Mini-dose weekly adriamycin therapy for patients with advanced malignant disease at increased risk for adriamycin toxicity

In an effort to administer adriamycin safely to patients with advanced progressive malignant disease and an increased risk for adriamycin toxicity, a weekly schedule of 10-20 mg of intravenous adriamycin was used for 38 patients. All patients had been previously treated with chemotherapy and/or radiation therapy. These patients also had advanced age (8), liver disease (8), previous radiation to the myocardium (18), prior bone marrow depression (21), concurrent bone marrow depression (9) and/or were intolerant to usual adriamycin dosages (2). Five patients had an objective remission and eight had disease stabilization. Toxicity was not eliminated; 39% had leukopenia (WBC<3,500); four had alopecia; nausea and vomiting forced one to stop therapy; extravasation occurred in three; vaginitis occurred in one; one had diarrhea; and one had an arrhythmia. One patient died a septic death during a leukopenic phase. Adriamycin can be given to poor-risk patients on a weekly basis using mini-doses, but severe toxicity cannot be avoided at these dosages.