How it is administered

Doxorubicin is administered as an intravenous (IV) infusion. For multiple myeloma, it is given as a liposomal formulation (encapsulated in tiny fat-like particles called liposomes) to help reduce side effects and improve delivery to cancer cells. The typical dose for multiple myeloma is 30 mg/m², infused over 60 minutes on day 4 of each 21-day cycle, usually in combination with another medication called bortezomib. It is important that doxorubicin is not given as a rapid injection or undiluted solution. The infusion is started slowly to monitor for any reactions and then increased as tolerated.

How it works

Doxorubicin works by interfering with the DNA inside cancer cells. It belongs to a class of drugs called anthracycline topoisomerase inhibitors. Doxorubicin binds to DNA and prevents the cancer cells from copying their genetic material and dividing. This action stops the growth of cancer cells and can lead to their death.

In the liposomal form, doxorubicin is packaged in tiny vesicles that help it circulate in the bloodstream longer and target cancer cells more effectively. This targeted delivery helps reduce the exposure of healthy tissues to the drug, potentially lowering the risk of certain side effects, such as damage to the heart. Doxorubicin is especially useful in treating multiple myeloma when combined with other therapies.

Who Should take it

Doxorubicin is indicated for adults with multiple myeloma who have not previously received bortezomib and have had at least one prior therapy. It is used in combination with bortezomib to improve the effectiveness of treatment in patients whose disease has progressed or returned after earlier treatments.

It may also be used for other cancers, such as ovarian cancer and Kaposi’s sarcoma, but in the context of multiple myeloma, its use is specifically in combination with bortezomib for patients who meet the criteria above. Your healthcare provider will determine if doxorubicin is appropriate based on your medical history and previous treatments.

Who should not take it

Doxorubicin should not be taken by patients who have had severe allergic reactions (including anaphylaxis) to doxorubicin or any of its components. It is also not recommended for patients with certain heart conditions, as doxorubicin can cause damage to the heart muscle, especially at higher cumulative doses or in those with a history of heart disease.

Pregnant women should avoid doxorubicin, particularly during the first trimester, as it can cause harm to the developing fetus. Patients with severe liver problems or those who have previously received high doses of anthracyclines should also avoid this medication unless the benefits outweigh the risks.

Commonly used with

In multiple myeloma, doxorubicin is most commonly used in combination with bortezomib. This combination has been shown to improve outcomes compared to bortezomib alone. Doxorubicin may also be used alongside other supportive medications to help manage side effects, such as anti-nausea drugs or medications to boost blood counts.

Commonly tested with

Doxorubicin has been tested in combination with bortezomib in clinical trials for multiple myeloma. It has also been studied with other chemotherapy agents and supportive treatments in various blood cancers. Your doctor may also monitor your heart function, blood counts, and liver function regularly while you are on doxorubicin to ensure safety and effectiveness.