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Modification of the dosing schedule for doxorubicin (DOX) administration represents a possible method of reducing cardiotoxicity from this potent anti-cancer drug, while at the same time maintaining its cytotoxic action. The quantitative effects of modified dosage scheduling have been investigated in a clinically relevant rat model. Cardiotoxicity to DOX was assessed by the degree of reduction in cardiac output at 4-24 weeks after the intravenous administration of DOX. The effects of dose schedules involving three or six small dose administrations, over one and two weeks, were compared with that produced by large single doses of DOX. The total drug dose administered for each schedule was varied in order to establish dose-effect relationships. After a total dose of 3 mg/kg DOX, given as three or six equal small doses, there was a gradual decline in cardiac output in the first 12 weeks after drug administration. Between 12 and 24 weeks, the reduction in cardiac function was relatively stable at between 65% and 85% of that of age-matched controls for three and six equal small doses, respectively. Dose-effect curves for animals showing a > or = 30% reduction in cardiac function after 12 weeks indicated the degree of reduction in cardiac function produced by the modified dose scheduling. Compared with a large single dose, larger total doses were required to produce the same severity of damage. Thus, schedules based on three and six equal small doses resulted in dose modification factor of 1.5 +/- 0.23 and 2.1 +/- 0.28, respectively, when compared with the same effect produced by a large single dose. This appeared to be independent of the severity of cardiac damage, suggesting a simple mathematical relationship between the total acceptable dose of DOX and the dose administered at each intravenous injection. These modifications in the cardiotoxicity of DOX produced by the administration of multiple small doses were of the same order of magnitude as that produced by other methods introduced to reduce anthracycline cardiotoxicity.

The protective activity of the bisdioxopiperazine ICRF-187 against the cardiotoxicity of doxorubicin was evaluated in the rat using both functional and histological assays. Animals that had received a single i.v. dose of doxorubicin (4 mg/kg) alone were compared with those that had been pretreated with a single i.v. injection of saline or ICRF-187 (40 or 60 mg/kg). All rats showed a transient reduction in body weight during the first 3 weeks after drug administration. The greatest reduction (approximately 16%) was observed in animals that had received a combination of ICRF-187 (40 or 60 mg/kg) and doxorubicin. Deaths related to cardiotoxicity were observed only in rats that had received doxorubicin alone and in those treated with saline; most of the deaths occurred at between 8 and 13 weeks after drug administration. Sequential assessments of heart function showed a persistent depression of cardiac output in animals that had received doxorubicin, with or without pretreatment with ICRF-187. The reduction in cardiac output observed in rats that had been pretreated with ICRF-187 (40 or 60 mg/kg) amounted to approximately 15% and approximately 30% after 12 and 20 weeks, respectively, indicating that cardioprotection was only partial. Nevertheless, this represented a marked improvement as compared with the approximately 35% reduction in cardiac output measured at 12 weeks in animals that had received doxorubicin but without pretreatment with ICRF-187. Histological examination of animals that had died during the course of the study and had received doxorubicin after pretreatment with saline revealed severe myocardial lesions typical of doxorubicin-induced damage. In contrast, animals that had been pretreated with ICRF-187 and survived for up to 20 weeks after treatment showed a marked amelioration of these lesions. The present findings may be interpreted as a true cardioprotection or a delay in the onset of the cardiotoxicity of doxorubicin resulting from pretreatment with the bisdioxopiperazine ICRF-187. Although prior and ongoing clinical trials clearly indicate that ICRF-187 protects patients well against doxorubicin-induced heart damage, further investigations are required before high doses of ICRF-187 can be used as a means of increasing the protective activity of this drug against doxorubicin-induced cardiotoxicity.

