Epirubicin attacks neoplastic cells via multiple mechanisms, including generation of reactive oxygen species, activating signal transduction pathways, stimulation of apoptosis, and inhibition of protein synthesis by intercalating with DNA and disrupting topoisomerase activity.
Epirubicin toxicity can be manifested in a variety of acute and delayed reactions. Delayed toxicities can be severe, with the major problem being cumulative, dose-related, cardiac toxicity associated with binding of the drug to cardiac DNA and free radical damage to myocardial membranes. A dose-limiting toxicity of doxorubicin is severe myelosuppression.
Common side-effects include lethargy, diarrhea, vomiting, anorexia, hypersensitivity reactions and dermatitis associated with extravasation. The use of prophylactic anti-emetics, gastroprotectants and antibiotics does not reduce the frequency of gastrointestinal toxicity.
When used as a sole chemotherapy drug for hemangiosarcoma, it appears to be as efficacious as adjuvant doxorubicin-based protocols, but may result in a higher incidence of adverse gastrointestinal effects.
Recommended dose in dogs is 30 mg/m2 every 3 weeks for up to 4 to 6 treatments.
- Marrington AM et al (2012) Toxicity associated with epirubicin treatments in a large case series of dogs. Vet Comp Oncol 10(2):113-123
- Kim SE et al (2007) Epirubicin in the adjuvant treatment of splenic hemangiosarcoma in dogs: 59 cases (1997-2004). J Am Vet Med Assoc 231(10):1550-1557