Role of Adriamycin in Breast Cancer and Sarcomas

Abstract

Adriamycin is the most important component of present-day therapy for carcinoma of the breast and sarcomas. For the treatment of breast cancer, adriamycin is the most active single agent and is commonly used in combination with other chemotherapeutic agents. The development of various combination chemotherapy regimens incorporating adriamycin has resulted in objective response in approximately 70% of the patients with advanced disease. For advanced sarcanas, there was little useful therapy before adriamycin was discovered. The utilization of adriamycin in combination with chemotherapeutic agents has provided useful palliation in approximately one-half of the patients with sarcomas. The major limitation of adriamycin therapy has been a dose-dependent cardiomyopathy, which frequently precludes its continued use in the responding patients beyond 6–9 months of treatment. Approximately 50% of the patients on the standard 3-weekly schedule of adriamycin administration, up to cumulative doses of 450 to 550 mg/m², develop evidence of cardiac toxicity, either in the form of pathologic changes in the myocardial cells or reduction in left ventricular function (1,2). Recently, we have explored the administration of adriamycin by continuous infusion and have found that this results in a significant reduction of nausea-vomiting as well as cardiac toxicity without compromising the therapeutic effect. This method of administration also allows continued adriamycin therapy for a longer duration compared to that of the standard schedule and has the promise of improving the duration of response and survival of patients with breast cancer and sarcomas.