Table 1. Comparation between doxorubicin, epirubicin and amrubicin (28-30).

	Doxorubicin	Epirubicin	Amrubicin
Mechanism of action	It intercalates the cell nucleotide base and binds the cell membrane lipid. Intercalation blocks replication of nucleotide and action of DNA and RNA polymerases. It also interacts with topo-II to form DNA-cleavable complexes	It intercalates between nucleotide base pairs with inhibition of nucleic acid and protein synthesis, thus triggers DNA cleavage. It also prevents DNA helicase activity by inhibiting enzymatic separation of double-stranded DNA and interfering with the replication and transcription	It is an inhibitor of DNA topoisomerase II, exerting their cytotoxic effects by stabilizing a topoisomerase II-mediated cleavable complex
Pharmacokinetics
Distribution	Vd: 809 to 1,214 L/m2, Protein binding 75%	Vd: 21 to 27 L/kg, Protein binding 77%	Vd: 71 L
Metabolism	Hepatic	Hepatic	Hepatic
Excretion	Biliary 40%; renal 10%	Fecal 34%; renal 27%
Elimination half life	20 to 48 hrs	30 to 35 hrs
Dose-limiting toxicity	Cardiotoxicity	Myelosuppression	Myelosuppression
Risk for heart failure	>400 mg/m2	>900 mg/m2