small cell 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 perfor-

mance have been reported in survivors of childhood cancers (1-6). Late car-

diotoxicity has been observed in bone marrow transplant patients who received

anthracyclines (7). Cardiac failure and dysrhythmias have occurred from 6 to

19 years after anthracycline therapy in some patients (8). Table 1 provides an

overview of the cardiotoxicity of various antineoplastic agents.