Generic Name: Doxorubicin liposomal

Drug Type:

Doxil is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  It is the drug doxorubicin encapsulated in a closed lipid sphere (liposome). Doxil is classified as an "anthracycline antibiotic."  (For more detail, see "How Doxil Works" section below).

What Doxil Is Used For:

Doxil is used to treat AIDS-related Kaposi's sarcoma, breast cancer, ovarian cancer, and other solid tumors.

Note:  If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful. 

How Doxil Is Given:

• Doxil is given by injection through a vein (intravenously, by IV).
• Doxil is an irritant.  An irritant is a chemical that can cause inflammation of the vein through which it is given.  If Doxil escapes from the vein it can cause tissue damage. The nurse or doctor who gives Doxil must be carefully trained. If you experience pain or notice redness or swelling at the IV site while you are receiving Doxil, alert your health care professional immediately. 
• There is no pill form of Doxil.
• The amount of Doxil you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dose and schedule. 

Side Effects:

Important things to remember about Doxil side effects:

• Most people do not experience all of the Doxil side effects listed.
• Doxil side effects are often predictable in terms of their onset and duration.
• Doxil side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent Doxil side effects.
• There is no relationship between the presence or severity of Doxil side effects and the effectiveness of Doxil.
• The side effects of Doxil and their severity depend on how much Doxil is given.  In other words, higher doses may produce more severe side effects.

Infusion-related Doxil side effects (symptoms which may occur during the actual treatment) include: 

• Infusion-related reaction: symptoms include flushing, shortness of breath, facial swelling, headache, back pain, flushing, tightness in the chest and throat and/or low blood pressure.  Happens in less than 10% of patients. Symptoms go away when the infusion is stopped and typically does not recur when the infusion is restarted at a slower rate.  The first infusion is usually given at a slow rate to avoid the risk of these reactions.

The following Doxil side effects are common, meaning they occur in 30 percent or more of patients taking Doxil: 

• Low blood counts.  Your white and red blood cells may temporarily decrease.  This can put you at increased risk for infection and/or anemia.

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 7 days
Nadir: 10-14 days
Recovery: 21-28 days

• Hand -foot syndrome (Palmar-plantar erythrodysesthesia or PPE) -skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet.  Usually mild, starting 5-6 weeks after start of treatment.  May require reductions in the dose of Doxil.  
• Mouth sores

These Doxil side effects are less common, meaning they occur in 10-29 percent of patients receiving Doxil:

• Nausea and vomiting
• Low blood counts (low platelet counts).  This may put you at an increased risk of bleeding.
• Weakness
• Hair loss
• Constipation
• Poor appetite
• Diarrhea
• Discoloration of the urine (red/orange color) for about 48 hours after treatment
• Darkening of skin at the site of previous radiation therapy (radiation recall - see skin reactions).
• Darkening, discoloration of nail beds (see skin reactions)

A serious but uncommon side effect of Doxil can be interference with the pumping action of the heart.  You can receive only up to a certain amount of Doxil during your lifetime.  This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs.  No "lifetime maximum dose" has been established for Doxil.  You may be given Doxil for as long as the disease does not progress and you show no evidence of heart toxicity.  

Delayed Effects of Doxil:

There is a slight risk of developing a blood cancer such as leukemia years after taking drugs similar to Doxil.  Talk to your doctor about this risk in relation to Doxil.

Not all Doxil side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher or chills (possible signs of infection).

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Mouth sores (painful redness, swelling or ulcers)
• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Fast or irregular heart beats
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Extreme fatigue (unable to carry on self-care activities)
• Constipation
• Swelling of the feet or ankles
• Tingling or burning, redness, swelling or peeling of skin, blisters or small sores on the palms of the hands or soles of feet.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Doxil treatment, make sure you tell your doctor about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies).  Do not take aspirin or products containing aspirin unless your doctor permits this.
• Do not receive any kind of vaccination without your doctor's approval while taking Doxil.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D Doxil may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Use contraceptives, and do not conceive a child (get pregnant) while taking Doxil.  Barrier methods of contraception, such as condoms, are recommended.  Discuss with your doctor when you may safely become pregnant after therapy.
• Do not breast feed while taking Doxil.
• You may be more sensitive to sunlight, take extra care to avoid sun exposure. 
• People with congestive heart failure, those who have already had high doses of Doxil or a similar drug, and those with permanent problems with blood counts (bone marrow suppression) cannot receive Doxil. 
• Anyone who has had an allergic reaction to Doxil or any of its components cannot receive it again. 

Self-Care Tips:

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor. 
• Prevention of hand-foot syndrome. Modification of normal activities of daily living to reduce friction and heat exposure to hands and feet, for about a week after treatment. (For more information see - Managing side effects: hand foot syndrome).
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Drink two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• Keep your bowels moving. Your health care provider may prescribe a stool softener to help prevent constipation that may be caused by Doxil. 
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• Get plenty of rest.
• Maintain good nutrition.
• In general, drinking alcoholic beverages should be minimized or avoided.  You should discuss this with your doctor.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing

A baseline heart evaluation is recommended before starting treatment, and a heart function test will be done as your doctor prescribes.  You will be checked regularly by your health care professional while you are taking Doxil, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How Doxil Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Doxil is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific. There are several types of antitumor antibiotics:

• Anthracyclines:  Doxil, Daunorubicin, Mitoxantrone, and Idarubicin
• Chromomycins:  Dactinomycin and Plicamycin
• Miscellaneous:  Mitomycin and Bleomycin

Doxil is the drug doxorubicin encapsulated in a STEALTH^® liposome.  Liposomes are closed lipid spheres made of the basic components of natural human cell walls.  The STEALTH^® liposome have on their surface a substance to protect the liposome from detection by the body's immune system and to increase the time Doxil is circulating in the blood.  By enclosing a drug in a STEALTH^® liposome, scientists have shown that they are able to get close to the tumor and the encapsulated drug doxorubicin becomes available to work against the tumor cells.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org