How it is administered

Daunorubicin, when used in combination with cytarabine as a liposomal formulation, is administered by intravenous (IV) infusion. The medication is supplied as a sterile, preservative-free, purple, lyophilized cake in a single-dose vial. Each vial contains a fixed amount of daunorubicin and cytarabine, and it must be reconstituted and diluted before administration.

The infusion is given over 90 minutes through a central venous catheter or a peripherally inserted central catheter (PICC). The dosing schedule involves multiple cycles, with specific doses and days depending on the treatment phase (induction or consolidation).

How it works

Daunorubicin is an anthracycline topoisomerase inhibitor. In the liposomal formulation combined with cytarabine, daunorubicin works by forming complexes with DNA, which inhibits the activity of topoisomerase II, an enzyme essential for DNA replication and repair. This action leads to DNA damage and prevents cancer cells from dividing and growing.

Additionally, daunorubicin inhibits DNA polymerase activity, affects gene expression, and produces DNA-damaging free radicals. When encapsulated in liposomes with cytarabine, the combination is designed to deliver both drugs directly to the bone marrow, where leukemia cells are most active. The liposomes are taken up by leukemia cells, where they release daunorubicin and cytarabine inside the cells, enhancing their ability to kill cancer cells.

This dual mechanism targets leukemia cells more effectively and helps reduce the growth and spread of the disease.

Who Should take it

Daunorubicin, in combination with cytarabine as a liposomal formulation, is indicated for the treatment of newly-diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC) in adults and pediatric patients 1 year and older.

While not specifically indicated for chronic myeloid leukemia (CML), daunorubicin is used in the treatment of certain types of blood cancers, particularly acute myeloid leukemia. Patients who have been diagnosed with these specific subtypes of AML and meet the criteria for treatment may be prescribed this medication as part of their chemotherapy regimen.

Who should not take it

Daunorubicin should not be taken by patients who have a history of serious hypersensitivity reactions to daunorubicin, cytarabine, or any component of the formulation. This includes severe allergic reactions or anaphylaxis.

It is also not recommended for patients with cardiac function that is less than normal, as daunorubicin has a known risk of cardiotoxicity. Patients who have reached the maximum cumulative lifetime dose of anthracyclines or have significant pre-existing heart disease should not receive this medication unless the benefits outweigh the risks. Additionally, it should be avoided in pregnant women due to the risk of harm to the fetus.

Commonly used with

Daunorubicin is most commonly used in combination with cytarabine, especially in the treatment of acute myeloid leukemia. The combination is provided in a fixed ratio in the liposomal formulation to maximize the effectiveness against leukemia cells.

It may also be used alongside supportive medications such as anti-emetics (to prevent nausea), antibiotics (to prevent or treat infections), and transfusions (to manage low blood counts).

Commonly tested with

Daunorubicin, particularly in the liposomal combination with cytarabine, has been tested against the standard combination of cytarabine and daunorubicin (known as the "7+3" regimen) in clinical trials for acute myeloid leukemia.

It may also be studied with other supportive care agents, such as growth factors, antibiotics, and antifungals, to manage side effects and complications during treatment.