Doxorubicin, which kills cancer cells, is among the most widely used chemotherapy drugs. It is also known by its trade name, Adriamycin.
This anticancer drug may be used to fight several different cancers: breast cancer , ovarian cancer , gastric (stomach) cancer, thyroid cancer , lung cancer, testicular cancer , and endometrial cancer . In addition it may be used against Hodgkin's and non-Hodgkin's lymphoma , acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), sarcomas of the soft tissue, sarcomas of the bone (osteosarcomas), neuroblastoma , Wilms' tumor , small cell lung cancer (SCLC), and non-small cell lung cancer (NSCLC).
Because doxorubicin is used to treat so many different cancers, a complete description of how it may be combined with other medications in the treatment of each of the cancers cannot be given here. A few examples follow: In the treatment of Hodgkin's disease, for instance, one widely used chemotherapy regimen is the so-called ABVD, which consists of doxorubicin, bleomycin , vinblastine , and dacarbazine . Another is the so-called MOPP/ABV, which consists of mechlorethamine , vincristine (Oncovin), prednisone, procarbazine , doxorubicin, bleomycin, and vinblastine. Yet another is the so-called EVA: etoposide , vinblastine, and doxorubicin. Still another is the so-called EPOCH, which consists of etoposide, vincristine, doxorubicin, cyclophosphamide , and prednisone.
Doctors may treat stage III and IV non-Hodgkin's lymphoma with the so-called m-BACOD chemotherapy regimen, which consists of methotrexate , bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone . Yet another regimen called the ProMACECytaBOM, which consists of cyclophosphamide, doxorubicin, etoposide, prednisone, cytarabine , bleomycin, vincristine, methotrexate, and leucovorin .
Complete remission (CR) is the total elimination of all diseased cells detectable following therapy. Continuous complete remission is CR that continues indefinitely. In the treatment of acute lymphocytic leukemia (ALL), it has been found that the likelihood that continuous complete remission will be achieved is increased if the patient receives at least three drugs. Two of these are usually prednisone and vincristine. The third may be doxorubicin.
Doxorubicin is a DNA-binding anticancer drug and belongs to an anthracycline antibiotic, although doctors do not use this drug to attack microbial infections.
Between 60 and 90 milligrams per square meter of doxorubicin are administered via a single intravenous (IV) injection every 21 days. Alternately, between 20 and 30 milligrams per square meter per day may be given via IV for three days every three to four weeks. Alternately, 20 milligrams per square meter may be given via IV weekly. The dose of doxorubicin used depends upon which regimen for cancer is being followed.
For example, in the treatment of acute myelocytic leukemia (AML), 30 milligrams per square meter may be given over a period of three days. When the medication is used in the treatment of breast cancer, one chemotherapy regimen is the so-called AC, which consists of doxorubicin plus cyclophosphamide. A total of 60 milligrams of doxorubicin per square meter are given per day. AC is then repeated every 21 days.
Another chemotherapy regimen used for breast cancer is known as either FAC or CAF: fluorouracil , doxorubicin, and cyclophosphamide. In this regimen, 50 milligrams of doxorubicin are given per square meter per day.
Doxorubicin is not given by mouth, as an insufficient amount of the medication would be transported through the stomach wall if this were done. Rather this medication is usually administered through an intravenous (IV) procedure. Patients with liver problems may be given a reduced dose of doxorubicin.
Doxorubicin may cause serious heart problems. To prevent these, doctors may limit the amount of doxorubicin given to each patient so that the total amount of doxorubicin a patient receives over her or his entire lifetime is 550 milligrams per square meter, or less. An encouraging recent development is that medication is now available that appears to help protect the patient's heat from the effects of doxorubicin. This new medication is called dexrazoxane (Zinecard).
Patients may develop problems with heart rhythms while doxorubicin is being taken. In addition, a serious heart illness known as heart failure may develop later. Some patients develop heart failure more than 20 after having received doxorubicin.
Studies have shown that the use of the new medication dexrazoxane (Zinecard) helps protect the patient's heart from the harmful effects of doxorubicin. However, dexrazoxane itself has side effects. For example, it may intensify the reduction of blood cells that may occur with doxorubicin therapy. In addition, it may make doxorubicin less effective in attacking cancer. Dexrazoxane is used only in patients being treated for breast cancer and only in patients who have already been given more than half of the total lifetime amount of doxorubicin they should ever receive.
The activity of the bone marrow in producing blood cells may be harmed by doxorubicin. Side effects affecting the heart and bone marrow may cause doctors to lower the dose of doxorubicin. Other side effects associated with doxorubicin are nausea and vomiting , stomach problems, eye problems, loss of appetite (anorexia ), and hair loss (alopecia ). Blistering may result if bleeding occurs. In addition, the medication has a harmless side effect about which patients should be forewarned: the urine and tears may have a red color.
Patients receiving doxorubicin in conjunction with certain other anticancer drugs may, very rarely, develop a type of leukemia.