How it is administered

Doxorubicin is given as an intravenous (IV) injection or infusion. It is supplied as a sterile solution or as a powder that is reconstituted before use. The medication is administered through a vein, either via a central intravenous line or a secure and free-flowing peripheral venous line. The infusion typically takes 3 to 10 minutes, but in some cases, it may be given as a continuous infusion through a central line. The dose and schedule depend on the specific treatment plan, type of cancer, and whether it is used alone or in combination with other chemotherapy drugs.

How it works

Doxorubicin is an anthracycline topoisomerase II inhibitor. It works by interfering with the growth and spread of cancer cells in the body. Doxorubicin binds to DNA inside cancer cells and inserts itself between the DNA base pairs (a process called intercalation). This action blocks the ability of the cell to replicate DNA and RNA, which are essential for cell division and growth. Additionally, doxorubicin interacts with an enzyme called topoisomerase II, forming complexes that break DNA strands and prevent them from being repaired. This leads to cell death, particularly in rapidly dividing cells like cancer cells.

Doxorubicin also generates free radicals, which can damage cell membranes and other cellular components. While these effects help destroy cancer cells, they can also affect healthy cells, especially those that divide quickly, such as cells in the bone marrow, digestive tract, and hair follicles.

Who Should take it

Doxorubicin is used as part of combination chemotherapy regimens for several types of cancer, including Hodgkin lymphoma. It is often included in the ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine) for treating Hodgkin lymphoma. Doxorubicin is also used to treat other blood cancers such as non-Hodgkin lymphoma, acute lymphoblastic leukemia, and acute myeloblastic leukemia, as well as various solid tumors.

Your doctor will determine if doxorubicin is appropriate for you based on your specific diagnosis, overall health, and treatment goals. It is usually recommended for patients who can tolerate chemotherapy and do not have contraindications such as severe heart or liver problems.

Who should not take it

Doxorubicin should not be used in patients with:

• Severe myocardial insufficiency (serious heart failure)
• Recent myocardial infarction (heart attack within the past 4 to 6 weeks)
• Severe persistent drug-induced myelosuppression (very low blood counts from previous chemotherapy)
• Severe hepatic impairment (liver problems, defined as Child Pugh Class C or serum bilirubin greater than 5 mg/dL)
• Severe hypersensitivity or allergic reaction to doxorubicin, including anaphylaxis

If you have any of these conditions, your doctor will discuss alternative treatments. Doxorubicin can also harm a developing fetus, so it should not be used during pregnancy unless absolutely necessary.

Commonly used with

In Hodgkin lymphoma, doxorubicin is most commonly used in combination with other chemotherapy drugs as part of the ABVD regimen. These drugs include bleomycin, vinblastine, and dacarbazine. In other blood cancers, doxorubicin may be used with cyclophosphamide, vincristine, prednisone, and other agents depending on the specific protocol.

Doxorubicin is rarely used alone for blood cancers, as combination therapy is more effective.

Commonly tested with

Doxorubicin has been tested in combination with many other chemotherapy drugs in clinical trials for Hodgkin lymphoma and other cancers. Common combinations include ABVD (with bleomycin, vinblastine, dacarbazine), CHOP (with cyclophosphamide, vincristine, prednisone), and other regimens. It has also been studied with newer targeted therapies and supportive medications to reduce side effects, such as dexrazoxane to help protect the heart.