Anthracyclines are widely used in medical oncology treatment and are representative cytotoxic agents with a history of use for more than 50 years. Although significant advances in oncology drug therapy have been made in the last few decades, with targeted agents and immunotherapeutic agents bringing new breakthroughs in oncology treatment, anthracyclines still play an important role in the treatment of many solid tumors and hematologic malignancies.
Anthracyclines are antitumor antibiotics, which are chemicals produced by microorganisms that have antitumor activity. The major anthracyclines include:
- Roxithromycin (daunorubicn, DNR);
- Desoxorubicin (idarubicin, IDA) also known as idarubicin;
- Adriamycin (ADM) also known as doxorubicin;
- Epiomycin (epi-adriamycin, ADM) also known as doxorubicin;
- epirubicin (EPI), also known as epirubicin;
- pyrantelamycin (4′-0-tetrahydropyranyladriamyein, THP) also known as pirarubicin;
- mitoxantrone (4′-0-tetrahydropyranyladriamyein, THP) also known as pirarubicin;
- mitoxantrone (MIT);
- carobicin (carubicin), etc.
The first anthracycline, flexoxantrone, was introduced in 1963 and was immediately used in the treatment of hematologic tumors, where it continues to play an important role today. This was followed by a second anthracycline, adriamycin, which has the broadest antitumor spectrum and is effective against tumor cells of all growth cycles. Pyranoadriamycin and epiadriamycin were widely used because of their comparable efficacy but lower cardiotoxicity compared with adriamycin; the introduction of the new liposomal adriamycin allowed further reduction of cardiotoxicity.
Anthracyclines have a broad antitumor spectrum and have been used effectively and extensively in the treatment of hematologic and solid tumors, including acute leukemia, lymphoma, breast cancer, ovarian cancer, gastric cancer, and soft tissue sarcomas.
Adverse effects of anthracyclines include cardiotoxicity, bone marrow suppression, and gastrointestinal reactions, all of which are dose-dependent.