Cited by 223Chemotherapy-induced cardiotoxicity and mitigationCancer therapeutics and mechanismsCancer Treatment and Pharmacology

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Epirubicin: A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Use in Cancer Chemotherapy

Plosker, Greg L., Faulds, Diana·1993·Drugs

DOI 10.2165/00003495-199345050-00011

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Abstract

Epirubicin is the 4' epimer of the anthracycline antibiotic doxorubicin, and has been used alone or in combination with other cytotoxic agents in the treatment of a variety of malignancies. Comparative and noncomparative clinical trials have demonstrated that regimens containing conventional doses of epirubicin achieved equivalent objective response rates and overall median survival as similar doxorubicin-containing regimens in the treatment of advanced and early breast cancer, non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), non-Hodgkin's lymphoma, ovarian cancer, gastric cancer and nonresectable primary hepatocellular carcinoma. Recently, dose-intensive regimens of epirubicin have achieved high response rates in a number of malignancies including early and advanced breast cancer and lung cancer. The major acute dose-limiting toxicity of anthracyclines is myelosuppression. In vitro and clinical studies have shown that, at equimolar doses, epirubicin is less myelotoxic than doxorubicin. The lower haematological toxicity of epirubicin, as well as the recent introduction of supportive measures such as colony-stimulating factors, has allowed dose-intensification of epirubicin-containing regimens, which is particularly significant because of the definite dose-response relationship of anthracyclines. Cardiotoxicity, which is manifested clinically as irreversible congestive heart failure and/or cardiomyopathy, is the most important chronic cumulative dose-limiting toxicity of anthracyclines. Epirubicin has a lower propensity to produce cardiotoxic effects than doxorubicin, and its recommended maximum cumulative dose is almost double that of doxorubicin, thus allowing for more treatment cycles and/or higher doses of epirubicin. In summary, dose-intensive epirubicin-containing regimens, which are feasible due to its lower myelosuppression and cardiotoxicity, have produced high response rates in early breast cancer, a potentially curable malignancy, as well as advanced breast, and lung cancers. Furthermore, there is evidence to suggest that improved response rates can improve quality of life in some clinical settings, but whether this leads to prolonged survival has not yet been determined. Recently implemented supportive measures such as colony-stimulating factors, prophylactic antimicrobials and peripheral blood stem cell support may help achieve other potential advantages of dose-intensive epirubicin-containing regimens such as reductions in morbidity and length of hospital admissions.

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Authors: Plosker, G. L., & Faulds, D.
Venue: Drugs
Publisher: Springer Science and Business Media LLC
Published: 1993-05
Volume: 45
Issue: 5
Pages: 788-856
ISSN: 0012-6667 (ISSN-L)
DOI: 10.2165/00003495-199345050-00011
OpenAlex: W1993672158
Cited by: 223
References: 429
Citations by year: 2026: 6 · 2025: 9 · 2024: 13 · 2023: 8 · 2022: 14 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 1 · 2017: 10 · 2016: 7 · 2015: 5 · 2014: 7 · 2013: 10 · 2012: 4
FWCI: 3.62
Type: journal article
Language: en
Open access: closed
Locations: Drugs (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cancer therapeutics and mechanisms
Health Sciences › Medicine › Oncology › Cancer Treatment and Pharmacology
Keywords: epirubicin, anthracyclines, doxorubicin, dose-intensive chemotherapy, myelosuppression, cardiotoxicity, breast cancer, non-small cell lung cancer, small cell lung cancer, non-Hodgkin lymphoma, ovarian cancer, gastric cancer, hepatocellular carcinoma, colony-stimulating factors, hematopoietic growth factors
MeSH terms: Clinical Trials as Topic, Female, Humans, Male, Neoplasms, Epirubicin

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Epirubicin: A Review of its Pharmacodynamic and Pharmacokinetic Properties, and Therapeutic Use in Cancer Chemotherapy

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