Anthracycline derivative adriamycin (ADR) is one of the most important anticancer drugs with major clinical application in carcinomas of the brest, endometrium, ovary, testicle, thyroid, lung and in treatment of many sarcomas. It is useful also in haematological cancers including acute leukaemia, multiple myeloma, Hodgkin's disease and the diffuse non-Hodgkin lymphomas. A factor limiting ADR clinical practice is represented by a severe dose-dependent cardiac toxicity, the mechanism of which is still under study, but appears to involve excessive intracellular production of free radicals within myocardium: this is rarely seen at ADR dosage below 500 mg/m2. A series of new anthracycline analogues has recently entered clinical trials: they include 4'-epiadriamycin, 4'-deoxy-adriamycin, aclacynomycin A, carminomycin and N-trifluoroacetyladriamycin-14-valerate. These new agents appear to have different spectrum of action and somewhat less toxicity, however antitumor activity in only now being defined, consequently major clinical interest is still concentrated in the use of ADR. The present article reviews the most relevant data from literature concerning the pharmacology, the toxicology and the clinical use of ADR.
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