Makindo Medical Notes

In order to avoid cardiomyopathy, the dose should be carefully calculated according to body surface area. Usually < 500 mg/m²

About: Always check the BNF link here

• Doxorubicin, also known by its brand name Adriamycin, is a chemotherapy drug used to treat various types of cancer. It belongs to the class of drugs called anthracyclines and works by interfering with the growth of cancer cells, ultimately leading to their destruction.

Mechanism of Action

• Intercalates into DNA strands, inhibiting DNA and RNA synthesis.
• Inhibits the enzyme topoisomerase II, preventing the relaxation of supercoiled DNA and blocking DNA replication.
• Generates free radicals, causing damage to cellular components and leading to cell death.

Uses of Doxorubicin

• Breast cancer
• Ovarian cancer
• Bladder cancer
• Non-Hodgkin lymphoma
• Hodgkin lymphoma
• Leukaemias
• Soft tissue sarcomas
• Wilms' tumour
• Neuroblastoma

Administration

• Administered intravenously (IV). Ensure proper IV placement and monitor the infusion site.
• Immediate action required if extravasation is suspected.
• Dosage varies based on the type of cancer, patient's body surface area, and overall health.
• Typically given in cycles, with periods of treatment followed by rest periods.
• Often combined with other chemotherapy agents to enhance effectiveness.

Indications/Dose

• Small-cell lung cancer (SCLC), Breast cancer, Recurrent ovarian carcinoma
• Treatment of local advanced or metastasized bladder carcinoma
• Intravesical prophylaxis of recurrences of superficial bladder carcinoma following transurethral resection
• Neoadjuvant and adjuvant therapy of osteosarcoma
• Advanced soft-tissue sarcoma in adults
• Ewing's sarcoma, Hodgkin's disease
• Non-Hodgkin's lymphoma, ALL, AML,
• Advanced multiple myeloma, Advanced or recurrent endometrial carcinoma,
• Wilms' tumour , Advanced papillary/follicular thyroid cancer
• Anaplastic thyroid cancer, Advanced neuroblastoma
• Doxorubicin can be given by intravesical instillation for treatment of superficial cancer of the bladder and to prevent relapse after transurethral resection (T.U.R).

Interactions

• Pre-treatment with Digoxin (starting 7 days before doxorubicin) showed a protective effect against cardiotoxicity

Cautions

• Assess Cardiac function before treatment

Advise patient to seek help if your temperature goes over 37.5 C depending on the advice given by your chemotherapy team you suddenly feel unwell, even with a normal temperature you have symptoms of an infection - this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.

Contraindications

• Infection, Low WCC, liver disease

Side effects

• Urinary discolouration (red)
• Myelosuppression (Low WCC, HB, plt), Alopecia
• Cardiomyopathy with high cumulative dose

References

• SPC for Doxorubicin