Doxorubicin skin toxicity

Lotem M, Hubert A, Lyass O, Goldenhersh MA, Ingber A, Peretz T, Gabizon A. Skin toxic effects of polyethylene glycol-coated liposomal doxorubicin. Arch Dermatol 2000 136(12) 1475-80. 

Of 99 patients who received low-dose docetaxel (60 mg/m every 3 or 4 weeks), 25 had skin toxicity, mainly erythema and nail changes (7). Of a subset of 25 patients who received irradiation before docetaxel, four had recall dermatitis during their first infusion of docetaxel. AH had previously received doxorubicin, which may in part have explained some of the toxicity. 

The main dose-limiting toxicity of all anthracyclines is myelosuppression, with neutropenia more commonly observed than thrombocytopenia. In some cases, mucositis is dose-limiting. Two forms of cardiotoxicity are observed. The acute form occurs within the first 2-3 days and presents as arrhythmias or conduction abnormalities, other electrocardiographic changes, pericarditis, and myocarditis. This form is usually transient and is asymptomatic in most cases. The chronic form results in a dose-dependent, dilated cardiomyopathy associated with heart failure. The chronic cardiac toxicity appears to result from increased production of free radicals within the myocardium. This effect is rarely seen at total doxorubicin dosages below 500-550 mg/m2. Use of lower weekly doses or continuous infusions of doxorubicin appear to reduce the incidence of cardiac toxicity. In addition, treatment with the iron-chelating agent dexrazoxane (ICRF-187) is currently approved to prevent or reduce anthracycline-induced cardiotoxicity in women with metastatic breast cancer who have received a total cumulative dose of doxorubicin of 300 mg/m2. All anthracyclines can produce "radiation recall reaction," with erythema and desquamation of the skin observed at sites of prior radiation therapy. 

Bleomycin is much used in the clinic because of its rapid attack on solid forms of cancer. It is one of the very few anti-cancer drugs that does not attack the bone-marrow. Its characteristic toxicity (fibrosis of the lung, and some effect on skin) is not shared with the few other drugs that are effective against solid tumours, such as doxorubicin and cisplatin. Hence, bleomycin is given (parenterally) in conjunction with one of these, so that the anti-cancer effect is additive whereas the toxicity to healthy cells in minimized (Carter and Blum, 1976 Carter /a/., 1976). 

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