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Cardiac toxicity

Cardiac toxicity is most often related to anthracyclins (adriamycine) and has led to research for theoretically less cardiotoxic analogues (epirubicin, mitoxantrone).

During infusion, generally transitory electrocardiogram modifications can be observed (modifications of ST segment, repolarisation disorders, rhythm disorders).

Chronic cardiomyopathy is far more alarming and should lead to immediate stopping of anthracyclins. The risk becomes high with cumulative dosage over 500 mg/m2, or occasionally less according to age or previous radiotherapy or chemotherapy (cyclophosphamide).

Screening of such cardiomyopathy involves regular control of the ventricular ejection fraction.

Other anticancer drugs may be complicated by myocardial infarction but more rarely than those mentioned above (cyclophosphamide, 5-FU, cisplatin, methotrexate, VP 16).

Pulmonary complications

Pulmonary complications are not very frequent.

Bleomycin is responsible for the most dramatic accidents like chronic pulmonary fibrosis, which is frequent after a cumulative dosage of 300 mg/m² in adults ; a dose which should therefore never be prescribed. Prognosis is very gloomy.

Immunoallergic pneumopathy is a rarer form of pulmonary toxicity with devastating evolution.

Other anticancer drugs may have pulmonary toxicity: methotrexate (after a very long period of treatment) and misulban (after long treatment for chronic myeloid leukaemia).

Digestive complications

Constipation is frequent with Oncovin and rare with Eldisine or Vinorelbine. In fact, it is related to neurological toxicity on digestive nerves and can result in occlusive syndromes.

Toxic hepatitis is relatively frequent with elevation of hepatic enzymes (after belustine, aracytine), sometimes with cholostasis (purinethol, methotrexate). Mithracin may provoke small foci of hepatic necrosis which could be responsible for coagulation disorders.