Pharmacology of adriamycin: the message to the clinician.

In attempting to describe the human pharmacology of ADR, one is aware of the gaps in our knowledge and shortcomings of the available data. Nevertheless, such information is essential if we are ever to be able to convert rationally in vitro observations into clinical pharmacologic effect or, as is more often the case, explain why the desired effect has not been produced. Clinical pharmacokinetic studies to-date suggest that there is a clear relationship between ADR blood levels and toxicity. No such relationship between ADR blood levels and therapeutic response has been shown. The 7-deoxyaglycone tissue metabolites of ADR, which also appear in blood, may be more closely related to ADR cardiotoxicity and therefore may provide a better pharmacokinetic marker of its development. It appears that the only accurate pharmacokinetic indicator of response is the level of drug in the tumour itself.