These agents should be administered only under the supervision of physicians who are experienced in the use of cancer chemotherapeutic agents and in managing their side effects. All four agents have severe adverse events particularly myelosuppression that can lead to severe neutropenia and sepsis. These four agents are all semisynthetic derivatives of daunorubicin and share activities and toxicities. These actions lead to apoptosis of rapidly dividing cells. Doxorubicin (dox” oh roo’ bi sin), epirubicin (ep” i roo’ bi sin), idarubicin (eye” da roo’ bi sin) and valrubicin (val roo' bi sin) are cytotoxic, anthracycline antibiotics which are believed to act by intercalating between DNA base pairs and uncoiling the DNA helix, which results in inhibition of DNA synthesis and the normal DNA breaking and resealing action of DNA toposiomerase II.
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