How it is administered

Doxorubicin is given as an intravenous (IV) infusion, meaning it is administered directly into a vein. It is available as a sterile solution or as a powder that is reconstituted before use. The medication is typically given in a hospital or clinic setting by a healthcare professional.

There are two main forms:

• Standard doxorubicin (Adriamycin): Administered as an IV injection or infusion, often over 3 to 10 minutes, or as a continuous infusion through a central line.
• Liposomal doxorubicin (Doxil): This is a special formulation where doxorubicin is encapsulated in liposomes, allowing for a slower release. It is also given as an IV infusion, usually over 1 hour, and should not be given as a rapid injection or undiluted.

The dose and schedule depend on the specific cancer being treated, other medications being used, and individual patient factors.

How it works

Doxorubicin is a type of chemotherapy known as an anthracycline topoisomerase inhibitor. It works by interfering with the DNA inside cancer cells. Specifically, doxorubicin intercalates, or inserts itself, between DNA base pairs, which disrupts the normal function of DNA and prevents the cell from replicating and making RNA. It also inhibits an enzyme called topoisomerase II, which is essential for DNA replication and repair.

By blocking these processes, doxorubicin causes cancer cells to stop dividing and eventually die. Because it targets rapidly dividing cells, it is effective against many types of blood cancers, including lymphomas such as anaplastic large cell lymphoma (ALCL). However, it can also affect normal rapidly dividing cells, which leads to some of its side effects.

Liposomal doxorubicin (Doxil) is designed to circulate longer in the bloodstream and release the drug more slowly, which may help reduce some side effects and improve delivery to tumor tissues.

Who Should take it

Doxorubicin is used to treat a variety of cancers, including several blood cancers. For lymphoma, including anaplastic large cell lymphoma (ALCL), doxorubicin is often part of combination chemotherapy regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

It is also indicated for the treatment of:

• Acute lymphoblastic leukemia (ALL)
• Acute myeloblastic leukemia (AML)
• Hodgkin lymphoma
• Non-Hodgkin lymphoma (including ALCL)
• Other cancers such as breast cancer, ovarian cancer, sarcomas, and more

Your doctor will determine if doxorubicin is appropriate for you based on your type of cancer, overall health, and previous treatments.

Who should not take it

Doxorubicin should not be used in patients who have:

• Severe heart problems, including recent heart attack or severe heart failure
• Severe persistent drug-induced myelosuppression (very low blood counts due to previous chemotherapy)
• Severe liver impairment (especially if bilirubin is greater than 5 mg/dL)
• Known severe hypersensitivity or allergic reaction to doxorubicin or its components

If you have had prior high doses of doxorubicin or other anthracyclines, your doctor will be cautious due to the risk of heart damage. Doxorubicin should also be avoided during the first trimester of pregnancy due to the risk of fetal harm, and it is not recommended while breastfeeding.

Commonly used with

Doxorubicin is most often used in combination with other chemotherapy drugs. For lymphoma, it is commonly used with:

• Cyclophosphamide
• Vincristine
• Prednisone

This combination is known as the CHOP regimen, which is a standard treatment for many types of non-Hodgkin lymphoma, including ALCL. Doxorubicin may also be combined with other agents depending on the specific cancer and treatment protocol.

Commonly tested with

Doxorubicin has been studied in combination with various chemotherapy regimens. In blood cancers like lymphoma, it is commonly tested with:

• Cyclophosphamide, vincristine, and prednisone (CHOP)
• Other drugs such as methotrexate, etoposide, and rituximab (for B-cell lymphomas)

Liposomal doxorubicin (Doxil) has also been tested with bortezomib for multiple myeloma. Your treatment team will select the best combination based on the latest research and your individual needs.