A rat model was used to evaluate the general acute toxicity and the late cardiotoxicity of 4 mg/kg doxorubicin (DOX) given either as free drug or in the form of three N-(2-hydroxypropyl)methacrylamide (HPMA) copolymer conjugates. In these HPMA copolymers, DOX was covalently bound via peptide linkages that were either non-biodegradable (Gly-Gly) or degradable by lysosomal proteinases (Gly-Phe-Leu-Gly). In addition, one biodegradable conjugate containing galactosamine was used; this residue was targeted to the liver. Over the first 3 weeks after the i.v. administration of free and polymer-bound DOX, all animals showed a transient reduction in body weight. However, the maximal reduction in body weight seen in animals that received polymer-bound DOX (4 mg/kg) was significantly lower than that observed in those that received free DOX (4 mg/kg) or a mixture of the unmodified parent HPMA copolymer and free DOX (4 mg/kg; P less than 0.01). Throughout the study (20 weeks), deaths related to cardiotoxicity were observed only in animals that received either free DOX or the mixture of HPMA copolymer and free DOX; in these cases, histological investigations revealed marked changes in the heart that were consistent with DOX-induced cardiotoxicity. Sequential measurements of cardiac output in surviving animals that received either free DOX or the mixture of HPMA copolymer and free DOX showed a reduction of approximately 30% in function beginning at the 4th week after drug administration. The heart rate in these animals was approximately 12% lower than that measured in age-matched control rats (P less than 0.05). Animals that were given the HPMA copolymer conjugates containing DOX exhibited no significant change in cardiac output throughout the study (P less than 0.05). In addition, no significant histological change was observed in the heart of animals that received DOX in the form of HPMA copolymer conjugates and were killed at the end of the study. However, these animals had shown a significant increase in heart rate beginning at 8 weeks after drug administration (P less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)

The cardiotoxicity of the two anthracyclines, adriamycin and epirubicin, were studied in 14-week-old Sprague-Dawley rats after the intravenous administration of single doses of 1-4 mg/kg of adriamycin and 2-6 mg/kg of epirubicin. These doses of the two drugs were well tolerated with little acute toxicity. Acute toxicity was characterised by a transient reduction in body weight with recovery within 14 days. The cardiac output of the rats was measured at 4-weekly intervals, for up to 20 weeks, using an external counting technique with the radioactive tracer, 99mTc. The time-related changes in cardiac function in the rat after adriamycin and epirubicin were similar. The time course of the changes in cardiac output were biphasic. There was an initial phase of rapid decline in cardiac output in the first 12 weeks (phase I) and a second phase of persistent depression in cardiac function (phase II) after 12 weeks. The late progression of anthracycline-induced cardiotoxicity could be predicted from the measurements of cardiac output at 12 weeks. The relative cardiotoxicity of adriamycin and epirubicin was evaluated from the reductions in cardiac output and from the incidence of deaths related to cardiotoxicity. Both methods of evaluation showed that adriamycin was approximately twice as cardiotoxic as epirubicin. This relationship was independent both of the dose level of drugs used and of the damage level used for the evaluation. Dose-response curves were steeper for adriamycin than for epirubicin. The present findings agree with the somewhat limited clinical data suggesting that the present rat model is highly predictive and clinically relevant.

Time-related changes in cardiac output have been studied in rats after the intravenous administration of a range of single doses of epirubicin. There was an initial decline in cardiac function in the first 4-12 weeks after drug treatment at a rate that appeared to be dose-related. After 12 weeks, an average cardiac output of approximately 70%, relative to control values, was maintained in animals that survived until the end of the study. This effect was independent of the drug dose, reflecting the death of animals in the higher dose groups. The incidence of drug-induced cardiotoxic deaths, the majority of which (approximately 62%) occurred within the first 12 weeks, was dose-related, and suggested a LD50 for cardiac-related mortality of 5.48 +/- 0.39 mg/kg. There appeared to be a relationship between the reduction in cardiac output at 12 weeks and the probability of a further deterioration in function. Animals showing a greater than 40% reduction in cardiac output at 12 weeks accounted for greater than 90% of all the additional deaths between 12 and 20 weeks. Rats showing a less than 40% reduction in cardiac output at 12 weeks had a very high probability of surviving without clinical signs, although with a persistently depressed cardiac function. These findings are similar to the trends demonstrated in the sparse clinical data and this supports the view that the present simple animal model is suitable for the investigation of cardiotoxicity after the administration of cardiotoxic cytotoxic drugs.