Anthracyclines are used in the treatment of different types of childhood cancer. Unfortunately, one of the most important adverse effects of anthracyclines is damage to the heart. This can become manifest not only during treatment, but also years after the end of treatment. A well-informed decision on the use of anthracyclines in the treatment of different types of childhood cancer should be based on the available evidence on both antitumour effects of anthracyclines and the risk for damage to the heart.
This systematic review focused on randomised studies evaluating the antitumour effects of anthracycline therapy. The authors found that at the moment no high quality evidence is available which shows that the use of anthracyclines has an increased antitumour effect in acute lymphoblastic leukaemia (ALL) as compared to treatment without anthracyclines, but there was some suggestion that this might be the case. Further high quality studies are needed to give a definitive conclusion. For Wilms' tumour, rhabdomyosarcoma/undifferentiated sarcoma, Ewing's sarcoma, non-Hodgkin lymphoma and hepatoblastoma the reviewers found only limited data and were unable to draw conclusions. Also, there are no data for other childhood cancers. More high quality research is needed. At the moment, there are six ongoing or unpublished randomised studies evaluating the use of anthracyclines in the following types of childhood cancer: hepatoblastoma, acute myeloid leukaemia (AML), ALL, rhabdomyosarcoma, and Wilms' tumour.