Anthracyclinebased

Anthracycline-based chemotherapy refers to treatment regimens that include an anthracycline antibiotic, most commonly doxorubicin, daunorubicin, epirubicin, or idarubicin. These agents exert cytotoxic effects primarily by intercalating into DNA and inhibiting topoisomerase II, causing DNA breaks, and by generating reactive oxygen species. They are cell-cycle non-specific and have broad activity against many solid tumors and hematologic malignancies.

Common uses and regimens include those in breast cancer (for example, doxorubicin or epirubicin combined with cyclophosphamide, sometimes followed by a taxane), lymphomas (such as R-CHOP which includes doxorubicin), and leukemias (where daunorubicin or idarubicin are used in induction therapy). In pediatric oncology, daunorubicin is used in various regimens with vincristine and prednisone or other agents. The choice of drug and combination depends on tumor type, stage, prior therapy, and patient factors.

Toxicities and monitoring are central to management. A key risk is dose-dependent cardiotoxicity, which can range from subclinical changes to congestive heart failure; risk rises with cumulative dose (for doxorubicin, about 450–550 mg/m2 is a commonly cited threshold). Other frequent adverse effects include myelosuppression, mucositis, nausea, vomiting, alopecia, and potential tissue injury if extravasation occurs. Cardiac function is typically monitored with echocardiography or MUGA scans before and during treatment, especially at higher cumulative doses.

Mitigation strategies include limiting cumulative dose, using liposomal formulations to reduce toxicity, and using dexrazoxane as a cardioprotectant in selected cases. The anthracyclines were developed from Streptomyces species and were introduced into clinical practice in the 1960s, earning a prominent role in many chemotherapy protocols.