***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: BACKGROUND Cardiomyopathy following anthracycline chemotherapy may have ominous clinical implication s in cancer patients treated with this effective yet potentially toxic therapy . Early detection at sub clinical stage is pivotal to minimize the risk of overt cardiotoxicity . Liposomal anthracyclines have the potential for more selective uptake by cancer cells and reduced cardiac toxicity . OBJECTIVE We design ed a single-center r and omized clinical trial , the Liposomal doxorubicin-Investigational chemotherapy-Tissue Doppler imaging Evaluation ( LITE ) pilot study to compare the safety of liposomal doxorubicin vs st and ard epirubicin in terms of clinical and sub clinical cardiotoxicity . METHODS Whereas diagnostic and prognostic instruments effective at early recognition of cardiomyopathy are lacking , promising data have been reported for tissue Doppler imaging ( TDI ) echocardiography . The study will enroll 80 patients with breast cancer and indication to anthracycline chemotherapy  , r and omizing them in a 1:1 ratio to liposomal doxorubicin or st and ard epirubicin . The primary end-point will be the comparison of changes from baseline to 12-month follow-up of left ventricular TDI systolic function parameters , and the co- primary end-point will be based instead on changes in TDI diastolic function parameters . Among secondary end-points , we will adjudicate changes in st and ard 2-dimensional echocardiography parameters , including ejection fraction , peak values of biochemical markers of cardiac damage and heart failure , ie cardiac troponin T and BNP , overall survival , functional class , freedom from cancer recurrence , and adverse effects of chemotherapy . CONCLUSIONS Results of the LITE pilot study should provide important clinical and mechanistic insights on the promising role of liposomal anthracyclines in patients with breast cancer and indication to anthracycline chemotherapy ( Clinical Trials.gov identifier NCT00531973 ) Anthracyclines are a group of drugs that are useful in the treatment of Hodgkin 's disease , but have been associated with severe , and in some cases lethal , cardiac toxicity . Apparently , cardiac toxicity is more frequent after 10 years of anthracycline therapy , but no longer studies of cardiac toxicity have been reported . Four hundred and seventy-six patients with Hodgkin 's disease , stages III and IV , were r and omly assigned to receive ABVD ( doxorubicin , bleomycin , vinblastine and dacarbazine ) compared with EBVD ( epirubicin instead of doxorubicin ) and MBVD ( mitoxantrone instead of doxorubicin ) at st and ard doses . The endpoint was the presence of a clinical cardiac event ( CCE ) or abnormalities in equilibrium radionuclide angiocardiography ( ERNA ) and echocardiogram . The patients did not receive radiation therapy and when relapsed they were censored from cardiac toxicity . The median follow-up was 11.5 years ( range 7.5 - 14.8 years ) . CCE was observed in 17 % in the MBVD arm , 9 % in the ABVD arm and 6 % in the EBVD arm ( P < 0.001 ) . Mortality associated with CCE was 12 % with MBVD , 7 % with ABVD and 2 % with EBVD . Abnormalities in ERNA and echocardiogram were observed 6 - 36 months before the presence of a CCE . An excess in the st and ard mortality ratio was observed with the 3 regimens when compared with the general population : 19.4 for EBVD , 46.0 for ABVD and 67.8 for MBVD , which was confirmed with an increase in absolute excess risk/10,000 person-years of 15.6 , 39.0 and 58.7 , respectively . Overall survival was better in patients treated with EBVD because less cardiac events were observed . The use of mitoxantrone was associated with a high rate of relapse and cardiac events . Thus , we would not recommend use of the drug in Hodgkin 's disease . ERNA and echocardiogram are early detection tests for cardiac toxicity and can be employed in surveillance studies Stage III and IV epithelial ovarian cancer patients were prospect ively r and omized to receive eight courses of 60 mg/m2 of cisplatin plus either 75 mg/m2 of epirubicin ( 62 patients ) or 60 mg/m2 of doxorubicin ( 54 patients ) . Clinical response rates for cisplatin/epirubicin of 42 % [ 15 % complete response ( CR ) and 27 % partial response ( PR ) ] and for cisplatin/doxorubicin of 55 % ( 24 % CR and 31 % PR ) were not statistically different ( p = 0.14 ) . The negative second look rate was 35 % ( 10/29 ) for cisplatin/doxorubicin and 17 % ( 5/30 ) for cisplatin/epirubicin ( p = 0.12 ) . The progression-free interval for cisplatin/epirubicin ( 13 months ) was not statistically different ( p = 0.09 ) from that for cisplatin/doxorubicin ( 19 months ) . The median survivals for cisplatin/epirubicin ( 756 days ) and cisplatin/doxorubicin ( 739 days ) were similar ( p = 0.70 ) . Cardiotoxicity was greater for the cisplatin/doxorubicin group ( p = 0.0003 ) . With similar survival and less cardiotoxicity , the cisplatin/epirubicin regimen had the more favorable therapeutic index Fifty-one patients with ovarian cancer were entered in a r and omised trial comparing treatment with cisplatin + adriamycin + cyclophosphamide ( PAC ) to cisplatin + 4'epi-adriamycin + cyclophosphamide ( PEC ) .  Complete response rates for the two treatment arms were similar ( 9/27 PAC , 14/24 PEC ) . Patients with less than 2 cm residual disease had significantly higher rate of complete remission than those with greater than 2 cm residual disease . Cardiotoxicity was significantly less in the PEC-treated group ( 0/24 ) as compared with the PAC-treated group ( 6/27 , chi2 = 4.09 , p less than 0.05 ) Purpose . Doxorubicin ( dox ) still appears to be one of the most active drugs in the treatment of soft tissue sarcomas . However , treatment duration is limited due to cumulative cardiotoxicity . A number of small studies from single institutions have suggested activity of other analogues . In two studies the EORTC STBSG tested whether epirubicin ( epi ) is an alternative to st and ard dose dox in the treatment of chemonaive patients with advanced soft tissue sarcoma . The present report gives the final results of these studies . Patients / Methods . In the first study 210 patients were r and omized to receive either  dox or epi both at a dose of 75 mg/m2 given as bolus injection at 3-week intervals . In the second study 334 patients were r and omized to dox  75 mg/m2 ,  epi 150 mg/m2 or  epi 50 mg/m2 days 1–3 , all given as bolus injection at 3-week intervals . Results . In the first study no differences in median survival and duration of response were found . Of 167 evaluable patients the response rate was slightly in favour of dox ( 23 % vs 18 % ) but at the expense of more toxicity . These data could suggest that increasing the epi dose may lead to a greater antineoplastic effect with acceptable toxicity . In the second study 15 % of 314 evaluable patients had an objective tumour response . There were no differences between the three groups with regard to response rate , progression-free and overall survival , but both dose schedules of epi were more myelotoxic than dox . Conclusion . Regardless of schedule and dose , epi is not superior to dox in the treatment of patients with advanced soft tissue sarcomas . In addition , the results illustrate that the data from small studies of single institutions should always be confirmed by large multi-institutional studies before being taken for granted Fifty-four patients with advanced breast cancer who had failed prior non-anthracycline combination chemotherapy  were r and omized to treatment with either epirubicin 85 mg/m2 or doxorubicin 60 mg/m2 intravenously every three weeks . Of 52 evaluable patients , 25 % ( six of 24 ) treated with epirubicin , and 25 % ( seven of 28 ) treated with doxorubicin experienced major therapeutic responses . The median duration of response to epirubicin was 11.9 months compared to 7.1 months with doxorubicin .  Cardiotoxicity was monitored by serial multigated radionuclide cineangiocardiography performed at rest and after exercise . Laboratory evidence of cardiotoxicity was defined as a decrease in resting left ventricular ejection fraction of greater than 10 % from the baseline value , or a decrease of 5 % or greater with exercise compared with the resting study performed on the same day . Fifteen patients treated with epirubicin and 18 patients treated with doxorubicin  had at least two determinations of left ventricular ejection fraction and were evaluable for laboratory cardiotoxicity . Using methods of survival analysis , the median doses to the development of laboratory cardiotoxicity were estimated to be 935 mg/m2 of epirubicin and 468 mg/m2 of doxorubicin . Four patients treated with epirubicin and five treated with