How it is administered

Doxorubicin is given as an intravenous (IV) injection or infusion. It is available as a sterile solution or as a powder that is reconstituted before use. The medication is usually administered by a healthcare professional in a hospital or clinic setting.

For standard doxorubicin, the dose and schedule depend on your specific type of cancer and treatment plan. Doxorubicin is never given as a pill or by mouth.

Liposomal doxorubicin (such as Doxil) is also given by IV infusion, but it is encapsulated in tiny fat-like particles (liposomes) to help reduce some side effects and change how the drug is absorbed and distributed in the body.

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 (inserts itself) between DNA base pairs and binds to cell membrane lipids. This action blocks the replication of DNA and the activity of enzymes needed for cell division, such as DNA and RNA polymerases.

A key mechanism is its interaction with the enzyme topoisomerase II, forming complexes that cause breaks in DNA strands. This prevents cancer cells from dividing and leads to their death. Doxorubicin also generates free radicals, which can damage cell membranes and contribute to its effectiveness against cancer, but also to some of its side effects, especially on the heart.

Liposomal doxorubicin (Doxil) is formulated to circulate longer in the bloodstream and to concentrate more in tumor tissues, potentially reducing some side effects.

Who Should take it

Doxorubicin is used to treat a variety of cancers, including blood cancers such as acute lymphoblastic leukemia (ALL), acute myeloblastic leukemia (AML), Hodgkin lymphoma, and non-Hodgkin lymphoma. It is also used for other cancers like breast cancer, ovarian cancer, and soft tissue sarcomas.

For blood cancers, doxorubicin is often part of combination chemotherapy regimens. While it is not specifically approved for B-Cell Prolymphocytic Leukemia (B-PLL), it may be used as part of broader treatment protocols for lymphoid malignancies when recommended by your oncologist.

Your doctor will determine if doxorubicin is appropriate for you based on your diagnosis, overall health, and prior treatments.

Who should not take it

You should not take doxorubicin if you have:

• Severe heart problems or recent heart attack
• Severe persistent drug-induced bone marrow suppression (myelosuppression)
• Severe liver impairment (Child-Pugh Class C or serum bilirubin >5 mg/dL)
• A history of severe allergic reaction to doxorubicin or its components

Doxorubicin should be used with caution in people with pre-existing heart conditions, those who have received prior radiation to the chest, or those who have previously received high doses of anthracyclines. It is not recommended during pregnancy unless absolutely necessary, as it can harm the unborn baby.

Commonly used with

Doxorubicin is often used in combination with other chemotherapy drugs to increase effectiveness. For blood cancers, it may be combined with:

• Cyclophosphamide
• Vincristine
• Prednisone
• Methotrexate
• Cytarabine

The exact combination depends on your specific diagnosis and treatment plan.

Commonly tested with

Doxorubicin is commonly tested in combination with other chemotherapy agents in clinical trials for various cancers, including blood cancers. It is often studied with:

• Cyclophosphamide, vincristine, and prednisone (CHOP regimen)
• Methotrexate and cytarabine for leukemias
• Bortezomib for multiple myeloma (especially with liposomal doxorubicin)

Your oncologist will select the most appropriate regimen based on the latest research and your individual needs.