Anthracycline chemotherapy drugs damage the DNA in cancer cells, so they cannot reproduce. They can treat several types of cancer. However, they can also cause a range of side effects.

Anthracycline drugs are among the most effective anticancer drugs. Doctors use them to treat a variety of cancers, including leukemia, lymphoma, breast cancer, and many metastatic cancers.

Although they are effective, anthracyclines can cause various side effects ranging from mild to severe.

This article explains how anthracyclines work, the side effects they can cause, and more.

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Anthracyclines are anti-tumor drugs made from the Streptomyces bacterium. They are antibiotics. However, doctors do not use them to treat infections in the same way they use other antibiotics.

Anthracyclines work by damaging the DNA in cancer cells and interfering with their ability to reproduce. The drugs bind with DNA to prevent cancer cells from reproducing.

Anthracycline drugs may affect several mechanisms, including:

  • free radical formation
  • lipid peroxidation
  • direct membrane effects
  • enzyme interactions

All anthracyclines are extracted from the Streptomyces bacterium. However, each has a slightly different chemical composition. Doctors select anthracycline drugs based on the type of cancer cells they want to target and how potent they need to be.

Anthracyclines include:

Daunorubicin (Cerubidine)

Doctors prescribe daunorubicin for certain types of acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL).

Doxorubicin (Adriamycin)

Doxorubicin is suitable for use in combination with other medications. It can treat many cancers, including certain types of lung, bladder, breast, stomach, and ovarian cancer.

Epirubicin (Ellence)

Doctors prescribe epirubicin alongside other medications to treat breast cancer in people who have already had surgery to remove the tumor.

Mitoxantrone (Novantrone)

The primary use for mitoxantrone is to treat multiple sclerosis. It is also suitable for treating certain types of leukemia alongside other medications.

Valrubicin (Valstar)

Valrubicin treats bladder cancer in patients who are not eligible for surgery right away.

Idarubicin (Idamycin PFS)

Idarubicin can treat AML in adults, and researchers are studying its use for other types of cancer.

A person usually takes anthracyclines by injection or intravenous infusion. Some drugs are inserted directly into the bladder to treat bladder cancer.

Each treatment session could last a few minutes up to several hours. The kind of cancer and its stage will impact the dosage and administration.

For example, treatment might be daily for 2 weeks, with a week off for the body to regenerate cells. The cycle may then repeat.

Each clinician will determine their patient’s proper dosing and administration schedule based on individual needs.

Side effects of anthracycline chemotherapy can range from mild to severe. A person can talk with a doctor about the side effects they may experience from their drug regimen.

Common anthracycline side effects include:

Sometimes, drugs can leak from a vein into surrounding tissue, causing irritation and pain. A healthcare professional will monitor the administration site closely for a reaction. If a person notices the following symptoms, they should call a doctor right away:

  • pain
  • itching
  • swelling
  • redness
  • blisters
  • sores

Anthracyclines may alter the way the heart functions during treatment or for months to years afterward. Before and during treatment, doctors will order tests to monitor the heart’s ability to pump blood. If a person’s heart function decreases, they may not be able to have the treatment.

Another side effect of anthracyclines is a decrease in blood cells in a person’s bone marrow. This may cause symptoms such as bleeding and bruising more easily than usual, becoming anemic, and being more prone to infection.

A person should call a doctor immediately if they have any of the following symptoms:

  • fever
  • sore throat
  • signs of infection
  • cough or congestion
  • unusual bleeding or bruising
  • bloody, black, or tarry stool
  • vomiting blood or brown material that looks like coffee grounds

The use of anthracyclines increases a person’s risk of developing other serious conditions at a later date. The risk is cumulative, which means that the more anthracyclines a person receives, and the longer and more intense the treatment, the more their risk increases.

For this reason, there is a maximum lifetime cumulative dose for anthracyclines. Doctors will take this into account when deciding on a person’s treatment.


Anthracyclines can induce cardiotoxicity, which causes damage to the heart’s structures and functions. A person may develop symptoms of heart damage during chemotherapy treatment or in the months and years afterward.

Doctors have no way of identifying people at risk of cardiotoxicity beyond considering factors such as age and pre-existing cardiovascular conditions.

People who take anthracyclines are 57% more likely to develop heart problems than people who do not. They are also 8.2 times more likely to die as a result of heart issues.

Secondary cancers

Anthracyclines also increase the risk of a person developing other types of cancer. Secondary cancers linked to anthracycline use include:

  • AML
  • myelodysplastic syndrome (MDS)
  • ALL
  • breast cancer

Different types of cancer have different survival rates so generalizing about the success of anthracyclines is not possible. Some studies have looked at the impact of anthracyclines on specific cancer types.

One study focused on women treated with chemotherapy following surgery to remove early-stage, HER2-negative breast cancer with a high risk of recurrence. Of 4,130 women in the study, 2052 received anthracycline chemotherapy while 2,078 received non-anthracycline treatment.

After around 3 years, those treated with anthracyclines fared slightly better than the non-anthracycline group. 92.4% of the anthracycline group were still alive and cancer-free after 3 years, compared to 91.7% of the other group.

Many factors can impact the success of treatment, including a person’s age, general health, and cancer stage.

Anthracycline chemotherapy drugs derive from the Streptomyces bacterium, and doctors use them to treat a variety of cancers. They are some of the most successful cancer-fighting drugs available.

The drugs work by binding with DNA in cancer cells and preventing them from reproducing.

Anthracylines can cause a range of side effects. Mild side effects include nausea, chills, and vomiting. More serious side effects include changes in heart function and a decrease in bone marrow blood cells.

Anthracyclines increase a person’s chance of developing heart problems and secondary cancers later on. Doctors take this into account when deciding on treatment.

Many factors can influence the effectiveness of cancer treatment, such as age, cancer stage, and general health. A person can talk with a doctor about their outlook and chances of successful treatment.