Clinical correlations of adriamycin pharmacology

Adriamycin is an effective antineoplastic agent with dose-limiting acute toxicity and a cumulative dose-dependent cardiotoxicity. It undergoes extensive biotransformation to both active and inactive compounds; changes in metabolism may affect its therapeutic index.

Hepatic metabolism and bile secretion are the major routes of drug elimination. Factors which affect liver function, whether disease-related or due to concomitant drug administration, may affect both adriamycin efficacy and toxicity.

Cardiomyopathy due to adriamycin has a biochemical basis, but presently the mechanisms are unknown. Methods to avoid this complication are under study.

Consideration of the cytokinetics of normal and tumor cells may be as important in planning adriamycin combinations as is consideration of drug-drug interactions.

Because of its broad spectrum of action and high antitumor activity, adriamycin is used in many cancer patients both as a single agent and in combination with other drugs. An understanding of the pharmacology of this drug by the physicians who administer it will lead to better selection of appropriate patients, drug combinations and dosage schedules. This increased awareness of adriamycin pharmacology should be translated into safer, more efficacious therapy for cancer patients.