Doxorubicin (Adriamycin)
General information
Class/mechanism: Anthracycline; binds and intercalates into DNA, inhibiting nucleotide replication and DNA/RNA polymerase activity. Intercalation of DNA triggers DNA cleavage via topoisomerase II. Toxic effects on organs may be related to cell membrane lipid binding activities; enzymatic electron reduction of doxorubicin creates reactive species, e.g. hydroxyl free radicals OH-, which has been implicated in cardiotoxicity by means of Cu (II) and Fe (III) reduction.[1][2]
Route: IV
Extravasation: vesicant
For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.[1]
Diseases for which it is established (work in progress)
- Bladder cancer
- Breast cancer
- Hepatocellular carcinoma
- Non-Hodgkin lymphoma
- Osteosarcoma
Diseases for which it is used
- Adrenocortical carcinoma
- Adult T-cell leukemia-lymphoma
- Anaplastic large cell lymphoma
- B-cell acute lymphoblastic leukemia
- Burkitt lymphoma
- Cutaneous basal cell carcinoma
- Cutaneous squamous cell carcinoma
- Endometrial cancer
- Ewing sarcoma
- Hepatoblastoma
- High-grade B-cell lymphoma
- HIV-associated lymphoma
- Classical Hodgkin lymphoma
- Hodgkin lymphoma, nodular lymphocyte-predominant
- Kaposi sarcoma
- Malignant pleural mesothelioma
- Marginal zone lymphoma
- Mediastinal gray-zone lymphoma
- Multiple myeloma
- Neuroblastoma
- Pancreatic NET
- Post-transplant lymphoproliferative disorder
- Primary mediastinal B-cell lymphoma
- Rhabdomyosarcoma
- Sarcomatoid renal cell carcinoma
- Soft tissue sarcoma
- Thymoma
- Transformed lymphoma
- Urothelial carcinoma
- Waldenström macroglobulinemia
Diseases for which it was used
- Acute myeloid leukemia
- Chronic lymphocytic leukemia
- Gastric cancer
- Non-small cell lung cancer
- Ovarian cancer
- Prostate cancer
- Small cell lung cancer
- Testicular cancer
Patient drug information
- Doxorubicin (Adriamycin) patient drug information (Chemocare)[3]
- Doxorubicin (Adriamycin) package insert page 1[1]
- Doxorubicin (Adriamycin) patient drug information (UpToDate)[4]
History of changes in FDA indication
- 1974-08-07: Initial FDA approval
- 2003-05-08: Earliest date with label information at Drugs @ FDA: "Doxorubicin has been used successfully to produce regression in disseminated neoplastic conditions such as acute lymphoblastic leukemia, acute myeloblastic leukemia, Wilms’ tumor, neuroblastoma, soft tissue and bone sarcomas, breast carcinoma, ovarian carcinoma, transitional cell bladder carcinoma, thyroid carcinoma, gastric carcinoma, Hodgkin’s disease, malignant lymphoma and bronchogenic carcinoma in which the small cell histologic type is the most responsive compared to other cell types. (No supporting studies are cited)
- Uncertain date: Doxorubicin is also indicated for use as a component of adjuvant therapy in women with evidence of axillary lymph node involvement following resection of primary breast cancer. (Based on EBCTCG 1998 meta-analysis)
History of changes in EMA indication
- 1996-06-21: EURD
History of changes in PMDA indication
- 2014-12-18: Revised indication and a new dosage for the relief of symptoms of malignant lymphoma.
Also known as
- Code name: FI-106
- Generic names: ADM, doxorubicin hydrochloride, hydroxydaunorubicin
- Brand names:
Synonyms | |||||||
---|---|---|---|---|---|---|---|
Adriablastina | Adriacept | Adriacin | Adriamycin | Adriamycine | Adriblastin | Adriblastina | Adriblastine |
Adricept | Adricin | Adrim | Adrimedac | Adrosal | Antraciclin | Biorrub | Biorubina |
Cadria | Carcinocin | Cloridrato DE | Doxorrubicina Colhidrol | Deldoxin | Dicladox | Dobicin | Dobixin |
Doxo | Doxobin | Doxo Cell | Doxocris | Doxokebir | Doxolem | Doxonolver | Doxor |
Doxorrubicina | Doxoruben | Doxorubicina | Doxorubicine | Doxorubicinum | Doxorubin | Doxotec | Doxtie |
Duxocin | Evacet | Farmiblastina | Fauldoxo | Flavicina | Ifadox | Kemodoxa | Lyphidox |
Nagun | Neoxane | Nuaze | Oncodria | Onkodox | Onkostatil | Pallagicin | Ranxas |
Rastocin | Ribodoxo | Roxorin | Rubex | Varidoxo | Zodox |
References
- Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists' Collaborative Group. Lancet. 1998 Sep 19;352(9132):930-42. link to original article PubMed
- Drugs
- Intra-arterial medications
- Intravenous medications
- Intravesical medications
- Vesicant
- Anthracyclines
- Topoisomerase II inhibitors
- Adrenocortical carcinoma medications
- Adult T-cell leukemia-lymphoma medications
- Anaplastic large cell lymphoma medications
- B-cell acute lymphoblastic leukemia medications
- Bladder cancer medications
- Breast cancer medications
- Burkitt lymphoma medications
- Cutaneous basal cell carcinoma medications
- Cutaneous squamous cell carcinoma medications
- Diffuse large B-cell lymphoma medications
- Endometrial cancer medications
- Ewing sarcoma medications
- Follicular lymphoma medications
- Hepatoblastoma medications
- Hepatocellular carcinoma medications
- High-grade B-cell lymphoma medications
- HIV-associated lymphoma medications
- Classical Hodgkin lymphoma medications
- Hodgkin lymphoma, nodular lymphocyte-predominant medications
- Kaposi sarcoma medications
- Malignant pleural mesothelioma medications
- Mantle cell lymphoma medications
- Marginal zone lymphoma medications
- Mediastinal gray-zone lymphoma medications
- Multiple myeloma medications
- Neuroblastoma medications
- Osteosarcoma medications
- Pancreatic NET medications
- Peripheral T-cell lymphoma medications
- Post-transplant lymphoproliferative disorder medications
- Primary mediastinal B-cell lymphoma medications
- Rhabdomyosarcoma medications
- Sarcomatoid renal cell carcinoma medications
- Soft tissue sarcoma medications
- Thymoma medications
- Transformed lymphoma medications
- Urothelial carcinoma medications
- Waldenström macroglobulinemia medications
- Acute myeloid leukemia medications (historic)
- Chronic lymphocytic leukemia medications (historic)
- Gastric cancer medications (historic)
- Non-small cell lung cancer medications (historic)
- Ovarian cancer medications (historic)
- Prostate cancer medications (historic)
- Small cell lung cancer medications (historic)
- Testicular cancer medications (historic)
- FDA approved in 1974
- EMA approved in 1996
- WHO Essential Cancer Medicine