A comprehensive review was made of the methods employed to ameliorate the cardiotoxicity produced by anthracyclines. These methods were classified into 3 categories: 1. Decreasing myocardial concentrations of anthracyclines and their metabolites. Decreased exposure of the myocardium to the anthracyclines has been accomplished by slowly infusing the drug in order to keep plasma concentrations low or by decreasing the availability of the drug to the myocytes by binding anthracyclines to carrier molecules. 2. Using less cardiotoxic analogues of anthracyclines. Considerable effort has been directed to the synthesis and development of new compounds (epirubicin, esorubicin, 0- tetrahydrapyranyladriamycin, idarubicin, 5-iminodaunorubicin, and aclarubicin) which retain significant antitumor activity but with lessened cardiac toxicity. 3. Concurrently administering other drugs that will block the cardiotoxic effects of anthracyclines. A variety of different substances have been examined as potential protective agents, including: free radical scavengers, calcium channel blockers, histamine and catecholamine blockers, cardiac glycosides, carnitine and EDTA derivatives (ICRF-159, ICRF-187).
