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Anthracyclines are widely used chemotherapy drugs derived from certain types of Streptomyces bacteria. Anthracycline drugs are used to treat many types of cancer, including leukemias, lymphomas, and cancers of the breast, stomach, uterus, ovary, and lung, among others.

Because of its origin, an anthracycline is also an antibiotic, one of several types of antibiotics for cancer. But anthracyclines aren’t prescribed for bacterial infections, which is how most antibiotics are used.

And while anthracyclines are effective cancer treatments, they carry significant side effects. The primary concern is how they may injure the heart. But a 2019 study suggests that ongoing research is discovering helpful information on how the drugs affect the heart and how to limit those harmful effects.

How do anthracyclines work against cancer?

Anthracyclines work by damaging the DNA of cancer cells, which causes them to die before they can multiply. There are several types of anthracyclines used in chemotherapy, with certain drugs proving especially effective in treating specific cancer types.

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Though all anthracyclines are made from the Streptomyces bacteria, each drug has a slightly different chemical structure that makes it more or less potent than similar drugs and more effective in attacking certain types of cancer cells.

All chemotherapy drugs work by interfering with some stage of a cancer cell’s life cycle. Anthracyclines specifically interfere with the enzymes necessary in copying DNA. This means the cancer cells cannot reproduce.

  • aclarubicin (Aclacin): It’s primarily used to treat acute myeloid leukemia. Aclarubicin is also considered less toxic than certain other anthracyclines.
  • daunorubicin (Cerubicine): It’s used to treat certain types of acute myeloid leukemia and acute lymphocytic leukemia. Daunorubicin may cause heart problems during your treatment or long after treatment ends. It can also cause a serious decrease in blood cells in your bone marrow, raising the risk of infection and bleeding incidents.
  • doxorubicin: This drug is used to treat certain types of breast, lung, stomach, ovarian and bladder cancers, as well as Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, and certain types of leukemia and other cancers. Doxorubicin is one of the strongest anthracyclines, and is among the most cardiotoxic anthracyclines used in chemotherapy. In addition to risks posed to the heart, this drug may also cause a serious drop in red blood cells in your bone marrow, which means you’ll need regular lab tests before and during treatment. Monitoring heart function and red blood cell counts is part of treatment with doxorubicin.
  • epirubicin (Ellence): It is most often used to treat breast cancer once the tumor has been removed. Epirubicin may interfere with healthy heart function, so monitoring heart health is done before, during, and after treatment. The drug may also cause a decrease in blood cells in bone marrow, increasing the risk of leukemia, infection, and bleeding problems.
  • mitoxantrone (Novantrone): It is used primarily to treat acute myeloid leukemia. When combined with the corticosteroid prednisone, mitoxantrone is also used to treat prostate cancer. Mitoxantrone is also prescribed to people with secondary-progressive multiple sclerosis. Like most other anthracyclines, mitoxantrone may cause damage to the heart and cause a reduction in blood cells within the bone marrow.
  • Valrubicin (Valstar): It is used most often in treating bladder cancer. Valrubicin is delivered directly to the bladder through a catheter and may cause side effects such as bladder irritation and urinary frequency. Valrubicin is prescribed when other medications have not been effective in slowing the spread of cancer or if surgery to remove a tumor is not an option.

Anthracyclines are administered by injection or with an intravenous (IV) infusion, in which the drugs are part of a liquid solution delivered into a vein through a catheter. The type and stage of cancer can determine how long your chemotherapy treatment lasts. For example, you may have daily treatments for 2 weeks and then have a week of no treatments to allow your body to recover and new cells to form. Then that 3-week cycle may repeat.

There are a variety of time and administration sequences used. Your doctors should explain the expected treatment schedule and what factors may cause it to change.

Common side effects for anthracyclines are like those of many other chemotherapy drugs. You may experience one or more of the following in the first few days after treatment starts:

  • chills
  • rash
  • nausea and vomiting
  • extreme thirst
  • fatigue
  • fever
  • diarrhea
  • abdominal pain

Additional side effects, such as photosensitivity, skin hyperpigmentation, and other changes, sometimes occur in the weeks and months after you start treatment.

Though anthracyclines are among the most effective chemotherapy drugs still in use, they still carry risks. While the powerful drugs used in chemotherapy can often destroy cancer cells, they can also damage healthy cells in tissue and organs throughout the body.

One of the main concerns with anthracyclines is cardiotoxicity — damage to the heart muscle. The risk of a complication such as heart failure can be particularly high when anthracyclines are used to treat a type of cancer known as acute myeloid leukemia, which on its own raises the risk of heart infections.

However, a 2020 study found that many of the drugs’ effects on the heart are reversible if diagnosed and treated early on.

Anthracyclines are chemotherapy drugs used to treat many types of cancer. They are helpful in slowing the spread of cancer or putting it in remission. Injury to the heart and a severe reduction in blood cells in your bone marrow are two of the main complications. But with careful monitoring, these problems may be avoided or kept to a minimum. The most important thing you can do is to talk with your healthcare team about the risks and benefits of all the available treatment options.