DOXORUBICIN - MEDICATION THAT EXTENDS AND SHORTENS LIFESPAN

INTRODUCTION: Doxorubicin (anthracycline) is an effective and until recently often used drug for treating several malignant diseases. It's use is substantially limited by it's effect on development of cardiomyopathy, which leads to chronic hearth failure (CHF). CHR can develop in only days (11%) or in months – years (1,7%). Incidence is in correlation with given dose and age of patient. Prognosis is bad and often results in death. CASE STUDY: 60-year old patient was healthy until 2008 when she developed breast cancer. Preoperative investigation was in normal range. After operation she received six chemotherapies – combination of cyclophosphamide and hydroxydaunorubicin and additional 25 radiotherapies. Combined dosage was 6000mg of cyclophosphamide and 600mg/ m2 anthracycline. She later received Tamoxifen Citrate for five years and is now on anastrozole. Recovery after finished oncological treatment was good with regular check up which revealed nothing special. Six years after her finished treatment she visited GP due to heavy breathing and respiratory insufficiency. Ultrasound examination revealed dilative cardiomyopathy with ejection fraction (EF) of 20% and NYHA III. Intensive therapy with maximal dosage of ACE inhibitor, beta-blocker, spironolactone and reolysin helped to bring EF to 38% and NYHA II. DISCUSSION: 1. GP should be familiar with chemotherapy regime (medication and dosage) and with all side effects. 2. CHF is probably a side effect of radio and chemotherapy. 3. CHF can occur even more than ten years after the completion of therapy.