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How it is administered
Daunorubicin, when used in combination with cytarabine as a liposomal formulation, is administered intravenously (IV) by infusion. The medication is supplied as a sterile, preservative-free, purple, lyophilized cake in a single-dose vial, and is reconstituted and diluted before being infused over 90 minutes through a central venous catheter or a peripherally inserted central catheter. It is not given by mouth or by injection into muscle or under the skin.
How it works
Daunorubicin is an anthracycline topoisomerase inhibitor. It works by interfering with the DNA inside cancer cells. Specifically, it forms complexes with DNA, inhibits the enzyme topoisomerase II, and disrupts DNA polymerase activity. This leads to DNA damage and prevents the cancer cells from dividing and growing. When combined with cytarabine in a liposomal formulation, the two drugs are delivered together directly to the bone marrow, where they are taken up by leukemia cells. The liposomes allow for a sustained release of the drugs inside the cancer cells, maximizing their effectiveness while limiting exposure to the rest of the body. This combination has been shown to have a synergistic effect, meaning the two drugs work better together than alone, especially in killing leukemia cells.
Common side effects
- Hemorrhagic events (bleeding, including nosebleeds, gastrointestinal bleeding, and rare but serious brain bleeds)
- Febrile neutropenia (fever with low white blood cell count)
- Rash
- Edema (swelling)
- Nausea and vomiting
- Mucositis (mouth sores)
- Diarrhea and constipation
- Musculoskeletal pain
- Fatigue
- Abdominal pain
- Dyspnea (shortness of breath)
- Headache
- Cough
- Decreased appetite
- Arrhythmia (irregular heartbeat)
- Pneumonia
- Bacteremia (bacteria in the blood)
- Chills
- Sleep disorders
All patients will develop low blood counts (neutropenia, thrombocytopenia, and anemia) during treatment. Serious or fatal bleeding, infections, and heart problems can occur.
Who Should take it
Daunorubicin, in combination with cytarabine as a liposomal formulation, is indicated for adults and children 1 year and older with newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC). These forms of leukemia are considered high-risk and may be related to previous cancer treatments or underlying blood disorders such as myelodysplastic syndromes. While not specifically indicated for chronic myelomonocytic leukemia (CMML), this combination may be considered in cases where CMML has transformed into AML or has features overlapping with AML-MRC. Your doctor will determine if this treatment is appropriate based on your specific diagnosis and overall health.
Who should not take it
You should not take daunorubicin (in combination with cytarabine as a liposomal formulation) if you have a history of serious hypersensitivity reactions to daunorubicin, cytarabine, or any component of the formulation. It is also not recommended for patients with significantly reduced heart function or those who have reached the maximum lifetime cumulative dose of anthracyclines due to the risk of heart damage. If you have Wilson’s disease or other copper-related metabolic disorders, caution is needed due to the copper content in the formulation. This medication can cause harm to an unborn baby, so it should not be used during pregnancy unless absolutely necessary, and effective contraception should be used during and after treatment.
Commonly used with
Daunorubicin is most commonly used in combination with cytarabine, especially in the treatment of certain types of acute myeloid leukemia. The liposomal formulation delivers both drugs together in a fixed ratio. It may also be used alongside supportive care medications such as anti-nausea drugs, antibiotics, antifungals, and blood transfusions to manage side effects and complications.
Commonly tested with
Daunorubicin and cytarabine are often tested together as a combination therapy in clinical trials for acute myeloid leukemia, including therapy-related AML and AML with myelodysplasia-related changes. Studies may also compare this combination against standard chemotherapy regimens or in conjunction with other supportive treatments or stem cell transplantation.
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