doxorubicin developed symptomatic congestive heart failure . The median cumulative dose at which congestive heart failure occurred was 1,134 mg/m2 of epirubicin compared with 492 mg/m2 of doxorubicin . Fewer episodes of nausea and vomiting were observed in patients receiving epirubicin . Epirubicin is a new anthracycline with reduced cardiac toxicity , but preserved efficacy in the treatment of patients with advanced breast cancer From January 1986 to December 1989 , 157 previously untreated patients , with Hodgkin 's disease stage I or II without bulky disease , were enrolled in a clinical comparative study . The objectives of the study were to compare the efficacy and safety of using epirubicine or mitoxantrone instead of adriamycin in the combination chemotherapy regimen ABVD ( adriamycin , bleomycin , vinblastine , and dacarbazine ) . The complete response rate was better in the patients treated with the ABVD or EBVD regimens compared to the MBVD arm . Also , differences in overall survival and relapse-free survival were better in the patients who received ABVD or EBVD compared to the MBVD regimen . Hematological , gastrointestinal and cardiac toxicity were similar in the three groups . Dose intensity , delays and complications were also similar in the three groups . The mitoxantrone-containing regimen was found to have less efficacy in comparison to the other regimens tested in the present study in patients with favorable stage I or II Hodgkin 's disease One hundred patients with untreated non-Hodgkin 's lymphoma were entered in a prospect i ve r and omized study in South and West Wales design ed to assess the value of the anthracycline antibiotic , epirubicin ( 4'-epidoxorubicin ) , in their management . Patients with low grade histology and progressive disease were r and omized to receive either epirubicin , vincristine and prednisolone ( EVP ) or cyclophosphamide , vincristine and prednisolone ( CVP ) . The response rate of 81 % in patients receiving EVP with complete remission rate of 52 % were similar to a response rate of 88 % and complete remission rate of 58 % for patients receiving CVP . No difference was observed in survival between the two groups . Patients with high grade lymphoma were r and omized to receive either cyclophosphamide , doxorubicin , vincristine and prednisolone ( CHOP ) or cyclophosphamide , epirubicin , vincristine and prednisolone ( CEOP ) . The response rate was 71 % for CHOP and 84 % for CEOP . The complete remission rates were 46 % for CHOP and 61 % for CEOP . The cardiotoxicity of the two anthracyclines were monitored closely in 45 patients using measurements of systolic time intervals . Patients receiving epirubicin tolerated higher dose per course and higher total cumulative dose with less evidence of compromised left ventricular function than patients receiving doxorubicin . Epirubicin is an effective agent when used in combination chemotherapy in both low grade and high grade lymphoma with less toxicity than doxorubicin BACKGROUND AND OBJECTIVE To compare the efficacy of ProME(Epidoxorubicin)CE-CytaBOM ( PE-C ) and ProMI(Idarubicin)CE-CytaBOM ( PI-C ) in the treatment of adult patients with aggressive non Hodgkin 's lymphoma in a multicenter r and omized controlled trial performed by 18 centers of the Italian Lymphoma Study Group ( GISL ) . DESIGN AND METHODS One hundred and twenty-eight and 122 patients were r and omly assigned to receive either 6 courses of PE-C or PI-C , respectively . Some patients ach 
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However , there is some suggestion of a lower rate of clinical heart failure in patients treated with epirubicin .
We are not able to favour either  epirubicin  or doxorubicin when given with the same dose .
Based on the currently available evidence on heart failure , we conclude that in adults with a solid tumour liposomal-encapsulated doxorubicin should be favoured over doxorubicin .
For both epirubicin versus doxorubicin and liposomal-encapsulated doxorubicin versus conventional doxorubicin no conclusions can be made about the effects of treatment in children treated with anthracyclines  and also not in patients diagnosed with leukaemia .
For other combinations of anthracycline derivates not enough evidence was available to make definitive conclusions about the occurrence of cardiotoxicity in patients treated with anthracyclines