Question: What are the anthracycline chemotherapeutic agents and what is the primary toxicity that is dose limiting for these agents?
Answer: The four most common anthracyclines are doxorubicin, daunorubicin, epirubicin and idarubicin. Doxorubicin and daunorubicin were the first to be used in clinical practice. Cardiotoxicity is the primary dose limiting toxicity for these agents. The cited reference notes “The exact mechanism of anthracycline-induced cardiotoxicity remains unclear, though it is likely to be multifactorial. Until recently, the most widely accepted hypothesis was that anthracyclines interfered with redox cycling, resulting in DNA damage due to reactive oxygen species (ROS) production. More recently, topoisomerase 2 has been suggested to be the main mediator of cardiotoxicity, though other mechanisms contribute. (McGowan JV et al. Anthracycline chemotherapy and cardiotoxicity. 2017 Cardiovsc Drugs 31:63-75)