Continuous infusion or intravenous bolus: what is the rationale for doxorubicin administration?

In order to achieve a better therapeutic index of anticancer drugs, numerous authors are using continuous infusion therapy rather than classical intravenous bolus injection. In the case of doxorubicin or daunorubicin numerous experimental data have been published, which could provide a rationale to this clinical problem. However, due to the variety of the approaches used, the results are inconsistent and no definitive conclusion can be drawn. Several clinical phase I and II trials have been performed since 1980; they show that the toxicity of doxorubicin may be reduced by the use of continuous infusion, but the preservation of the efficacy of the drug has never been proved. Comparative phase III trials are required before this schedule of administration become routine procedure for this drug.