III. Mechanism

  1. See Antibiotic Chemotherapy
  2. This formulation is a liposome-encapsulated preparation of Doxorubicin
    1. See Non-Liposomal Doxorubicin
    2. Liposomal delivery of Doxorubicin has several benefits
      1. Increases Doxorubicin penetration into tumors
      2. Decreases Doxorubicin clearance resulting in longer duration of effects
      3. Decreases Doxorubicin-associated toxicity (esp. cardiotoxicity)
  3. Doxorubicin is a derivative of Daunorubicin, an anthracycline Aminoglycoside antineoplastic
    1. Daunorubicin is isolated from the bacterium Streptomyces peucetius (Caesius variety)
    2. Doxorubicin is a hydroxylated form of Daunorubicin
  4. Doxorubicin inserts between adjacent DNA base pairs
    1. Blocks DNA Transcription by RNA Polymerase
  5. Doxorubicin also inhibits Topoisomerase 2
    1. Inhibits normal Nucleotide strand ligation during DNA Replication
  6. Doxorubicin also induces free radical formation with several secondary effects
    1. Lipid peroxidation of cell membrane lipids (cytotoxic effects)
    2. Toxic effects (esp. cardiovascular adverse effects)

IV. Medications

  1. Liposomal Doxorubicin IV Solution: 20 mg and 50 mg vials

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Severe skin and soft tissue necrosis on extravasation
    1. Doxorubicin is a strong Vesicant (causes Blistering)
  2. Cardiotoxicity (esp. children)
    1. Risk of Congestive Heart Failure (esp. with multiple doses)
  3. Myelosuppression
  4. Hyperuricemia
  5. Infusion reactions (severe)
  6. Alopecia
  7. Mucositis
  8. Necrotizing colitis
  9. Palmar-Plantar erythrodysesthesia
  10. Carcinogenic (risk of secondary malignancy)
  11. Urine Discoloration (transient red coloration)

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Liver Function Tests
    3. Renal Function Tests
    4. Serum Uric Acid
    5. Echocardiogram with ejection fraction

IX. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Ontology: doxorubicin hydrochloride liposome (C1522690)

Definition (NCI) A liposome-encapsulated preparation of the hydrochloride salt of the anthracycline antineoplastic antibiotic doxorubicin. Doxorubicin intercalates between DNA base pairs, thereby hinders the movement of replication machinery along DNA strands, as well as blocks the activity of topoisomerase II during replication. As a result, this agent causes DNA adducts formation, renders single- and double-stranded DNA breakages that induce DNA repair and or apoptotic processes. Doxorubicin also generates reactive oxygen species that leads to cytotoxicity secondary to lipid peroxidation of cell membrane lipids. Liposomal delivery of doxorubicin HCl improves drug penetration into tumors and decreases drug clearance, thereby increasing the duration of therapeutic drug effects. A liposomal formulation of doxorubicin also modulates toxicity, specifically the cardiac effects commonly seen with anthracycline antitumor drugs.
Definition (NCI_NCI-GLOSS) A form of the anticancer drug doxorubicin that is contained in very tiny, fat-like particles. It may have fewer side effects and work better than doxorubicin. Doxil is used to treat ovarian cancer, AIDS-related Kaposi sarcoma, and multiple myeloma in patients whose disease has not gotten better after treatment with other anticancer drugs. It may be used together with other anticancer drugs. It is also being studied in the treatment of other types of cancer. Doxil is a type of anthracycline antitumor antibiotic.
Definition (PDQ) A liposome-encapsulated form of the hydrochloride salt of the anthracycline antineoplastic antibiotic doxorubicin. Liposomal delivery of doxorubicin HCL improves drug penetration into tumors and decreases drug clearance, thereby increasing the duration of therapeutic drug effects. Doxorubicin intercalates into DNA and interacts with topoisomerase II, consequently inhibiting DNA replication and repair and RNA and protein synthesis. This agent also produces toxic free-radical intermediates and interacts with cell membrane lipids causing lipid peroxidation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=269242&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=269242&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1555" NCI Thesaurus)
Definition (PDQ) A liposome-encapsulated form of the hydrochloride salt of the anthracycline antineoplastic antibiotic doxorubicin. Liposomal delivery of doxorubicin improves drug penetration into tumors and decreases drug clearance, thereby increasing the duration of therapeutic drug effects. Doxorubicin intercalates into DNA and interacts with topoisomerase II, consequently inhibiting DNA replication and repair and RNA and protein synthesis. This agent also produces toxic free-radical intermediates and interacts with cell membrane lipids causing lipid peroxidation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39424&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39424&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1555" NCI Thesaurus)
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
SnomedCT 412379006
English (8S-cis)-8-Acetyl-10-[(3-amino-2,3,6-trideoxy-a-L-lyxo-hexopyranosyl)oxy]-7,8,9,10-tetrahydro-6,8,11-tri-hydroxy-1-methoxy-5,12-naphthacenedione Hydrochloride, Pegylated Liposomal Doxorubicin, S-Liposomal Doxorubicin, Liposomal Doxorubicin Hydrochloride, Stealth Liposomal Doxorubicin, Doxorubicin Hydrochloride Liposomal, Pegylated Doxorubicin HCl Liposome, pegylated doxorubicin HCl liposome, Doxorubicin HCl Liposome, Pegylated Liposomal Doxorubicin Hydrochloride, Sterically Stabilized Liposome, Doxorubicin Hydrochloride Liposome, liposomal doxorubicin hydrochloride (medication), liposomal doxorubicin hydrochloride, DOXOrubicin hydrochloride liposome, doxorubicin hydrochloride liposome, doxorubicin HCl peg-liposomal, Doxorubicin hydrochloride (as pegylated liposomal), PEG-LD, Liposomal doxorubicin hydrochloride (substance), Liposomal doxorubicin hydrochloride, DOXORUBICIN HYDROCHLORIDE LIPOSOME
Spanish clorhidrato de doxorubicina liposómica, clorhidrato de doxorrubicina liposómica (sustancia), clorhidrato de doxorrubicina liposómica, clorhidrato de doxorubicina liposómica (sustancia)

Ontology: Liposomal Adriamycin (C1704361)

Concepts Organic Chemical (T109) , Antibiotic (T195)
English Liposomal Adriamycin