How it is administered

Doxorubicin is administered as an intravenous (IV) infusion. It is available as a solution or as a powder that is reconstituted and diluted before being given through a vein. The medication should never be given as a rapid injection or as an undiluted solution. The infusion is typically given over 3 to 10 minutes, or as a longer infusion depending on the treatment protocol. Doxil, a liposomal formulation of doxorubicin, is also given as an IV infusion, but it must be administered slowly, starting at 1 mg/min to minimize the risk of infusion reactions.

How it works

Doxorubicin is a type of chemotherapy known as an anthracycline topoisomerase inhibitor. It works by binding to DNA inside cancer cells, which blocks the ability of the cells to make new DNA and RNA. This stops the cancer cells from growing and dividing, leading to their death. Doxorubicin also interferes with an enzyme called topoisomerase II, which is necessary for DNA replication and repair. By disrupting these processes, doxorubicin helps to kill rapidly dividing cancer cells.

The liposomal form (Doxil) encapsulates doxorubicin in tiny fat-like particles called liposomes, which helps the drug stay in the bloodstream longer and may reduce some side effects. This formulation is designed to deliver the drug more directly to cancer cells while sparing healthy tissues.

Who Should take it

Doxorubicin is used to treat a variety of cancers, including certain blood cancers like Hodgkin lymphoma, non-Hodgkin lymphoma, and leukemia. It is also used for breast cancer, ovarian cancer, and other solid tumors. In the context of blood cancers, doxorubicin is often part of combination chemotherapy regimens.

For Waldenström's Macroglobulinemia, doxorubicin may be considered as part of a multi-drug regimen in certain cases, although it is not the most common first-line therapy. Your doctor will determine if doxorubicin is appropriate based on your specific diagnosis, prior treatments, and overall health.

Who should not take it

Doxorubicin should not be used in patients who have had a recent heart attack, severe heart problems, or severe persistent low blood counts due to previous chemotherapy. It is also contraindicated in those with severe liver impairment (such as very high bilirubin levels) and in people who have had a severe allergic reaction to doxorubicin or its components.

Women who are pregnant should avoid doxorubicin, as it can harm the unborn baby. Breastfeeding is also not recommended during treatment and for a period after the last dose. Your doctor will check your heart and liver function before starting treatment, and may not recommend doxorubicin if you have significant heart or liver disease.

Commonly used with

Doxorubicin is frequently used in combination with other chemotherapy drugs. In blood cancers, it is often combined with cyclophosphamide, vincristine, and prednisone (the CHOP regimen), or with other agents depending on the specific cancer type. For multiple myeloma, Doxil (liposomal doxorubicin) is used with bortezomib. Your treatment plan may include other supportive medications to help manage side effects or prevent infections.

Commonly tested with

Doxorubicin has been tested in combination with a variety of chemotherapy agents, including cyclophosphamide, vincristine, prednisone, methotrexate, fluorouracil, and bortezomib. In clinical trials for blood cancers, it is often part of multi-drug regimens to assess the best combination for effectiveness and safety. Your doctor will select the combination based on the latest evidence and your individual needs.