How it is administered

Doxorubicin is given as an intravenous (IV) infusion, meaning it is injected directly into a vein. It comes as a solution or as a powder that is mixed with liquid before use. The medication is administered by a healthcare professional, usually in a hospital or clinic setting. The dosing schedule and amount depend on your specific type of blood cancer, other treatments you may be receiving, and your overall health.

For the liposomal form (used in Doxil), the medicine is also given by IV infusion, but it is encapsulated in tiny fat-like particles called liposomes, which can affect how the drug is absorbed and distributed in the body.

How it works

Doxorubicin is a type of chemotherapy known as an anthracycline. It works by interfering with the DNA inside cancer cells, preventing them from growing and multiplying. Specifically, doxorubicin inserts itself between DNA strands (a process called intercalation) and inhibits enzymes like topoisomerase II, which are necessary for DNA replication and repair. This leads to breaks in the DNA and ultimately causes cancer cells to die.

The liposomal form (as in Doxil) is designed to circulate in the bloodstream longer and to deliver more of the drug to cancer cells while reducing exposure to healthy tissues. This can help decrease some of the side effects associated with standard doxorubicin.

Who Should take it

Doxorubicin is used to treat several types of blood cancers, including:

• Acute lymphoblastic leukemia (ALL)
• Acute myeloblastic leukemia (AML)
• Hodgkin lymphoma
• Non-Hodgkin lymphoma

It may be used alone or in combination with other chemotherapy drugs. Your doctor will decide if doxorubicin is right for you based on your specific diagnosis, stage of disease, previous treatments, and overall health. In multiple myeloma, the liposomal form (Doxil) is sometimes used in combination with other medications, such as bortezomib, especially if other treatments have not worked or are no longer effective.

Who should not take it

You should not receive doxorubicin if you have:

• Severe heart problems (such as recent heart attack or severe heart failure)
• Severe, ongoing suppression of bone marrow function (myelosuppression)
• Severe liver problems (especially if your bilirubin is very high)
• Had a severe allergic reaction to doxorubicin or similar drugs in the past

Doxorubicin can also harm an unborn baby, so it should not be used during pregnancy unless absolutely necessary. Women and men should use effective birth control during and after treatment. Breastfeeding is not recommended during treatment and for a period after the last dose.

Commonly used with

Doxorubicin is often used in combination with other chemotherapy drugs to treat blood cancers. Common combinations include:

• Cyclophosphamide
• Vincristine
• Prednisone
• Bortezomib (especially with the liposomal form for multiple myeloma)

Your treatment plan will be tailored to your specific type of cancer and your individual needs.

Commonly tested with

Doxorubicin has been tested in combination with many other chemotherapy agents in clinical trials for blood cancers. Some of the most common combinations include:

• Cyclophosphamide, vincristine, and prednisone (as in the CHOP regimen for lymphoma)
• Bortezomib (for multiple myeloma with the liposomal form)
• Methotrexate and other agents for leukemia

Your doctor may also order regular heart tests (like echocardiograms) and blood tests to monitor for side effects during treatment.